Tuesday, 30 April 2013

Medication for Attention Deficit–Hyperactivity Disorder and Criminality

New England Journal of Medicine 2012; 367:2006-2014 November 22, 2012 doi: 10.1056/NEJMoa1203241

Seeing people with ADHD it is often difficult weighing up the pros and cons of treatment. On the one hand there are benefits with a reduction of ADHD symptoms and on the other there are the risks of side effects, over prescription and development of tolerance and addiction. One paper that may help clinicians and patients reach a conclusion is this one from Sweden published in the NEJM.

The design is a case control study nested within a cohort study where the cohort cases are people with ADHD and the controls are a general population sample. The authors found that when men with ADHD were prescribed ADHD medication (mainly methylphenidate) they committed about a third less crimes than when they were not taking medication and that for women the figure was a 41% reduction.

A question not answered by this study is what happens when the medication is stopped – does the reduction in criminality persist – does the medication cause permanent change? The authors did not find any association between being on medication in 2006 and the crime rate in 2009 which suggests that the association between reduced criminality and being on medication does not persist. So back to being crime prevention officers….

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