Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Sep 1;86(5):335-343.
doi: 10.1016/j.biopsych.2019.04.009. Epub 2019 Apr 17.

Risks and Benefits of Attention-Deficit/Hyperactivity Disorder Medication on Behavioral and Neuropsychiatric Outcomes: A Qualitative Review of Pharmacoepidemiology Studies Using Linked Prescription Databases

Zheng Chang  1 , Laura Ghirardi  2 , Patrick D Quinn  3 , Philip Asherson  4 , Brian M D'Onofrio  5 , Henrik Larsson  6
Affiliations

Risks and Benefits of Attention-Deficit/Hyperactivity Disorder Medication on Behavioral and Neuropsychiatric Outcomes: A Qualitative Review of Pharmacoepidemiology Studies Using Linked Prescription Databases

Zheng Chang et al. Biol Psychiatry. .

Abstract

Attention-deficit/hyperactivity disorder (ADHD) medication is one of the most commonly prescribed medication classes in child and adolescent psychiatry, and its use is increasing rapidly in adult psychiatry. However, major questions and concerns remain regarding the benefits and risks of ADHD medication, especially in real-world settings. We conducted a qualitative systematic review of studies that investigated the effects of ADHD medication on behavioral and neuropsychiatric outcomes using linked prescription databases from the last 10 years and identified 40 studies from Europe, North America, and Asia. Among them, 18 used within-individual designs to account for confounding by indication. These studies suggested short-term beneficial effects of ADHD medication on several behavioral or neuropsychiatric outcomes (i.e., injuries, motor vehicle accidents, education, substance use disorder), with estimates suggesting relative risk reduction of 9% to 58% for these outcomes. The within-individual studies found no evidence of increased risks for suicidality and seizures. Replication studies are needed for several other important outcomes (i.e., criminality, depression, mania, psychosis). The available evidence from pharmacoepidemiology studies on long-term effects of ADHD medication was less clear. We discuss time-varying confounding and other limitations that should be considered when interpreting results from pharmacoepidemiology studies. Furthermore, we highlight several knowledge gaps to be addressed in future research and implications for research on mechanisms of outcomes of ADHD medications.

Keywords: ADHD medication; Long-term outcomes; Pharmacoepidemiology; Real-world evidence; Short-term outcomes; Within-individual design.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.. Forest plot of within-individual studies for short-term effects of ADHD medications.
Note: Studies on educational outcomes were not included because they used continuous measures of outcome.
See this image and copyright information in PMC

References

    1. Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015;56:345–365. - PubMed
    1. Lahey BB, Lee SS, Sibley MH, Applegate B, Molina BSG, Pelham WE. Predictors of adolescent outcomes among 4–6-year-old children with attention-deficit/hyperactivity disorder. J Abnorm Psychol. 2016;125:168–181. - PMC - PubMed
    1. Costello EJ, Maughan B. Annual research review: Optimal outcomes of child and adolescent mental illness. J Child Psychol Psychiatry. 2015;56:324–341. - PMC - PubMed
    1. Sayal K, Prasad V, Daley D, Ford T, Coghill D. ADHD in children and young people: prevalence, care pathways, and service provision. The Lancet Psychiatry. 2018;5:175–186. - PubMed
    1. Xu G, Strathearn L, Liu B, Yang B, Bao W. Twenty-year trends in diagnosed attention-deficit/hyperactivity disorder among us children and adolescents, 1997–2016. JAMA Network Open. 2018;1:e181471. - PMC - PubMed

Publication types

MeSH terms

Substances