Our main analyses did not address the question of whether there are only concomitant associations or whether criminality rates were affected beyond treatment termination. It is possible that pharmacologic ADHD treatment helps patients to better organize their lives or contributes to enduring changes at the neuronal level. Another possibility is that the concomitant associations with treatment do not persist, which could be an explanation for previous findings of a lack of long-term effects. In line with the latter possibility, we found no significantly persistent association between medication use in 2006 and the crime rate in 2009, an interpretation also supported by our finding of an association between medication use and criminality regardless of whether it was the first or second time that patients changed their medication status.
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We found similar reductions in criminality rates associated with the use of ADHD medication regardless of whether the drug was a stimulant (hazard ratio, 0.66) or a nonstimulant (hazard ratio, 0.76) or whether analyses were restricted to less severe or specific crimes (). The hazard ratios did not materially change when patients were identified solely on the basis of their prescriptions (hazard ratio, 0.64), from general child and adolescent mental health services on the basis of the Pastill Register (hazard ratio, 0.83), and when patients with a diagnosis of a coexisting disorder (conduct, oppositional–defiant, antisocial-personality, or substance-use disorder) were excluded (hazard ratio, 0.77), although the estimate did not reach significance on the basis of data from the Pastill Register (). When the outcome was changed to suspicion of a crime, there was also a reduction in the criminality rate during the treatment period (hazard ratio, 0.81). In contrast to the results for the use of ADHD medication, there was no evidence of an association between a criminal conviction and the use of an SSRI among patients with a diagnosis of ADHD in the National Patient Register) (hazard ratio, 1.04; 95% CI, 0.93 to 1.17).
attention deficit hyperactivity disorder (ADHD) - KidsHealth
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Since 2005, the use of ADHD medication in both children and adults has increased exponentially. Methylphenidate is recommended for first-line drug treatment, whereas amphetamine and dextroamphetamine are prescribed more rarely. The nonstimulant atomoxetine is also used regularly.
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That it is an extreme form of commonly occurring types of behavior rather than a disorder with discrete determinants is suggested by genetic studies, including a large study of twins, in . . .
How can the answer be improved?
The Multimodal Treatment of Attention Deficit–Hyperactivity Disorder (MTA) study is the largest randomized clinical trial of ADHD medication with long-term follow-up. The most sensitive measures of treatment (a composite of ADHD symptoms, as rated by parents and teachers) suggested that the benefit of medication at the 14-month assessment had diminished at 36 months. No association was observed with early delinquency and substance use at 36 months. Although the study did not suggest long-term effects of medication, high rates of treatment discontinuation, a lack of placebo-treated controls, and a limited range of outcomes mean that the longer-term effects of ADHD medication remain uncertain. In this study, we used Swedish population-based data to investigate the association between the use of ADHD medication and criminality.
Can the Increase in ADHD Diagnosis Be Explained?
Since the diagnosis of ADHD often coexists with conduct, oppositional–defiant, antisocial-personality, or substance-use disorder, it is not clear whether these disorders should be regarded as confounders, mediators, or colliders. Thus, to test whether the association between medication use and criminality was different depending on coexisting diagnoses, we performed a sensitivity analysis that included only patients without a diagnosis of a coexisting disorder.