ADHD Treatment Reduces Suicidality in Pediatric Patients

According to new research from the Lifespan Brain Institute (LiBI) of Children’s Hospital of Philadelphia (CHOP) and the University of Pennsylvania, ADHD medications may reduce suicide risk in children with hyperactivity, oppositional defiance, and other behavioral disorders.

Published in JAMA Network Open, the study helps fill a critical gap in understanding childhood suicide risk and could guide prevention efforts amid rising suicide rates among children.

ADHD Treatment Reduces Suicidality in Pediatric Patients

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ADHD Treatment Medications Associated with Reduced Risk of Suicidality in Children with Significant Behavioral Symptoms

This study marks a significant step in childhood suicide prevention, using data from about 12,000 U.S. children to identify a concrete approach to reducing suicides.

Early diagnosis and treatment of behavioral symptoms with ADHD medication, especially in children with severe externalizing behaviors, may not only improve learning and behavior but also lower suicide risk.

Suicide rates among children have been steadily increasing, with the CDC reporting it as the second leading cause of death for individuals aged 10 to 24 in 2018.

However, rates remain relatively low in preadolescents, making it challenging to identify risk or protective factors in this age group.

Ethical constraints also limit the ability to enroll potentially suicidal youth in placebo-controlled clinical trials.

“In an ideal world, we want to test a medication effect on suicidality with a randomized prospective trial,” Barzilay said. “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.”

LiBI researchers, along with Gal Shoval, MD, of Tel Aviv University, addressed this challenge by analyzing data from the Adolescent Brain Cognitive Development (ABCD) Study.

As the largest long-term study of brain development and health in the U.S., the ABCD Study includes 11,878 children aged 9 to 10, recruited through school systems across 21 sites, representing over 20% of the population in this age group.

This extensive dataset provides detailed information on child development, including mental, social, and emotional health, allowing researchers to control for multiple confounders and examine the specific link between ADHD medications and suicidal tendencies.

A secondary analysis of the data revealed that 8.5% of children were treated with ADHD medication, such as methylphenidate, Adderall, or clonidine, while 8.8% reported past or current suicidality.

Researchers found that children with suicidal tendencies exhibited more externalizing symptoms and were more likely to receive ADHD medication than non-suicidal children.

However, among those with significant externalizing behaviors, those taking ADHD medication had lower odds of suicidality, suggesting a potential protective effect.

To assess whether this effect persisted, researchers analyzed one-year follow-up data.

They found that children with high externalizing symptoms who were treated with ADHD medication at baseline were less likely to report suicidality a year later.

In contrast, those with high externalizing symptoms who were not on ADHD medication at baseline had a higher likelihood of suicidality at 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. “These symptoms are treatable, and addressing them early has the strong potential to prevent and mitigate serious mental health issues later in life.”