TY  - JOUR
PY  - 2021//
TI  - Evaluation of attention-deficit/hyperactivity disorder medications, externalizing symptoms, and suicidality in children
JO  - JAMA network open
A1  - Shoval, Gal
A1  - Visoki, Elina
A1  - Moore, Tyler M.
A1  - DiDomenico, Grace E.
A1  - Argabright, Stirling T.
A1  - Huffnagle, Nicholas J.
A1  - Alexander-Bloch, Aaron F.
A1  - Waller, Rebecca
A1  - Keele, Luke
A1  - Benton, Tami D.
A1  - Gur, Raquel E.
A1  - Barzilay, Ran
SP  - e2111342
EP  - e2111342
VL  - 4
IS  - 6
N2  - IMPORTANCE: Childhood suicidality (ie, suicidal ideation or attempts) rates are increasing, and attention-deficit/hyperactivity disorder (ADHD) and externalizing symptoms are common risk factors associated with suicidality. More data are needed to describe associations of ADHD pharmacotherapy with childhood suicidality. <br><br>OBJECTIVE: To investigate the associations of ADHD pharmacotherapy with externalizing symptoms and childhood suicidality. DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, cross-sectional and 1-year-longitudinal associations were examined using data (collected during 2016-2019) from the Adolescent Brain Cognitive Development (ABCD) Study, a large, diverse US sample of children aged 9 to 11 years. Data analysis was performed from November to December 2020. EXPOSURES: Main and interaction associations of externalizing symptoms (hyperactivity ADHD symptoms, oppositional defiant, and conduct disorder symptoms) and ADHD medication treatment (methylphenidate and amphetamine derivatives, α-2-agonists, and atomoxetine) at baseline assessment. MAIN OUTCOMES AND MEASURES: Child-reported suicidality (past and present at baseline; current at longitudinal assessment). Covariates were age, sex, race/ethnicity, parents' education, marital status, and concomitant child psychiatric pharmacotherapy (antidepressants and antipsychotics). <br><br>RESULTS: Among 11 878 children at baseline assessment (mean [SD] age, 9.9 [0.6] years; 6196 boys [52.2%]; 8805 White [74.1%]), 1006 (8.5%) were treated with ADHD medication and 1040 (8.8%) reported past or current suicidality. Externalizing symptoms (median [range], 1 [0-29] symptom count) were associated with suicidality (for a change of 1 SD in symptoms, odds ratio [OR], 1.34; 95% CI, 1.26-1.42; P < .001), as was ADHD medication treatment (OR, 1.32; 95% CI, 1.06-1.64; P = .01). ADHD medication use was associated with less suicidality in children with more externalizing symptoms (significant symptom-by-medication interaction, B = -0.250; SE = 0.086; P = .004), such that for children who were not receiving ADHD medications, there was an association between more externalizing symptoms and suicidality (for a change of 1 SD in symptoms, OR, 1.42; 95% CI, 1.33-1.52; P < .001); however, for children who were receiving ADHD medication, there was no such association (OR, 1.15; 95% CI, 0.97-1.35; P = .10). The association with medication remained even when covarying for multiple confounders, including risk and protective factors for suicidality in ABCD, and was replicated in 1-year longitudinal follow-up. Sensitivity analyses matching participants with high numbers of externalizing symptoms taking and not taking ADHD medication treatment confirmed its association with less suicidality. <br><br>CONCLUSIONS AND RELEVANCE: These findings suggest that ADHD medication treatment is associated with less suicidality in children with substantial externalizing symptoms and may be used to inform childhood suicide prevention strategies.<p />  <p>Language: en</p>
LA  - en
SN  - 2574-3805
UR  - http://dx.doi.org/10.1001/jamanetworkopen.2021.11342
ID  - ref1
ER  -