Image: CC/CDC. Prevalence of ADHD (dark = highest)
Dr. Paul Lichtenstein talks to 2 Minute Medicine:Department of Medical Epidemiology and Biostatistics, Karolinska Institute
“One potential implication of this study is that ADHD medication should be seriously considered for adolescents and young adults with ADHD that are at risk for criminality. For instance, research indicates that about 30-40% of long-serving criminals have ADHD. If their risk of recidivism can be reduced by 30%, it would clearly affect total crime numbers in many societies. It should be noted that ADHD medications, like all medications, have potential risks, and the clinician needs to weigh risk and benefits for each patient. Based on our study, we suggest that clinicians also should include the potential decreased risk for criminality in their risk-benefit evaluation.”
Key study points:
1. ADHD medication is associated with short term decreases in rates of criminality in men and women in ADHD patients in comparison to periods without medication usage.
Primer: Attention deficit/hyperactivity disorder is present in 3% to 7% of school-age children in the United States, making it the most common neurobehavioral disorder in this group. The disorder commonly presents with over-activity, impulsivity, and/or inattentiveness. ADHD is known to persist into adolescence and adulthood in the majority of patients. While supportive intervention is typically the first line of action for ADHD, there are several pharmacological options that have been used with increasing frequency recently. Among the benefits of ADHD medication, previous studies have demonstrated that typical medications, such as methylphenidate, reduce the incidence of associated conduct problems in children and adults with ADHD. Given such findings, the present study investigated the effect of ADHD medication in reducing criminality overall.
Background reading:
1. A 30-Year Prospective Follow-up Study of Hyperactive Boys with Conduct Problems
3. Evolution of the treatment of attention-deficit/hyperactivity disorder in children: A review
This [retrospective cohort] study: A total of 16,087 men and 9,569 women with ADHD were investigated via a retrospective pharmacoepidemiologic approach using data from multiple population-based registries in Sweden. Criminality data, defined as any conviction for a crime, was attained through the National Crime Register. Several sensitivity analyses were used to check for and reduce bias in the study.
36.6% of men and 15.4% of women with ADHD were convicted of at least one crime compared to 8.9% and 2.2% of the general population, respectively. Following adjustment for all confounding variables, ADHD medication was shown to reduce criminality by 32% (P<0.001) in men and 41% in women (P<0.001) during treatment periods.
In sum: The findings of this study suggest that ADHD medication reduces the rates of all types of criminality, although this effect does not seem to persist after termination of treatment. One should consider the possibility that patients may stop treatment because of their criminal behavior (reverse causation), but this is unlikely given that the impact of the order of treatment to non-treatment status or vice versa was insignificant. Given the nature of this type of retrospective study, it was unable to account for certain confounders (e.g. alcohol usage or other substance abuse). Also, the study was conducted exclusively in Sweden, and the authors note that there is a large variance in the diagnosis and use of ADHD medications across the world, although Sweden does not appear to be an outlier with respect to cases of ADHD or the use of ADHD medications. Thus, the study provides an additional possible benefit of pharmacological treatment of ADHD, which should be considered by physicians who must weigh the risks and benefits of using pharmacological options for ADHD patients.
Click to read the study in NEJM
By [JP] and [RR]
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