Impulsivity and an increase in risk-taking behaviors are hallmarks of attention-deficit hyperactivity disorder (ADHD) and contribute to a higher mortality rate among those with ADHD. These behaviors include increased risks of suicidal behaviors, substance misuse, accidental injuries, transport accidents, and criminality. Recent research by Zhang and colleagues provides evidence that the treatments associated with ADHD, primarily stimulants like methylphenidate and amphetamine, seem to help reduce these risky behaviors.

This study utilized the Swedish national registers from 2007-2020 to include 148,581 individuals aged 6-64 years old with a new ADHD diagnosis in a target trial emulation framework. Within this cohort, 56.7% initiated medication with methylphenidate as the most prescribed drug at initiation (88.4%), followed by atomoxetine (7.9%) and lisdexamfetamine (3.3%). Outcomes were tracked for two years, where first events and recurrent events were analyzed.

ADHD medication was associated with significant reductions in 4 out of 5 outcomes. Specifically, incidence rate ratios (IRRs) showed that suicidal behaviors (0.83), substance misuse (0.85), transport accidents (0.88), and criminality (0.87) behaviors were significantly reduced if prescribed ADHD medication (see Figure 1 for percentage comparisons). The only outcome that did not show a significant change was accidental injuries (0.98). Analysis of recurrent events showed that ADHD drug treatment was associated with significantly reduced rates for all outcomes: suicidal behaviors (0.85), substance misuse (0.75), accidental injuries (0.96), transport accidents (0.91), and criminality (0.75). In other words, if a person engaged in an outcome behavior, ADHD pharmacotherapies reduced the likelihood of it happening again.

When comparing outcome behaviors between treatments, stimulants were associated with lower event rates than non-stimulants. Additionally, reductions in outcome behaviors were more pronounced in adults than in children, and in female patients compared to male patients.

This study shows that ADHD medication can have a significant impact on the quality of an individual’s life, considering they are less likely to engage in problematic behaviors. These findings are also consistent with previous findings showing that ADHD pharmacotherapies lead to a significant reduction in problem behaviors and an increase in mortality. Overall, it seems as though stimulants are a favorable option to non-stimulants when comparing the likelihood that a person will engage in these problematic behaviors; any treatment is significantly better than none. The researchers suspect that decreases in impulsivity from the medication drive the reductions in these outcome behaviors. In conclusion, ADHD medication use leads to significant reductions in suicidal behaviors, substance misuse, transport accidents, criminality, and accidental injuries (Figure 1).

Reference:

Zhang L et al. BMJ 2025;390:e083658. Abstract