Research In Action

We know that the leading cause of morbidity and mortality among US children is unintentional injury We also know that children with a diagnosis of attention-deficit hyperactivity disorder (ADHD) are at a significantly increased risk of unintentional injury.

A mainstay of ADHD treatment is medication treatment, which can be quite effective for the core symptoms of ADHD (e.g., inattention, hyperactivity, impulsivity). However, research examining the effect of ADHD medication on reducing unintentional injury risk has not always assessed risk according to age or injury type. A recent study in the Journal of the American Academy of Child & Adolescent Psychiatry, however, did find that ADHD medications reduce the risk of unintentional injury (and specifically traumatic brain injury, or TBI) in both children and adolescents, and in both boys and girls. 

How They Did It

De-identified inpatient, outpatient, and filled prescription claims from the Truven Health MarketScan Commercial Claims and Encounters database were analyzed in this study. All individuals with an ADHD diagnosis or an ADHD medication prescription (amphetamine salt combination, atomoxetine hydrochloride, dexmethylphenidate sulfate, dextroamphetamine sulfate, lisdexamfetamine dimestylate, metamphetamine hydrochloride, methylphenidate, and methylphenidate hydrochloride) between 2005 and 2014 were included in this analysis. An age and sex matched non-ADHD control group was also included. Outcome variables included emergency department (ED) visits for injuries (including TBIs) with an unintentional cause. Comparisons were made at various levels: population level versus within individual, boys versus girls, and children ages 6 to 15 and 16 to 19 years.

What They Found

General

• Over 1.9 million individuals with a diagnosis of ADHD or a prescription for an ADHD medication were identified.
• The majority were boys (60%), of whom 4.8% had at least one event. A slightly lower percentage of girls (3.6%) had at least one event.
• Median age was 11 for boys and 12 for girls.

Unintentional Injuries

• The diagnosis of ADHD was associated with increased odds of having an unintentional injury in both boys (OR 1.18, 95% CI = 1.17-1.20) and in girls (OR 1.36, 95% CI = 1.34-1.38).
• ADHD medication use was associated with a lower risk of having an ED visit for unintentional injuries at a population level (OR = 0.85, 95% CI= 0.84-0.86 in boys, and OR = 0.87, 95% CI = 0.85-0.89 in girls), as well as within individual analyses (OR = 0.71, 95% CI = 0.70−0.73 for boys and OR = 0.71, 95% CI = 0.68−0.73 in girls).

Traumatic Brain Injury

• Having a diagnosis of ADHD was associated with an increased odds of having a TBI (boys 1.21 boys (OR = 1.21, 95% CI = 1.18−1.24) and in girls (OR = 1.49, 95% CI = 1.42−1.56).
• ADHD medication use was associated with a lower odds of TBI during population level analyses, as well as during individual analyses, both in boys and in girls

Other Findings

This large population study suggests that ADHD medication use may have a protective effect on both unintentional injuries, including TBI. It helps to support our common recommendation for medication to treat ADHD in children and adolescents. I know that I often strongly recommend medications especially if safety due to impulsivity issues is a concern. This study validates my thinking that medications can not only help with the core symptoms of ADHD, but also reduce unintentional injury.

• ADHD medication use was associated with a lower risk of having an ED visit for unintentional injuries and TBI in both children and adolescents, both in boys and in girls.
• Similar estimates were found when the within-individual analyses were restricted to patients with no other psychotropic medication or psychotherapy, suggesting that other medications or presence of therapy did not change estimates of injury risk. 
• Concurrent use of selective serotonin reuptake inhibitor medications were not associated with a decreased risk of ED visits due to unintentional injuries, suggesting that the reduced risk of injury associated with ADHD medication was not due to concurrent SSRI medication use.