'Diminishing Returns With Broader Use of ADHD Meds?'

 It’s well known that medications used to treat attention-deficit hyperactivity disorder (ADHD) do more than address the core symptoms of inattention, hyperactivity, and impulsivity. They have also been associated with significant reductions in the risk for serious real-world outcomes such as self-harm, unintentional injury, car crashes, and crime. 

However, a large-scale Swedish study has found that the magnitude of associations between ADHD medication use and these real-world outcomes appears to have weakened, in parallel with rising prescription rates.

“The declining strength of the associations of ADHD medication and real-world outcomes could be attributed to the expansion of prescriptions to a broader group of individuals having fewer symptoms or impairments,” first author Lin Li, PhD, Karolinska Institutet, Stockholm, Sweden, and colleagues wrote.

The findings were published online on June 25 in JAMA Psychiatry. 

Waning Real-World Impact?

The rate of ADHD medication use has risen substantially in many countries over the past two decades. With treatment now reaching a broader population of individuals who may have less severe symptoms, an emerging question is whether there remains a meaningful reduction in real-world harm.

To investigate, Li and colleagues analyzed health data from Swedish national registers for 247,420 individuals aged 4-64 years who were prescribed ADHD medications between 2006 and 2020.

They employed a self-controlled case series design, which allowed individuals to serve as their own controls. Outcomes included rates of self-harm, unintentional injury, traffic crashes, and crime measured during medicated vs nonmedicated periods.

Over the 14-year study period, ADHD medication use rose sharply in Sweden — from 0.6% to 2.8% in children and from 0.1% to 1.3% in adults.

ADHD medication use was consistently linked to reduced risks for self-harm (incidence rate ratio [IRR] range, 0.77-0.85), unintentional injury (IRR range, 0.87-0.93), traffic crashes (IRR range, 0.71-0.87) and crime (IRR range, 0.73-0.84) across all analyzed time periods, age groups, and sexes.

However, the magnitude of risk reduction for these real-world outcomes diminished significantly over time (P < .01) and was not fully explained by the age and sex distribution of people taking ADHD medication.

The study team noted that the strongest associations between ADHD medication and reduced risk for real-world outcomes were consistently observed in women during the earliest study period (2006-2010), a time when only the most severe ADHD cases in women were being diagnosed and treated.

Over time, as more women were prescribed ADHD medication, the sex differences on the various real-world outcomes narrowed, investigators said.

In an accompanying editorial in JAMA Psychiatry, Ryan S. Sultan, MD, Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York City, and colleagues said it’s “critically” important to remember that the purpose of ADHD treatment is not primarily to prevent arrests, car crashes, or self-harm crises but to improve patients’ daily functioning and quality of life. 

“The accumulation of evidence makes one thing clear: When used appropriately, ADHD medications can help affected people not just feel better but live safer, more productive lives. This message is important as many individuals with ADHD still do not receive medication as their first-line treatment, despite medications having the most robust evidence for ADHD,” the editorialists wrote.

The study had no commercial funding. The authors and editorial writers had no relevant disclosures.

https://www.medscape.com/viewarticle/diminishing-returns-broader-use-adhd-meds-2025a1000h89