Treating ADHD

The current issue of The Medical Letter leads off with an article on Drugs for ADHD, a disorder once diagnosed only in children, but now recognized in adults as well. It has been estimated that about 5% of all the school children in the western world, mostly boys, fit the criteria for attention-deficit/hyperactivity disorder. In the US, the percentage of children diagnosed with ADHD is even higher, and many of these children are treated with the drugs we review. Editorial writers in medical journals and lay publications have argued that the diagnosis is made far too often and that too many children are exposed to stimulants and the other drugs used to treat ADHD. In the first paragraph of The Medical Letter, we cite 3 articles that, taken together, could be used to support the view that ADHD is underdiagnosed and undertreated.

An article published online February 26, 2015 by S. Daalsgard et al in The Lancet used Danish national registers to compare mortality rates, with all the appropriate adjustments, for all Danish children with and without ADHD born between 1981 and 2011 and found that the mortality rate ratio for those diagnosed at ages younger than 6 years was 1.86, for those diagnosed at age 6-17 was 1.58, and for those diagnosed at 18 or older was a frightening 4.25. Girls with ADHD had higher mortality rates than boys. Accidents were the most common cause of death.

The results of 2 earlier studies suggest that treatment could make a difference. Swedish national registers were used to look at serious traffic accidents associated with an ADHD diagnosis and compared the risk in the same patient on and off medication. The incidence of accidents, as expected, was higher in ADHD patients, and medication was associated with a 58% reduction in the risk for males. There was no significant association for females (Z Chang et al, JAMA Psychiatry 2014; 71:319). The third study assessed the effects of medication for ADHD on criminal behavior, also using Swedish national registers. Taking ADHD medication reduced the criminality rate by 32% in men and 41% in women (P Lichtenstein et al, N Engl J Med 2012; 367:2006).

How effective are the drugs, and how safe? All that and more can be found in the March 16th issue of The Medical Letter.

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