Study finds ADHD medication associated with reduced risks of suicide and criminal behaviour

Attention deficit hyperactivity disorder (ADHD) affects approximately 5% of children and often persists into adulthood. Pharmacological treatments, particularly stimulants such as methylphenidate, are the cornerstone of treatment.However, as authors of a new study point out, "the benefits of these medications beyond improving the core symptoms of ADHD have remained understudied in real-world clinical settings." This is the gap that the team at the Karolinska Institutet, located in Stockholm, sought to fill.The researchers analyzed data from Swedish national registries between 2007 and 2020. The cohort included 148,581 newly diagnosed patients, aged 6-to-64 years (mean age 17 years; 41% women). Of these, 57% received a prescription, the majority of which was methylphenidate (88.4%). To reduce bias, they used a "target trial emulation" approach, applying the logic of randomized trials to observational data. They also followed the patients for two years.The results highlight robust associations, at the first occurrence of an event:suicidal behavior: 17% reduction (hazard ratio [HR] 0.83; 95% CI 0.78 to 0.89);substance use: 15% reduction (HR 0.85; 95% CI 0.80 to 0.90);transport accidents: 12% reduction (HR 0.88; 95% CI 0.82 to 0.94);crime: 13% reduction (HR 0.87; 95% CI 0.82 to 0.92).In contrast, the difference was not significant for unintentional accidental injuries (88.5 events per 1,000 person-years in treated participants versus 90 in untreated participants).The analysis of recurrent events reinforced these results:15% reduction in repeated suicidal behaviors (HR 0.85; 95% CI 0.82 to 0.88);25% for substance use (HR 0.75; 95% CI 0.72 to 0.78);16% for transport accidents (HR 0.84; 95% CI 0.80 to 0.88);25% for crime (HR 0.75; 95% CI 0.72 to 0.78).The authors conclude that "pharmacological treatment of ADHD is associated with broader benefits than those traditionally considered in clinical practice."Beneficial effects to consider in practice?In their discussion, the researchers put forward several explanatory mechanisms. Better regulated impulsivity could reduce aggression and criminal behaviour. Increased attention could limit distractions while driving. However, they emphasize the limitations: the lack of data on dosages, concurrent non-pharmacological therapies or the severity of the disorder. "These associations do not prove a causal relationship," they stated, while emphasizing the consistency of the results with other studies.For Zheng Chang, lead author, quoted by the BBC, "our results provide a solid evidence base for evaluating the role of pharmacological treatments for ADHD in preventing serious health and social consequences."The prescription of stimulants remains controversial, amid fears of adverse effects and questions about their use. However, the study calls for a broader perspective— framing the issues ADHD presents as no longer solely a matter of alleviating cognitive and behavioural symptoms, but also of preventing serious outcomes such as suicide attempts, addiction, accidents or delinquency.As summarized by a child psychiatrist quoted by the Guardian, Dr. Samuele Cortese, "These results should encourage clinicians to look beyond symptom reduction and incorporate societal benefits into their discussions with patients and their families."Reference:Zhang L, Zhu N, Sjölander A, Nourredine M, Li L, Garcia-Argibay M et al. ADHD drug treatment and risk of suicidal behaviors, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials. BMJ 2025;390:e083658 doi:10.1136/bmj-2024-083658

Study finds ADHD medication associated with reduced risks of suicide and criminal behaviour

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