A nationwide Swedish study recently published in JAMA Psychiatry investigated whether the real-world benefits of ADHD medications have changed over time in parallel with increased prescribing. Using data from 247,420 individuals aged 4 to 64 who used ADHD medications between 2006 and 2020, the authors employed a self-controlled case series design to compare risks during medicated and nonmedicated periods. The group specifically measured reductions in self-harm, injuries, traffic crashes, and crime.

ADHD medications were consistently associated with reduced risk of self-harm (IRR range, 0.77–0.85), unintentional injury (0.87–0.93), traffic crashes (0.71–0.87), and crime (0.73–0.84). However, the protective associations for unintentional injury, traffic crashes, and crime significantly attenuated over time as prescribing prevalence rose from 0.6% to 2.8% during the study period. These trends were not fully explained by demographic shifts or changes in medication type. The most robust effects were seen in females and in earlier years, likely reflecting treatment of more severely affected individuals before broader diagnostic and prescribing criteria were adopted.

Clinically, this suggests that although ADHD pharmacotherapy continues to confer real-world benefits, these may be diminished as treatment expands to individuals with less impairment. Practitioners should remain vigilant in weighing benefits against risks, particularly in cases with subthreshold presentations, and ensure treatments are appropriately tailored.

Reference:

Li L et al. JAMA Psychiatry. 2025:e251281. Abstract