Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Risk of Injuries in Children with ADHD

What is the effect of medication?

While children with attention deficit hyperactivity disorder (ADHD) have an increased risk of injury compared with other children and accidents are the most common cause of death for those with ADHD, treatment with ADHD drugs reduced the risk of injuries by up to 43% and emergency ward visits by up to 45% in children with ADHD, according to a cohort study of 710,120 individuals, including 4,557 diagnosed with ADHA before age 10 years. Researchers also determined:

• Prevalence of injuries in children with ADHD who were treated with ADHD drugs decreased from 19% to 14% in individuals aged 5 to 10, compared with a prevalence of about 17% in non-treated children with ADHD.

• At age 10 years, an adjusted reduction of 31% was seen in prevalence of injuries due to treatment.

• At age 12 years, an adjusted reduction of 43% was seen in prevalence of injuries due to treatment.

• Pharmacological treatment reduced prevalence of emergency ward visits at age 10 years and 12 years.

Citation: Dalsgaard S, Leckman JF, Mortensen PB, Nielsen HS, Simonsen M. Effect of drugs on the risk of injuries in children with attention deficit hyperactivity disorder: a prospective cohort study. The Lancet Psychiatry. 2015; 2:702-709.

Commentary: ADHD is common, affecting approximately 10% of children in the US, with approximately 6% of children receiving medication for ADHD1. Adolescents with ADHD have higher rates of car accidents, substance abuse, and poor performance in school2. Children with ADHD have approximately twice the rate of accidental injury compared to children without ADHD. Other studies have shown that treatment of ADHD, in addition to improving symptoms, also improves school performance and among adolescents can decrease the rate of driving accidents. This study further emphasizes the importance of diagnosis and treatment of ADHD in showing that treatment of ADHD substantially decreases the rate of accidental injury in children with ADHD. —Neil Skolnik, MD

1. Felt BT, BiermannB, Christner JG, et al. Diagnosis and management of ADHD in children. Am Fam Physician. 2014;90(7):456-464.

2. Wolraich ML, Wibbelsman CJ, Brown TE, et al. Attention-deficit/hyper- activity disorder among adolescents: a review of the diagnosis, treatment, and clinical implications. Pediatrics. 2005;115(6):1734-1746.

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