Effectiveness of Pharmacological Treatment for Attention-Deficit/Hyperactivity Disorder on Physical Injuries: A Systematic Review and Meta-Analysis of Observational Studies

Abstract

Background

Patients with attention-deficit/hyperactivity disorder (ADHD) are more prone to physical injuries, including motor vehicle accidents, fractures and brain injuries. Several observational studies have been published investigating the association between the use of pharmacological treatment for ADHD and the incidence of physical injuries among patients with ADHD; however, the findings are not concordant.

Objective

This study is a systematic review and meta-analysis of the existing literature and estimates the overall association between the use of ADHD medications and physical injury. Injury is defined as medically attended physical injuries in the form of hospitalisations, emergency department visits or general practitioners visits.

Methods

The PubMed, EMBASE, PsycINFO, CINAHL and Cochrane Review databases were searched for relevant studies published up to May 2017 relating to ADHD medication and risk of injuries. Observational studies with any study design, all age groups (children and adults) and all ADHD medications (stimulant and non-stimulants) were included. Studies relevant to the association between ADHD medication exposure and risk of injuries in ADHD patients were extracted and compiled for meta-analysis. Both within-individual and between-individual analyses were conducted.

Results

Overall, 2001 citations were identified and 10 observational studies were included. Three self-controlled case series and two self-controlled cohorts were eligible for meta-analysis of within-individual studies. Five cohort studies were included in the meta-analysis of between-individual studies. The adjusted rate ratio of the within-individual methods was 0.76 (95% confidence interval [CI] 0.61–0.93) and 0.88 (95% CI 0.85–0.92) for between-individual studies.

Conclusion

The findings of this meta-analysis support a reduced risk of injuries among ADHD patients who were treated with ADHD medications.

Appendix

The search terms used were (Methylphenidate OR methylphenidate hydrochloride OR methylphenidate hcl OR metadate OR medikinet OR methylin OR ritalin OR equasym OR daytrana OR concerta OR atomoxetine OR atomoxetin OR strattera OR attentrol OR attentin OR recit OR tomoxetin OR amphetamine OR amfetamine OR amphetamines OR amfetamines OR amphetamines OR amfetamines OR levo amphetamine OR levo amfetamine OR dextro amphetamine OR dextro amfetamine OR methamphetamine OR methamphetamine OR detra amphetamine OR detra amfetamine OR lisdexamfetamine OR lisdexamfetamine OR dexamphetamine OR dexamfetamine OR benzedrine OR adderall OR desoxyn OR dexedrine OR destroStat OR vyvanse OR drug therapy OR pharmacological treatment OR stimulant*[SLL1]) AND (Epidemiological OR Pharmacoepidemiological OR observational OR post marketing surveillance OR cohort OR case control OR case crossover OR self-controlled case series OR cross sectional OR population based OR registry) AND (ADHD OR syndrome hyperkinetic OR hyperkinetic syndrome OR hyperactivity disorder OR hyperactive syndrome OR attention deficit hyperactivity disorder OR attention deficit hyperactivity disorders OR adhd attention deficit hyperactivity disorder OR addh OR overactive syndrome OR attention deficit hyperkinetic disorder OR hyperkinetic disorder OR adhd OR attention deficit disorder hyperactivity OR attention deficit disorders hyperactivity OR attention deficit disorder OR hyperkinetic syndromes OR syndromes hyperkinetic OR hyperkinetic syndrome) AND (trauma OR accident OR injury OR crime* OR hospitalisation OR hospitalization OR emergency OR fracture OR fall OR concussion OR traffic OR driving OR motor OR dental injury OR musculoskeletal OR arrest OR conviction OR incarceration OR bicycle OR nocturnal motor activity OR risk factor* OR violence OR drowning).