ADHD News & Research

Study: ADHD Increases Risk for Injuries Requiring Hospitalization Among Children, Adolescents

Children and adolescents with ADHD face an increased risk of hospitalization for serious injury, according to a study that suggests long-term medication use may lower the risk of injury among ADHD patients.

September 13, 2022

Children and adolescents with ADHD are more likely to sustain injuries and require hospitalization for those injuries than are patients without ADHD. This risk of serious injury is further heightened for males and adolescents, and it may be significantly reduced with long-term medication use, according to a study published by the Journal of Psychiatry and Clinical Neurosciences.1

Core symptoms of ADHD, including inattention, impulsivity, and hyperactivity, may contribute to an elevated risk of injury. From 2005 to 2013, researchers compared 4,658 ADHD patients to 18,632 sex- and age-matched control subjects ages 6 to 18 in Taiwan. After adjusting for sex, age, urbanization, and comorbidities, researchers found that patients with ADHD were 1.39 times more likely to experience an injury requiring hospitalization. In age- and sex-stratified subgroup analyses, males and adolescents ages 12 to 18 experienced a significantly higher risk of serious injury.

Researchers also found that long-term use of ADHD medication lowered the risk of sustaining an injury requiring hospitalization. The study looked at methylphenidate and atomoxetine — the only two ADHD medication treatments covered by Taiwanese health insurance. ADHD patients who received more than 365 cumulative defined daily doses (cDDD) of medication had a 49% decreased risk of injury requiring hospitalization compared to non-users (<30 cDDD) with ADHD.

“In clinical practice, healthcare providers should be cautious about the potential risks of injury among patients with ADHD, and they should highlight the importance of the duration and compliance with medication treatment,” the researchers wrote.

The most common injuries among children and teens with ADHD included fractures (54%), followed by intracranial/internal injuries (14%), and open wounds (10%). Approximately 9% of ADHD patients required ICU care. In all injury subtypes, ADHD patients had higher incidence rates and ICU care injuries than the control group. Of the injury subtypes, medication reduced the risk of fractures only.

Patient data was sourced from a retrospective population-based cohort study in Taiwan. The index date, or date of ADHD diagnosis, was limited to 2005 or later. Each ADHD patient was matched to four non-ADHD control patients. The male-to-female ratio was 4.2 to 1, or 80.59% to 19.41%.

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1Pai, M.-S., Yang, S.-N., Chu, C.-M. and Lan, T.-Y. (2022), Risk of injuries requiring hospitalisation in attention deficit hyperactivity disorder and the preventive effects of medication. Psychiatry Clin. Neurosci.. Accepted Author Manuscript.