ADHD has long been associated with higher rates of criminal behavior, but most studies have relied heavily on self-reported data and small, non-representative samples. A new Swedish study addresses these limitations, providing a more comprehensive and reliable picture using data from nationwide registers. It sheds light on the role of ADHD medication in reducing the risk of criminal convictions, offering insights for clinicians, policymakers, and families.
Earlier research, such as a 2019 Danish study, found that ADHD diagnosed in children and adolescents ages 4 to 15 was associated with a 1.6-fold increased risk of future criminal conviction. However, these findings were limited by a smaller sample size and a focus on just one nation’s context. Like Denmark, Sweden’s single-payer universal healthcare system allows for the collection of extensive data on health and crime records, providing an ideal environment for large-scale, population-based research.
To investigate ADHD’s connection to criminal behavior, the Swedish research team analyzed records from a cohort of 1,646,645 individuals born between 1986 and 1997. They excluded those who died or emigrated before age 15 (the age of criminal responsibility in Sweden) and those who immigrated to Sweden, resulting in a final study group of 1,235,939 individuals. Slightly more than half of the cohort was male.
ADHD diagnoses were based on clinical records and prescriptions for approved ADHD medications, while criminal convictions—both violent and nonviolent—were identified using Sweden’s National Crime Register, covering the years 2001 to 2013. The study adjusted for various potential confounding factors, including sex, birth year, parental education, and other psychiatric conditions. They also used the Swedish Multi-Generation Register to control for unmeasured familial factors to compare outcomes among full siblings.
The study found that ADHD is strongly associated with increased rates of criminal convictions. Compared to individuals without ADHD, those with an ADHD diagnosis were roughly:
Interestingly, when comparing conviction rates among males and females with ADHD, the rates of nonviolent convictions were similar, but females with ADHD were about 25% more likely to be convicted of a violent crime than males with ADHD.
The research also highlighted the importance of ADHD medication in reducing criminal behavior. When individuals with ADHD who were taking medication were excluded from the analysis, the data showed significantly higher rates of criminal convictions:
These findings suggest that ADHD medications can significantly reduce the risk of both violent and nonviolent criminal behavior in individuals with ADHD, emphasizing the value of pharmacological treatment for those with the condition.
The researchers concluded that “ADHD is a strong risk factor for both violent and non‐violent criminal convictions in males and females even after adjustments for psychiatric comorbidities and unmeasured familial factors.” The study also found that untreated ADHD poses a particularly high risk for criminal behavior, highlighting the protective role of medication.
These findings are clinically relevant for several reasons. First, they reinforce the importance of ensuring that individuals with ADHD have access to effective treatment options, especially during the transition from adolescence into adulthood, which is statistically a period of higher risk for criminal behavior. Additionally, the study provides critical data for shaping public policy and interventions aimed at supporting individuals with ADHD, with a focus on reducing criminality through proper management of the disorder.
This study offers new insights into the complex relationship between ADHD, medication, and criminal behavior, emphasizing the crucial role of treatment in mitigating risks. It provides a compelling case for prioritizing access to ADHD medication as part of a broader strategy for supporting those with ADHD.
A recent U.S. study challenges assumptions about the link between prescription stimulant use for ADHD and later substance abuse. Adolescents who used prescription stimulants under a physician’s supervision did not exhibit increased rates of non-medical stimulant use or cocaine use as they transitioned into young adulthood. However, other factors, like binge drinking and cannabis use, showed significant associations with later substance misuse, suggesting that the landscape of risk is more complex than previously understood.
Prescription stimulants are considered one of the most effective treatments for ADHD. While these medications can significantly improve focus and behavior, concerns have persisted that using stimulants during adolescence might predispose individuals to substance use disorder (SUD). Some theories suggest that early exposure to stimulants could increase the likelihood of cocaine use, as both substances affect the brain's dopamine pathways similarly.
Yet, previous research often lacked large, longitudinal studies focusing on adolescents with ADHD who had never been treated with stimulants. To fill this gap, a research team followed a nationally representative cohort of 11,905 high school seniors (12th graders, mostly aged 18) for six years, tracking their substance use behaviors.
At the start of the study, participants completed surveys regarding their ADHD treatment history—whether they had used stimulant therapy, non-stimulant therapy, or no medication at all. This formed three groups:
Participants then completed follow-up surveys every two years, reporting on their use of substances like prescription stimulants and cocaine, as well as their engagement in behaviors like binge drinking and cannabis use.
The study found no significant differences in the rates of non-medical stimulant use or cocaine use among the three groups. Adolescents who had been prescribed stimulant medications were not more likely to misuse prescription stimulants or cocaine as young adults than those who had not received such medications.
However, other behaviors at age 18 showed strong associations with later substance use:
The study’s findings have important implications for both clinicians and families managing ADHD. Although ADHD is associated with an increased risk of SUD, the researchers observed no higher risk of nonmedical stimulant use among adolescents who had taken stimulant therapy compared to those who hadn’t. Additionally, there was no evidence that stimulant medications posed a greater risk than non-stimulant medications for subsequent misuse.
The findings also highlight the need for more robust screening for alcohol and other drug use among adolescents. As the study notes, current guidelines do not recommend routine screening for substance misuse in adolescents due to limited evidence. However, given the associations found between binge drinking, cannabis use, and later substance misuse, such preventive measures could play a key role in reducing risks during this vulnerable period of development.
Ultimately, the study sheds light on the multifaceted nature of substance use risks in adolescents and young adults, suggesting that while prescription stimulant use for ADHD under medical supervision may not directly contribute to substance abuse, the broader context of an adolescent’s behaviors and environment is crucial in shaping future outcomes.
Potentially traumatic experiences (PTEs) refer to events where someone is exposed to situations that involve threats to life, serious injury, or danger to themselves or others. These events can include things like accidents, violence, or the death of someone close. PTEs are significant because they can have lasting effects on a person's mental health.
A research team from Norway, working with a collaborator from the U.S., used their country’s universal health care system to study how PTEs affect the mental health of children and adolescents in Hordaland County, which includes the city of Bergen. They wanted to see how experiencing PTEs influenced the likelihood of these young people seeking help from child and adolescent mental health services (CAMHS) or being diagnosed with psychiatric disorders, including ADHD.
In 2012, the study invited all 19,439 teenagers born between 1993 and 1995 in Hordaland County to participate. These teens were 16 to 19 years old at the time. Out of this group, 9,555 teens agreed to let the researchers link their personal data with the National Patient Registry (NPR), which keeps track of health records. There was no significant difference in the types or number of PTEs between those who agreed to this data sharing and those who did not.
After removing participants with incomplete information, the researchers were left with 8,755 teens. These teens’ psychiatric diagnoses, including ADHD, were taken from the NPR. The researchers asked the participants if they had ever experienced specific traumatic events, such as:
If a participant reported experiencing the death of someone close, they were asked to specify who it was (a parent, sibling, grandparent, other family member, close friend, or romantic partner). One limitation of the study was that it did not ask about bullying, which could also be a traumatic experience.
The researchers divided the teens into three trauma groups based on their experiences:
Teens in the situational and interpersonal trauma groups were more likely to see their economic situation as worse than those in the low trauma group. For example, 11% of the situational trauma group and 17% of the interpersonal trauma group considered themselves economically worse off, compared to just 6.1% of the low trauma group. Also, fewer parents of teens in the two higher trauma groups had higher levels of education, which can impact family support and resources.
After adjusting for gender and parental education, the researchers found that:
The effect was even stronger when comparing the interpersonal trauma group to the low trauma group. Teens in the interpersonal trauma group were almost five times more likely to be diagnosed with ADHD than those in the low trauma group.
One limitation of the study is that while the researchers acknowledged that sex and socioeconomic status (SES) are important factors in the relationship between trauma and psychiatric disorders, they did not directly adjust for SES. However, they did indirectly account for it by considering the education levels of the parents, which is closely related to SES.
The study showed that adolescents who experience more interpersonal trauma (like violence or sexual abuse) are at a significantly higher risk of being diagnosed with ADHD. The findings suggest that it’s important to pay special attention to teens who experience both situational and interpersonal traumas, especially those exposed to interpersonal violence. Early intervention and support could be key to helping these adolescents manage their mental health.
Using Statistics New Zealand’s Integrated Data Infrastructure (IDI), a large database of linked de-identified administrative and survey data about people and households, a local study team examined a three-year birth cohort (mid-1992 through mid-1995) totaling 149,076 persons.
Using Statistics New Zealand’s Integrated Data Infrastructure (IDI), a large database of linked de-identified administrative and survey data about people and households, a local study team examined a three-year birth cohort (mid-1992 through mid-1995) totaling 149,076 persons.
The team assessed the presence of ADHD within this cohort through diagnosis codes and inference from medication dispensing, where there was at least one code relating to an ADHD diagnosis in the medication datasets. This subgroup consisted of 3,975 persons.
Next, they related this information to criminal justice system interactions of increasing severity, starting with police proceedings, and continuing with court charges, court convictions, and incarcerations. These interactions were tracked during an eight-year period from participants’ 17th birthday through their 25th birthday.
In this same period the team also tracked types of offenses: against people; against property; against organizations, government, and community; and violent offenses.
In all cases, the study team adjusted for gender, ethnicity, deprivation, and area of residence as potential confounders.
With these adjustments, young adults with ADHD were over twice as likely as their typically developing peers to be proceeded against by police, to be charged with an offense, and to be convicted. They were almost five times as likely to be incarcerated.
With the same adjustments, young adults with ADHD were over twice as likely as their typically developing peers to be convicted of offenses against organizations, government, and community. They were almost three times as likely to be convicted of crimes against persons, and over three and a half times more likely to be convicted of either violent offenses or offenses against property.
The authors noted, “The greater effect size for incarceration observed in our study may be due to the lack of control for comorbid conditions such as CD [conduct disorder], which are known criminogenic risk factors.”
They also noted, “The sharp increase in the risk of incarceration observed may also signal differences in the NZ justice system’s approach to ADHD, which may be less responsive to the condition than other nations, particularly the steps in the justice system between conviction and sentence. This would suggest that the UNCRPD [United Nations Convention on the Rights of Persons with Disabilities] obligations of equal recognition before the law and the elimination of discrimination on the basis of disability are not being met for individuals with ADHD in NZ.”
They concluded, “Our findings revealed that not only were individuals with ADHD overrepresented at all stages of the CJS [criminal justice system] and offense types examined, there was also a pattern of increasing risk for CJS interactions as these individuals moved through the system. These results highlight the importance of early identification and responsivity to ADHD within the CJS and suggest that the NZ justice system may require changes to both of these areas to ensure that young individuals with ADHD receive equitable access to, and treatment within, the CJS.”
A transcontinental study team (California, Texas, Florida) used a nationally representative sample – the 2018 National Survey of Children’s Health – to query 26,205 caregivers of youth aged 3 to 17 years old to explore inequities in ADHD diagnosis.
A transcontinental study team (California, Texas, Florida) used a nationally representative sample – the 2018 National Survey of Children’s Health – to query 26,205 caregivers of youth aged 3 to 17 years old to explore inequities in ADHD diagnosis.
With increasing accessibility of the internet in the U.S., more than 80% of adults now search for health information online. Recognizing that search engine data could help clarify patterns of inequity, the team also consulted Google Trends.
The team noted at the outset that “[d]ocumenting the true prevalence of ADHD remains challenging in light of problems of overdiagnosis (e.g., following quick screening rather than full evaluation incorporating multi-informant and multi-method data given limited resources) and underdiagnosis (e.g., reflecting inequities in healthcare and education systems).” Underdiagnosis is known to be influenced by lack or inadequacy of health insurance, inadequate public health funding, stigma, sociocultural expectations in some ethnic groups, and structural racism, among other factors.
After controlling for poverty status, highest education in household, child’s sex, and child’s age, the team reported that Black youth were a quarter (22%) less likely to receive ADHD diagnoses than their white peers. Latino/Hispanic youth were a third (32%) less likely and Asian youth three-quarters (73%) less likely to receive ADHD diagnoses than their white peers.
The team also found that state-level online search interest in ADHD was positively associated with ADHD diagnoses, after controlling for race/ethnicity, poverty status, highest education in household, child’s sex, and child’s age. However, the odds ratio was low (1.01), “suggesting the need for additional evaluation.” Furthermore, “There was no interaction between individual-level racial/ethnic background and state-level information-seeking patterns. … the state-level online information-seeking variation did not affect the odds that youth of color would have a current ADHD diagnosis over and above other included characteristics.”
That could be due in part to the gap in high-speed broadband access between Black and Hispanic in contrast to white populations, but that would not explain the even larger gaps in diagnosis for Asian youth, who tend to come from more prosperous backgrounds.
The team concluded, “Persistent racial/ethnic inequities warrant systematic changes in policy and clinical care that can attend to the needs of underserved communities. The digital divide adds complexity to persistent racial/ethnic and socioeconomic inequities in ADHD diagnosis …”
Bipolar disorder is a severe mental illness that afflicts over one in fifty persons worldwide. About a quarter of those with bipolar disorder also has alcohol use disorder (AUD). This in turn complicates the treatment of their bipolar disorder. It exacerbates their symptoms, makes them more likely to be suicidal, and increases the risk of hospitalization.
More than one in five persons with bipolar disorder also have ADHD, which is likewise known to be correlated with AUD. To what extent does ADHD contribute to AUD in persons with comorbid bipolar disorder?
A European study team recently conducted a systematic search of the peer-reviewed medical literature to address that question. The team identified eleven studies with a combined total of 2,734 participants that could be aggregated to perform a meta-analysis.
They found that persons with comorbid ADHD and bipolar disorder were two and a half times more likely to be diagnosed with alcohol use disorder than persons with bipolar disorder but no ADHD.
Between-study heterogeneity was negligible, and there was no sign of publication bias.
The authors concluded, "At least a portion of the high rates of AUD in BD may, thereby, be related to comorbid ADHD. Longitudinal studies are needed to clarify the nature of this relationship."
The specific type of gaming disorder (GD) that is the focus of this review is "disordered video-gaming," or more precisely the addictive potential of interactive video games played on mobile phones, gaming consoles, individual computers, and over networks. Certain characteristics of such games, including structured rewards and multi-modal sensory stimulation, contribute to that addictive potential. Networked games also allow for direct social engagement through role playing and cooperation with others. They also lead to further opportunities for participation in a wider community of players on forums outside gameplay, such as discussion platforms, video play-through analyses, or live-streaming.
The authors performed a systematic search of the peer-review literature, and identified 29 studies exploring the relationship between Addend GD.
All studies found a positive association between ADHD and GD. Of studies reporting effect sizes, seven reported small effect sizes, three reported medium ones, and three reported large ones. There was a similarly wide variety of reported effect sizes among studies that reported correlations between ADHD scales and GD scales. These ranged from r = .12 (small) to r = .45(large).
Three studies examined longitudinal outcomes. One reported that lower ADHD scores at baseline predicted positive long-term recovery. Another noted that GD was more likely to develop into significant psychiatric symptoms and poorer educational outcomes two years later. The third study found that higher ADHD and GD scores were associated with higher incidences of delinquent or aggressive behaviors and externalizing problems, as compared to a sample with ADHD but not GD. All three studies reported that ADHD was a risk factor for the development of problematic gaming behavior. There was no clear indication of the reverse relationship - GD predicting ADHD.
The authors concluded, "This review found a consistent positive association between ADHD and GD, particularly for the inattention subscale. The strength of the association between ADHD and GD was variable. On symptom severity ratings, there was a positive relationship between scores measuring GD and ADHD pathology in some studies. Fewer studies in this review showed hyperactivity was commonly associated with GD. It is well known that hyperactivity in ADHD tends to improve significantly with age. It is possible that the natural progression of the disorder resulted in lower rates of hyperactivity. Such a hypothesis is strengthened by findings of a stronger association with hyperactivity among children aged between 4 and 8."
Ideas for policy interventions to address disordered video gaming include:
· Parental controls on games.
· Warning messages similar to those on cigarette packaging.
· Organizing help services for gamers.
The authors called for further study on:
· Effectiveness of intervention strategies.
· The contribution of GD to the dysfunction associated with ADHD.
· The relationship between the content of play (e.g., violence) and motivation to play (e.g., escapism) and ADHD symptoms.
role-playin· The role of depression, anxiety, and another comorbidity in mediating the relationship between ADHD and GD
"Clinicians should beware that ADHD is common in GD," the authors emphasized, "and we, therefore, recommend that ADHD is screened for when evaluating GD as part of routine practice. This would ensure interventions aimed at ADHD can be successfully combined with GD treatment, potentially improving patient outcomes."
Drivers with ADHD are far more likely to be involved in crashes, to be at fault in crashes, to be in severe crashes, and to be killed in crashes. The more severe the ADHD symptoms, the higher the risk. Moreover, ADHD is often accompanied by comorbid conditions such as oppositional-defiant disorder, depression, and anxiety that further increase the risk.
What can be done to reduce this risk? A group of experts has offered the following consensus recommendations:
· Use stimulant medications. While there is no reliable evidence on whether-stimulant medications are of any benefit for driving, there is solid evidence that stimulant medications are effective in reducing risk. But there is also a “rebound effect” in many individuals after the medication wears off, in which performance becomes worse than it had been before medication. It is therefore important to time the taking of medication so that its period of effectiveness corresponds with driving times. If one has to drive right after waking up, it makes sense to take a rapid-acting form. The same holds for late-night driving that may require a quick boost.
· Use a stick shift vehicle wherever possible. Stick shifts make drivers pay closer attention than automatic transmissions. The benefits of alertness are most notable in city traffic. But using a stick shift is far less beneficial in highway driving, where shifting is less frequent.
· Avoid cruise control. Highways can be monotonous, making drivers more prone to boredom and distraction. That is even more true for those with ADHD, so it is best to keep cruise control turned off.
· Avoid alcohol. Drinking and driving is a bad idea for everyone, but, once again, it’s even worse for those with ADHD. Parents should consider the no-questions-asked policy of either picking up their teenager anytime and anywhere or setting up an account with a ride-sharing service.
· Place the smartphone out of reach and hearing. Cell phone use is as about as likely to impair as alcohol. Hands-free devices only reduce this risk moderately, because they continue to distract. Texting can be deadly. Sending a short text or emoticon can be the equivalent of driving 100 yards with one’s eyes closed. Either turn on Do Not Disturb mode or, for even greater effectiveness, place the smartphone in the trunk.
· Make use of automotive performance monitors. These can keep track of maximum speeds and sudden acceleration and braking, to verify that a teenager is not engaging in risky behaviors.
· Take advantage of “graduated driver’s licensing laws” wherever available. These laws forbid the presence of peers in the vehicle for the first several (for example, six) months of driving. Parents can extend that period for teenagers with ADHD, or set it as a condition in states that lack such laws.
· Encourage practicing after obtaining a learner’s permit. Teenagers with ADHD generally require more practice than those without. A “pre-drive checklist” can be a good place to start. For example: check the gas, check the mirrors, make sure the view through the windows is unobstructed, put your cell phone in Do not disturb mode and place it out of reach, put on a seatbelt, and scan for obstacles.
· Consider outsourcing. Look for a driving school with a professional to teach good driving skills and habits.
Experts do not agree on whether to delay licensing for those with ADHD. On the one hand, teenagers with ADHD are 3-4 years behind in the development of brain areas responsible for executive functions that help control impulses and better guide behavior. Delaying licensing can reduce risk by about 20 percent. On the other hand, teens with ADHD are more likely to drive without a license, and no one wants to encourage that, however inadvertently. Moreover, graduated driver’s licensing laws only have a legal effect on teens who get their licenses at the customary age.
Drivers with ADHD are far more likely to be involved in crashes, to be at fault in crashes,to be in severe crashes, and to be killed in crashes. The more severe the ADHD symptoms, the higher the risk. Moreover, ADHD is often accompanied by comorbid conditions such as oppositional-defiant disorder, depression, and anxiety that further increase the risk.
What can be done to reduce this risk? A group of experts has offered the following consensus recommendations:
· Use stimulant medications. While there is no reliable evidence on whether non-stimulant medications are of any benefit for driving, there is solid evidence that stimulant medications are effective in reducing risk. But there is also a rebound effect in many individuals after the medication wears off, in which performance actually becomes worse than if had been prior to medication. It is therefore important to time the taking of medication so that its period of effectiveness corresponds with driving times. If one has to drive right after waking up, it makes sense to take a rapid acting form. The same holds for late night driving that may require a quick boost.
· Use a stick shift vehicle wherever possible. Stick shifts make drivers pay closer attention than automatic transmissions. The benefits in alertness are most notable in city traffic. But using a stick shift is far less beneficial in highway driving, where shifting is less frequent.
· Avoid cruise control. Highways can be monotonous, making drivers more prone to boredom and distraction. That is even more true for those with ADHD, so it is best to keep cruise control turned off.
· Avoid alcohol. Drinking and driving is a bad idea for everyone, but, once again, it's even worse for those with ADHD. Parents should consider a no-questions-asked policy of either picking up their teenager anytime and anywhere, or setting up an account with a ride-sharing service.· Place the smartphone out of reach and hearing. Cell phone use is as about as likely to impair as alcohol. Hands-free devices only reduce this risk moderately, because they continue to distract. Texting can be deadly. Sending a short text or emoticon can be the equivalent of driving 100 yards with one's eyes closed. Either turn on Do Not Disturb mode, or, for even greater effectiveness, place the smart phone in the trunk.
· Make use of automotive performance monitors. These can keep track of maximum speeds and sudden acceleration and braking, to verify that a teenager is not engaging in risky behaviors.
· Take advantage of graduated driver's licensing laws wherever available. These laws forbid the presence of peers in the vehicle for the first several (for example, six) months of driving. Parents can extend that period for teenagers with ADHD, or set it as a condition in states that lack such laws.
· Encourage practicing after obtaining a learner's permit. Teenagers with ADHD generally require more practice than those without. A pre-drive checklist can be a good place to start. For example:check the gas, check the mirrors, make sure the view through the windows is unobstructed, put cell phone in Do Not Disturb mode and place it out of reach, put on seat belt, scan for obstacles.
· Consider outsourcing. Look for a driving school with a professional to teach good driving skills and habits.
Experts do not agree on whether to delay licensing for those with ADHD. On the one hand, teenagers with ADHD are 3-4 years behind in the development of brain areas responsible for executive functions that help control impulses and better guide behavior. Delaying licensing can reduce risk by about 20 percent. On the other hand, teens with ADHD are more likely to drive without a license, and no one wants to encourage that, however inadvertently. Moreover, graduated driver's licensing laws only have legal effect on teens who get their licenses at the customary age.
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