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 “In addition to reducing accidental injuries, the medication often
is helpful in helping the child do better in school,” said Dr. James
Leckman, a professor and child psychiatrist at Yale School of
Medicine in New Haven, Connecticut.
“But many children with ADHD can also do well in school not on
medication if the parents and teachers are aware of the issues and
address them with appropriate accommodations,” said Leckman, who
coauthored the new study.
ADHD medications can have unwanted side effects like trouble
sleeping, anorexia, weight loss, reduced growth rates and headaches,
and the decision to treat with medication needs to be a joint
decision by the family and clinician, Leckman said.
He and his coauthors used Danish national health registries to look
at data on more than 700,000 people, and recorded reports of
injuries and ER visits as well as drug prescriptions.
The researchers included all children born in Denmark between 1990
and 1999, including 4,557 who had been diagnosed with ADHD between
ages five and 10 years, and followed their health status through the
end of 2010, as reported in The Lancet Psychiatry.
Of those children diagnosed with ADHD, about one quarter were
treated with prescriptions for the condition, often the stimulant
methylphenidate (Ritalin), for at least six months.
The researchers examined injury rates at three time points, when the
children were ages five, 10 and 12. For all children, average injury
rates were 11 percent, 13 percent and 16 percent at these ages,
respectively. For kids with ADHD, almost 20 percent sustained an
injury at age 5, 16 percent at age 10 and 18 percent at age 12.
Kids with ADHD who were taking medication had lower risk of injury,
which fell from 19 percent to 14 percent from age five to 10. In
comparison, those not taking medication had a 17 percent risk of
injury at both ages.
That is an important decrease in risk, Leckman told Reuters Health
by email.
In some settings, ADHD may be diagnosed too frequently, and each
case of ADHD is unique and will require a risk-benefit analysis to
decide on treatment, he said. It is more frequently diagnosed in the
U.S. than in Denmark, he added.
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“There have been a number of articles reporting an increased risk of
accidents in children with ADHD,” Leckman said. “Young children move
around a lot and children with ADHD can be inattentive and
distractible as well as being impulsive with poor inhibitory
control.”
Fall injuries are fairly common for younger children with ADHD, and
bicycle or car accidents are not uncommon for older children, he
said.
Parents can help prevent injuries by anticipating times of greatest
risk - like when kids will be subject to peer pressure, have no
adult supervision or when alcohol and drugs are available - and
encouraging their child to take precautions, he said.
Since this was an observational study, we can’t necessarily say that
medication caused a reduction in injuries, according to Dr. Jeffrey
Newcorn of the Icahn School of Medicine at Mount Sinai in New York,
who wrote a commentary accompanying the new results.
“One certainly could wonder whether kids who had ADHD and did not
receive medication would have had a reduction in their rate of
accidental injury if they had taken medication,” Newcorn told
Reuters Health by email. “You can’t say that for sure.”
Even if they did, non-medication therapies might have reduced the
rate of accidental injury as well, though that was not part of the
new study, he said.
“So, no, you cannot conclude that more kids with ADHD should be
taking medication,” Newcorn said. “But the fact that medication was
associated with a reduced rate of accidental injury supports the
potential value of this treatment for children who need it and
families who opt to pursue it.”
SOURCE: http://bit.ly/1U7SFtn and http://bit.ly/1OPwMMj Lancet
Psychiatry, online July 21, 2015.
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