ADHD Meds May Lower Suicidality Risk in Children

By Linda Carroll

June 07, 2021

(Reuters Health) - Children with ADHD and substantial externalizing symptoms may be at a lower risk of suicidality if they are taking ADHD medication, a new study suggests.

An analysis of data from 11,878 children, of whom 1,006 were taking ADHD medications, found that while substantial externalizing symptoms were associated with increased suicidality risk in kids not taking ADHD medications, those taking the medications were not at increased risk compared to children without substantial externalizing symptoms, researchers reported in JAMA Network Open.

"There is a major gap in identifying actionable factors to reduce childhood suicide risk," said study coauthor Dr. Ran Barzilay, a child psychiatrist at the Children's Hospital of Philadelphia and an assistant professor of psychiatry at the University of Pennsylvania. "We asked whether taking ADHD medications changes the risk in kids with more externalizing symptoms. In this very large sample of children from age 10 to 11, our results suggest that in kids with substantial behavioral symptoms, ADHD medications were associated with a reduced risk. That hasn't been shown before."

Because the study was observational, it doesn't prove that the medications reduce suicidality risk and it can't explain how the medications might reduce the risk, Dr. Barzilay said. He suggested two hypotheses to explain the results.

"First, the improvement in symptoms might make children feel and function better and make them think less about their problems," Dr. Barzilay said. "So, once a child's wellbeing has improved, they may become less suicidal. Another option we can't rule out is that there is something about the kids who get the medications that is protective. Maybe there is something in the home or about their families that makes them less prone to suicidality. Since this is not a randomized controlled trial, we can't tell."

The possibility that ADHD medications might have an impact on suicidality might reassure parents who are hesitant about treating their children with medications, Dr. Barzilay said.

To look at the potential impact of ADHD medications on child suicidal ideation or suicide attempts, Dr. Barzilay and his colleagues turned to the large, diverse longitudinal cohort participating in the Adolescent Brain Cognitive Development (ABCD) Study, which recruited 11,878 children at ages 9-10 years.

At the baseline assessment, the children's mean age was 9.9. Among kids in the cohort, 6,196 were boys (52.2%), 8,805 were white (74.1%), 1,006 (8.5%) were treated with ADHD medication, and 1,040 (8.8%) reported past or current suicidality.

Comparing children who were taking ADHD medications to those who had the symptom of hyperactivity but no medication, the researchers found that externalizing symptoms were associated with suicidality (for a change of one standard deviation in symptoms, the odds ratio was 1.34), as was ADHD medication treatment (OR 1.32).

ADHD medication use, however, was associated with less suicidality in children with more externalizing symptoms.

In children with substantial externalizing symptoms and not taking ADHD medication, one standard deviation increase in symptoms was associated with suicidality (OR 1.42). But for children who were receiving ADHD medication, there was no such association (OR 1.15). The association with medication remained even when accounting for multiple confounders, including risk and protective factors for suicidality in ABCD, and was replicated in one-year longitudinal follow-up, the study team notes.

"By themselves externalizing symptoms go with higher odds of suicidality," Dr. Barzilay said. "In parallel, because kids who receive ADHD medications have more symptoms to begin with - that is the reason they got medications - these kids have also higher odds of suicidality compared to kids without symptoms," he noted.

"However, when you look at kids with behavioral symptoms who are taking ADHD medications, they have less suicidality than kids with externalizing symptoms but are not taking ADHD medications," Dr. Barzilay said.

There is a literature showing an association between ADHD and suicidal behavior, mainly in people who are also depressed, said Dr. Jeffrey Newcorn, a professor of psychiatry and pediatrics and director of the division of ADHD and learning disorders at the Icahn School of Medicine at Mount Sinai in New York City, director of pediatric psychopharmacology at the Mount Sinai Health System, and president of the American Professional Society of ADHD and Related Disorders (APSARD). We can assume depressed mood or negative emotions are present in individuals with suicidal thinking or behavior in this study, but there is no information on depression in these children, Dr. Newcorn said.

Still, "the authors are telling us that children with hyperactivity, who are impulsive and have conduct symptoms which presumably come in combination with ADHD, are less likely to have suicidal behavior when treated with ADHD medications," Dr. Newcorn said.

The children who were not receiving ADHD medication presumably did not have a diagnosis of ADHD. However, Dr. Newcorn said, "it's likely that many of the children with behavioral problems who were not getting ADHD medications could also have had ADHD - which either was not identified or not treated with medication.

While this study "doesn't tell us why the children with symptoms of ADHD and disruptive behavior disorders in this study also had suicidal ideation, it is reassuring that treating the impulsive symptoms can be helpful in decreasing suicidal behavior - and that is consistent with the findings from other studies."

SOURCE: https://bit.ly/3z5jyIY JAMA Network Open, online June 4, 2021.

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