Medication Linked to Fewer Injuries in Kids With ADHD

Older teens experienced the greatest drop in injury risk while taking Ritalin, researchers report

Monday, December 15, 2014

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MONDAY, Dec. 15, 2014 (HealthDay News) --Taking medication for attention-deficit hyperactivity disorder (ADHD) might reduce the risk of young patients accidentally injuring themselves, new research suggests.

When several thousand children and teens were taking methylphenidate, which is marketed as Ritalin or Concerta in the United States, they were a little less likely to end up in the emergency room than when they weren't taking the drug, the study found. However, the report did not prove that taking ADHD medication prevented injuries.

Past research has shown that children with ADHD are more likely to get injured, according to three of the study authors who jointly responded to questions. The authors are pharmacy professor Ian Wong and pediatrics professor Dr. David Coghill, both from The University of Hong Kong medical school, and epidemiologist Ian Douglas, from the London School of Hygiene and Tropical Medicine in the U.K.

"These studies also suggest that impulsivity and poor concentration in some patients with ADHD may contribute to the high incidence of injury," they said.

Dr. Lawrence Diller, a behavioral developmental pediatrician at the University of California, San Francisco, put it another way: "Acting before you think things through may get you stuck in tight places. Low doses of stimulants make anyone who takes them more deliberate, less impulsive."

The researchers compared the medical records of nearly 5,000 children and teens, aged 6 to 19, who had at least one prescription for methylphenidate and went to the emergency room for trauma at least once between 2001 and 2013. Children who also took the ADHD drug Strattera (atomoxetine) were not included.

The patients had more than 8,400 trauma-related ER admissions overall. The trauma types weren't noted, but these visits acted as a stand-in for risk of physical injury, the authors said.

More than 6,400 of the emergency room visits occurred when patients were not taking methylphenidate, compared to more than 2,000 visits among those taking the medication.

After considering patients' ages and the season in which they were injured (injuries occur more frequently in the warmer months, according to past research), the researchers found that children and teens taking methylphenidate were about 9 percent less likely to injure themselves than those not taking the drug.

Put another way, for every 88 children taking methylphenidate, one child's injury would be prevented, the researchers calculated. Their findings, published online Dec. 15 in the journal Pediatrics, applied to both girls and boys.

Older teens were especially less likely to go to the ER for trauma while taking ADHD medication. The risk of those aged 16 and older dropped 32 percent while on methylphenidate, compared to a 7 percent drop for younger children.

Meanwhile, children's likelihood of going to the ER for reasons other than trauma were not different when on or off their medication.

The results partly answer whether reducing impulsivity with a stimulant medication has any real-world benefits, said Dr. Glen Elliott, medical director of Children's Health Council in Palo Alto, Calif.

"At least with respect to trips to the emergency room because of injuries, the answer is yes," Elliott said. "Because they were comparing the same individual on and off methylphenidate, it is reasonable to conclude that the medication produced that benefit."

"When asked, most children with ADHD will be able to tell you before or after what they should do in a circumstance, but when faced with that circumstance, they forget and follow the impulse," Elliott said. "It is interesting that the benefits were higher for subjects above 16, where risk-taking behaviors can be of particular concern."

Common side effects of ADHD medications include appetite suppression and trouble falling asleep, according to Diller. Longer term use of stimulants is linked to a slight decrease in overall height and a higher risk for obesity in young adulthood, he said.

Giving children stimulants as "the first and only intervention" for an ADHD diagnosis, Diller said, should not be a substitute for non-drug interventions, such as different parenting strategies or special education.

"But if those interventions have been tried and the kid is still running out into the street, then stimulants are a reasonable addition," Diller said.

The study authors suggest that drug treatment for ADHD should be part of a comprehensive treatment program, taking into account other health conditions the child has, possible side effects and the potential for misuse of or dependency on the drug.

The study, funded by the Research Grants Council in Hong Kong, was not underwritten by any pharmaceutical companies.

SOURCES: Ian Wong, Ph.D., Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong; David Coghill, M.D., Department of Pediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong; Ian Douglas, Ph.D., Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London; Lawrence Diller, M.D., behavioral developmental pediatrician, University of California at San Francisco; Glen Elliott, Ph.D., M.D., chief psychiatrist, medical director, Children's Health Council, Palo Alto, Calif.; Dec. 15, 2014, Pediatrics

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