Can Medication Curb Suicidal Thoughts in Kids With ADHD?

Medications used to treat attention-deficit/hyperactivity disorder (ADHD) were associated with less suicidality among kids with externalizing symptoms of the condition, a longitudinal cohort study found.

Use of ADHD medication was associated with less suicidal behavior in kids ages 9 to 11 with more severe externalizing symptoms, like hyperactivity, oppositional defiance, and other conduct disorder symptoms (significant symptom-by-medication interaction B = −0.250, SE = 0.086, P = 0.004), reported Ran Barzilay, MD, PhD, of Children’s Hospital of Philadelphia, and colleagues.

Not only that, but there was a significant association between externalizing symptoms and rates of suicidality among children who did not take ADHD medication (for a change of 1 SD in symptoms, OR 1.42, 95% CI 1.33-1.52, P <0.001), the authors wrote in JAMA Network Open.

However, there was no significant association between externalizing symptoms and rates of suicidality among children taking this medication for their symptoms (OR 1.15, 95% CI 0.97-1.35, P = 0.10), they added.

In an analysis of Adolescent Brain Cognitive Development (ABCD) study data, researchers performed 1-year follow-up analyses to measure how treatment with ADHD medication impacted the association between kids’ externalizing symptoms at baseline with reports of suicidality.

Participants were a mean age of about 10, and 52.2% were boys. About three-quarters of children were white. ADHD medications included methylphenidate (Ritalin) and amphetamine derivatives, α-2-agonists, and atomoxetine (Strattera).

At baseline, 11,878 children were included. Of these, 1,060 were treated with ADHD medications, and 1,040 reported either past or current suicidal thoughts or feelings. There were more boys than girls who reported suicidal behavior (58.0% and 42.0%, respectively), but no variation was found in reports of suicidality among kids from different racial/ethnic backgrounds.

Adjusted analyses found both ADHD medication (OR 1.32, 95% CI 1.06-1.64, P=0.01) and externalizing symptoms (OR 1.34, 95% CI 1.26-1.42, P<0.001) were associated with suicidality.

In keeping with the previous trend, the study found that at the 1-year mark, children with high externalizing symptoms who received ADHD medications at baseline were less likely to report suicidal behavior (significant symptom-by-medication interaction B = −0.34, SE = 0.18, 1-tailed test P = 0.03).

And for kids who did not receive medication at baseline, the authors found an association between higher externalizing symptoms and greater odds of reporting suicidal feelings (OR 1.33, 95% CI 1.14-1.55, P <0.001). These links were observed similarly across both boys and girls, the investigators said.

“Our findings address a knowledge gap on childhood suicidality that is critical,” Barzilay and colleagues wrote, explaining that instances of childhood suicidality have increased rapidly over the last decade. “The results offer a straightforward, actionable target to optimize prevention plans and intervention strategies in elementary school-age children with externalizing problems.”

A significant limitation to the study, they said, was that it was not possible to account for the number of higher-risk children who may have received other forms of mental health treatment and interventions, which may have affected the results.

Future analyses of the ABCD study data should be performed to better understand suicidality over the course of adolescence, when rates of suicidal ideation become even higher, the investigators suggested.