Study: ADHD Medications Associated With Reduced Risk of Suicidality in Children With Significant Behavioral Symptoms

New findings from the Lifespan Brain Institute (LiBl) of the Children’s Hospital of Philadelphia and the University of Pennsylvania found that attention-deficit hyperactivity disorder (ADHD) medications may lower the risk of suicide in children with hyperactivity, oppositional defiance, and other behavioral disorders. This information addresses a significant knowledge gap in childhood suicide risk and could enlighten suicide prevention strategies at this time, since suicide among children is on the rise.

“This study is an important step in the much-needed effort of childhood suicide prevention, as it leverages data collected from approximately 12,000 US children to identify an actionable target to reduce childhood suicides,” said senior author Ran Barzilay, MD, PhD, an assistant professor at LiBI, in a press release. “Early diagnosis and treatment of behavioral symptoms with ADHD medication, particularly among children with severe externalizing symptoms, may serve not only to improve learning and behavior problems, but also to decrease suicidality risk.”

Although suicide was the second leading cause of death among individuals between 10 and 24 years of age in 2018, according to the CDC, the rates are still relatively low in preadolescent children, making it difficult to identify the factors that may lead to or prevent suicidal tendencies in this age range. Further, there are ethical limitations in registering potentially suicidal youth in placebo-controlled randomized clinical trials, according to the study.

“In an ideal world, we want to test a medication effect on suicidality with a randomized prospective trial,” Barzilay said in the press release. “But given the challenges of conducting such studies, we are obligated as a society and as scientists to generate clinical insights using data collected in large-scale observational studies of children.”

The research team leveraged data from the Adolescent Brain Cognitive Development (ABCD) study, which included a sample cohort of 11,878 children between 9 and 10 years of age who were recruited through school systems. The cohort spans across 21 sites in the United States, including data on child development, mental, social, and emotional health.

In a secondary analysis of the ABCD data, the researchers found that out of the 11,878 children in the study, 8.5% were treated with ADHD medication, such as methylphenidate, Adderall, or clonidine, and 8.8% reported past or current suicidality.

Further, children who expressed suicidal tendencies had more externalizing symptoms, being more likely to receive ADHD medication than non-suicidal children, according to the study. However, among children who showed externalizing behaviors, those taking ADHD medications had a less chance for suicidality, suggesting a moderating role for ADHD medications in the children.

In a 1-year follow-up assessment of the participants, the research team found that children with high externalizing symptoms who were treated with ADHD medications at baseline were less likely to be suicidal 1 year later, whereas children who were not receiving ADHD medications at baseline but had high externalizing symptoms were more likely to be suicidal at the 1-year follow up.

“Given the connection between childhood suicidality and poor adult mental health, these findings emphasize the importance of better and more thorough screening of school-aged children for externalizing behavioral symptoms,” Barzilay said in the press release. “These symptoms are treatable, and addressing them early has the strong potential to prevent and mitigate serious mental health issues later in life.”

REFERENCE

ADHD Medications Associated with Reduced Risk of Suicidality in Children with Significant Behavioral Symptoms. Children’s Hospital of Philadelphia. June 4, 2021. Accessed July 21, 2021. https://www.chop.edu/news/adhd-medications-associated-reduced-risk-suicidality-children-significant-behavioral-symptoms