Medication for attention deficit-hyperactivity disorder and criminality

Abstract

Background: Attention deficit-hyperactivity disorder (ADHD) is a common disorder that has been associated with criminal behavior in some studies. Pharmacologic treatment is available for ADHD and may reduce the risk of criminality.

Methods: Using Swedish national registers, we gathered information on 25,656 patients with a diagnosis of ADHD, their pharmacologic treatment, and subsequent criminal convictions in Sweden from 2006 through 2009. We used stratified Cox regression analyses to compare the rate of criminality while the patients were receiving ADHD medication, as compared with the rate for the same patients while not receiving medication.

Results: As compared with nonmedication periods, among patients receiving ADHD medication, there was a significant reduction of 32% in the criminality rate for men (adjusted hazard ratio, 0.68; 95% confidence interval [CI], 0.63 to 0.73) and 41% for women (hazard ratio, 0.59; 95% CI, 0.50 to 0.70). The rate reduction remained between 17% and 46% in sensitivity analyses among men, with factors that included different types of drugs (e.g., stimulant vs. nonstimulant) and outcomes (e.g., type of crime).

Conclusions: Among patients with ADHD, rates of criminality were lower during periods when they were receiving ADHD medication. These findings raise the possibility that the use of medication reduces the risk of criminality among patients with ADHD. (Funded by the Swedish Research Council and others.).

Figure 1

Extended Kaplan-Meier curves for patients in the Swedish Patient Register diagnosed with ADHD and born 1990 or earlier, by sex and medication status. Footnote: Blue lines are for men and red lines for women. Solid lines are for medication and dashed lines are for no medication. The 16,087 men contributed to 56,227 periods and 23,693 convictions (on average 3.5 periods of medication/non-medication and 1.5 convictions). The 9,599 women contributed to 23,533 periods and 4,112 convictions (on average 2.5 periods of medication/non-medication and 0.4 convictions).