BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is often associated with other neurodevelopmental disorders (NDs) and with risky behaviors and adverse health outcomes, including injuries. Treatment with ADHD medication has been associated with reduced risk of injuries. However, it is unknown whether the association is present in individuals with co-occurring NDs. The aim of the present study was to estimate the association between ADHD medication use and unintentional injuries in Sweden in children and adolescents with ADHD, including those with co-occurring NDs. METHODS Using a linkage of several national registers via the unique personal identification number, we identified individuals with a diagnosis of ADHD and of other NDs, including autism spectrum disorder, intellectual disability, communication disorders, learning disorders and motor disorders. The primary outcome was unintentional injuries. Secondary outcome was traumatic brain injury (TBI). Individuals were followed from January 1st 2006 or their 5th birthday or the date of the first unintentional injury, whichever came last, to December 31st 2013 or their 18th birthday or death, whichever came first. We compared the rate of injuries during periods on-treatment with the rate of injuries during periods off-treatment within the same individual using stratified Cox regression to calculate hazard ratio (HR) with 95% confidence intervals (CIs). RESULTS For children and adolescents with ADHD (N = 9,421) the rate of any unintentional injuries (HR = 0.85; 95% CI = 0.78-0.92) and TBIs (HR = 0.27; 95% CIs = 0.20-0.38) during medicated periods was lower than during non-medicated periods. Similar results were found among individuals with co-occurring NDs (N = 2,986), for unintentional injuries (HR = 0.88; 95% CI = 0.77-1.01) and for TBIs (HR = 0.27; 95% CI = 0.16-0.44). CONCLUSIONS Beneficial effects of ADHD medication may extend beyond reduction of ADHD core symptoms to prevention of unintentional injuries in children and adolescents, including individuals with co-occurring NDs.

中文翻译：

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患有并发神经发育障碍的儿童和青少年对注意力不足/多动障碍和意外伤害风险的药物使用。

背景技术注意缺陷多动障碍（ADHD）通常与其他神经发育障碍（NDs）以及危险行为和不良健康后果（包括伤害）相关。用多动症药物治疗可以降低受伤风险。但是，尚不知道在同时存在ND的个体中是否存在这种关联。本研究的目的是评估多动症药物的使用与瑞典多动症儿童和青少年（包括并发ND的青少年）的意外伤害之间的关联。方法通过使用多个国家注册簿通过唯一的个人识别码建立的链接，我们确定了患有ADHD和其他ND诊断的个人，包括自闭症谱系障碍，智力障碍，沟通障碍，学习障碍和运动障碍。主要结果是意外伤害。次要结果是脑外伤（TBI）。从2006年1月1日或他们的5岁生日或第一次非故意伤害的日期（以较早者为准）开始追踪患者，直到2013年12月31日或他们的18岁生日或死亡（以先到者为准）。我们使用分层Cox回归比较同一个体内治疗期间的伤害发生率和非治疗期间的伤害发生率，以95％的置信区间（CI）计算危险比（HR）。结果在药物治疗期间，患有ADHD（N = 9,421）的儿童和青少年的任何意外伤害（HR = 0.85; 95％CI = 0.78-0.92）和TBI（HR = 0.27; 95％CIs = 0.20-0.38）的发生率分别为低于非药物治疗期间。在并发NDs（N = 2,986），意外伤害（HR = 0.88; 95％CI = 0.77-1.01）和TBI（HR = 0.27; 95％CI = 0.16-0.44）的个体中发现相似的结果。结论ADHD药物的有益作用可能不仅限于减轻ADHD核心症状，还可以预防儿童和青少年（包括并发ND的个体）的意外伤害。