Meta-analysis Reports ADHD More Than Triples Odds of Suicidal Behavior in Youth

According to the World Health Organization, suicide is the second leading cause of death among individuals aged 15 to 29 years. 

A European study team recently released findings of the first meta-analysis to explore the association between clinically diagnosed ADHD in children and adolescents and subsequent suicidality.  

The criteria for study inclusion were: 

  • Most participants had to be under 18 at baseline. 
  • Longitudinal design, meaning that participants were followed over time. 
  • Having an ADHD sample diagnosed in childhood that was followed up for suicidal behavior. 
  • Having a control group without ADHD that was followed up for suicidal behavior. 
  • That ADHD was clinically diagnosed based on DSM-5 criteria. 
  • The total number of participants and of those with suicidal behavior in both the ADHD group and the control group during follow-up were reported. 

All selected studies scored at least eight out of 11 points after quality assessment. The most frequent defect was that it was unclear whether suicidal behavior had occurred before study initiation. 

Meta-analysis of all nine included studies, encompassing more than 4.4 million participants, reported more than threefold greater odds of overall suicidal behavior among children and adolescents previously diagnosed with ADHD, as opposed to children and adolescents not previously diagnosed with ADHD. Study outcomes varied significantly (high heterogeneity) but showed no publication bias. 

Breaking this down into subcategories of risk: 

  • Two studies combining 521 participants reported roughly fourfold greater odds of suicidal ideation among those previously diagnosed with ADHD, with negligible heterogeneity. 
  • Six studies encompassing a total of more than 87,000 children and adolescents reported more than threefold greater odds of suicide attempt among those previously diagnosed with ADHD, with high heterogeneity. 
  • Two studies combining more than 2.6 million participants reported a near-quadrupling of the odds of suicide death among those previously diagnosed with ADHD, with negligible heterogeneity. 

The team concluded, “the current systematic review and meta-analysis has confirmed previous findings that there is an elevated risk for suicidal behavior in ADHD patients.” They also note, however, that “this relationship is heterogeneous and complex, with significant differences across ADHD subtypes, age groups, sexes, comorbidities, and social issues, all of which play important roles in the development of suicidal behavior.”

Peter Garas, Zsofia K. Takacs, and Judit Balázs, “Longitudinal Suicide Risk in Children and Adolescents With Attention Deficit and Hyperactivity Disorder: A Systematic Review and Meta-Analysis,” Brain and Behavior (2025), 15: e70618, https://doi.org/10.1002/brb3.70618.

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ADHD and the Risk for Suicide

ADHD and the Risk for Suicide

Suicide is one of the most feared outcomes of any psychiatric condition. Although its association with depression is well known, a small but growing research literature shows that ADHD is also a risk factor for suicidality.  Suicide is difficult to study. Because it is relatively rare, large samples of patients are needed to make definitive statements.
Studies of suicide and ADHD must also consider the possibility that medications might elevate that risk. For example, the FDA placed a black box warning on atomoxetine because that ADHD medication had been shown to increase suicidal risk in youth.  A recent study of 37,936 patients with ADHD now provides much insight into these issues (Chen, Q., Sjolander, A., Runeson, B., D'Onofrio, B. M., Lichtenstein, P. & Larsson, H. (2014). Drug treatment for attention-deficit/hyperactivity disorder and suicidal behavior: a register-based study. BMJ 348, g3769.). In Sweden, such large studies are possible because researchers have computerized medical registers that describe the disorders and treatments of all people in Sweden. Among 37,936 patients with ADHD, 7019 suicide attempts or completed suicides occurred during 150,721 person-years of follow-up. This indicates that, in any given year, the risk for a suicidal event is about 5%. For ADHD patients, the risk for a suicide event is about 30% greater than for non-ADHD patients. Among the ADHD patients who attempted or completed suicide, the risk was increased for those who had also been diagnosed with a mood disorder, conduct disorder, substance abuse, or borderline personality. This is not surprising; the most serious and complicated cases of ADHD are those that have the greatest risk for suicidal events. The effects of the medication were less clear.  The risk for suicide events was greater for ADHD patients who had been treated with non-stimulant medication compared with those who had not been treated with non-stimulant medication. A similar comparison showed no effect of stimulant medications. This first analysis suffers from the fact that the probability of receiving medication increases with the severity of the disorder. To address this problem, the researchers limited the analyses to ADHD patients who had some medication treatment and then compared suicidal risk between periods of medication treatment and periods of no medication treatment. This analysis found no increased risk for suicide from non-stimulant medications and, more importantly, found that for patients treated with stimulants, the risk for suicide was lower when they were taking stimulant medications. This protective effect of stimulant medication provides further evidence of the long-term effects of stimulant medications, which have also been shown to lower the risks for traffic accidents, criminality, smoking, and other substance use disorders.

March 28, 2021

Swedish nationwide population study finds mothers with ADHD have elevated risk of depression and anxiety disorders after childbirth

Swedish nationwide population study finds mothers with ADHD have elevated risk of depression and anxiety disorders after childbirth

In the general population, most mothers experience mood disturbances right after childbirth, commonly known as postpartum blues, baby blues, or maternity blues. Yet only about one in six develop symptoms with a duration and magnitude that require treatment for depressive disorder, and one in ten for anxiety disorder.

To what extent does ADHD contribute to the risk of such disorders following childbirth? A Swedish study team used the country’s single-payer health insurance database and other national registers to conduct the first nationwide population study to explore this question.

They used the medical birth register to identify all 420,513 women above 15 years of age who gave birth to their first child, and all 352,534 who gave birth to their second child, between 2005 and 2013. They excluded miscarriages. They then looked for diagnoses of depression and/or anxiety disorders up to a year following childbirth.

In the study population, 3,515 mothers had been diagnosed with ADHD, and the other 769,532 had no such diagnosis. 

Following childbirth, depression disorders were five times more prevalent among mothers with ADHD than among their non-ADHD peers. Excluding individuals with a prior history of depression made little difference, lowering the prevalence ratio to just under 5. Among women under 25, the prevalence ratio was still above 3, while for those 25 and older it was above 6.

Similarly, anxiety disorders were over five times more prevalent among mothers with ADHD than among their non-ADHD peers. Once again, excluding individuals with a prior history of depression made little difference, lowering the prevalence ratio to just under 5. Among women under 25, the prevalence ratio was still above 3, while for those 25 and older it was above 6.

The team cautioned, “There is a potential risk of surveillance bias as women diagnosed with ADHD are more likely to have repeated visits to psychiatric care and might have an enhanced likelihood of also being diagnosed with depression and anxiety disorders postpartum, compared to women without ADHD.”

Nevertheless, they concluded, “ADHD is an important risk factor for both depression and anxiety disorders in the postpartum period and should be considered in the post- pregnancy maternal care, regardless of sociodemographic factors and the presence of other psychiatric disorders. Parental education prior to conception, psychological surveillance during, and social support after childbirth should be provided to women diagnosed with ADHD.”

December 22, 2023

Nationwide population study in Denmark finds children and adolescents with ADHD more than twice as likely to suffer criminal violence

Denmark Population Study Finds Children and Adolescents with ADHD More than Likely to Suffer Criminal Violence

Children with disabilities are known to be at heightened risk of violence compared to their non-disabled peers. To what extent does this hold true for ADHD?

Denmark has a single-payer health insurance system through which health data about virtually the entire population can be cross-referenced with population, crime, welfare, and other registers through unique individual person numbers.

A Danish study team accessed national registers to examine the relationship between ADHD and criminal victimhood among nine yearly birth cohorts totaling more than 570,000 children and adolescents. 

Of these, 557,521, among them 12,040 with ADHD, were not reported as being exposed to violence, and 12,830, among which 1,179 with ADHD, were exposed to violence.

From the raw data, children and adolescents with ADHD were more than four times as likely to be exposed to violence than their typically developing peers.

The team then adjusted for other disabilities, family risk factors, gender, birth year, and ethnic background.

With these confounders out of the way, children and adolescents with ADHD remained more than twice as likely to be exposed to violence than their typically developing peers.

To place this outcome in further perspective:

  • Brain injuries increased the odds of being exposed to violence by over 75% relative to typically developing peers.
  • Physical and speech disabilities raised the odds by a bit over 35%.
  • Intellectual and sensory disabilities, dyslexia, and congenital malformations had no effect. 
  • Epilepsy reduced the odds of being exposed to violence by just under 20%, and autistic spectrum disorder by just over 25%.

Certain family risk factors further aggravated the odds:

  • Violence in the family by more than 2.5-fold.
  • Out-of-home care and breakup of parental relationship by more than 75%.

Perhaps surprisingly, substance abuse by family members had no effect whatsoever after adjusting for confounders.

January 24, 2024

Meta-analysis Reports ADHD More Than Triples Odds of Suicidal Behavior in Youth

According to the World Health Organization, suicide is the second leading cause of death among individuals aged 15 to 29 years. 

A European study team recently released findings of the first meta-analysis to explore the association between clinically diagnosed ADHD in children and adolescents and subsequent suicidality.  

The criteria for study inclusion were: 

  • Most participants had to be under 18 at baseline. 
  • Longitudinal design, meaning that participants were followed over time. 
  • Having an ADHD sample diagnosed in childhood that was followed up for suicidal behavior. 
  • Having a control group without ADHD that was followed up for suicidal behavior. 
  • That ADHD was clinically diagnosed based on DSM-5 criteria. 
  • The total number of participants and of those with suicidal behavior in both the ADHD group and the control group during follow-up were reported. 

All selected studies scored at least eight out of 11 points after quality assessment. The most frequent defect was that it was unclear whether suicidal behavior had occurred before study initiation. 

Meta-analysis of all nine included studies, encompassing more than 4.4 million participants, reported more than threefold greater odds of overall suicidal behavior among children and adolescents previously diagnosed with ADHD, as opposed to children and adolescents not previously diagnosed with ADHD. Study outcomes varied significantly (high heterogeneity) but showed no publication bias. 

Breaking this down into subcategories of risk: 

  • Two studies combining 521 participants reported roughly fourfold greater odds of suicidal ideation among those previously diagnosed with ADHD, with negligible heterogeneity. 
  • Six studies encompassing a total of more than 87,000 children and adolescents reported more than threefold greater odds of suicide attempt among those previously diagnosed with ADHD, with high heterogeneity. 
  • Two studies combining more than 2.6 million participants reported a near-quadrupling of the odds of suicide death among those previously diagnosed with ADHD, with negligible heterogeneity. 

The team concluded, “the current systematic review and meta-analysis has confirmed previous findings that there is an elevated risk for suicidal behavior in ADHD patients.” They also note, however, that “this relationship is heterogeneous and complex, with significant differences across ADHD subtypes, age groups, sexes, comorbidities, and social issues, all of which play important roles in the development of suicidal behavior.”

New Non-Stimulant ADHD Drug: Clinical Trial Results

The Newest Non-stimulant Medication for ADHD

Centanafadine, which is currently under investigation as a treatment for ADHD, will be the first triple reuptake inhibitor for the disorder if it is approved by the FDA. It improves norepinephrine, dopamine and serotonin levels. This new medication is not a stimulant, but due to the dopamine component, it has a stimulant-like effect in patients. In adults, two phase 3 trials and a year-long extension have shown sustained benefits and a tolerable safety profile, laying the groundwork for pediatric research.

Based on this study, improvement was already noticeable after the first week and held steady through week 6. The lower dose (164.4 mg) didn’t separate from placebo, reminding us that getting the dose right will be critical. The effect size was smaller than what is seen for stimulants but 50% of patients had excellent outcomes as indicated by reductions in the ADHD-RS of 50% or more.

Side effect patterns look familiar to anyone who prescribes ADHD medications; loss of appetite, nausea and headaches topped the list. About half of teens on the higher dose reported at least one treatment-emergent adverse event, compared with a quarter of those on placebo. Severe reactions were rare but did include isolated liver enzyme spikes, rash, and a few reports of aggression or somnolence. For everyday practice, that translates to routine growth checks, a look at baseline liver function, and clear guidance to families about reporting rashes or mood changes promptly.

The researchers noted that the study had certain limitations, including limited generalizability to adolescents beyond North America, the exclusion of teacher ratings on the ADHD-RS-5 scale and the study’s short duration. They added that future studies should explore long-term treatment outcomes and efficacy compared with other ADHD treatments, as well as its effect on treating ADHD with comorbid conditions.

Why should this matter to clinicians already juggling multiple non-stimulant options for ADHD?

First, speed. Centanafadine separated from placebo within a week. In this regard, it might be closer to stimulants than to the multi-week ramp-up we expect from current non-stimulants. Second, it offers another option when stimulants are contraindicated or poorly tolerated, or when they raise diversion concerns. Its mechanism also makes it intriguing for patients who need both norepinephrine and dopamine coverage but prefer to avoid schedule II drugs. Because it also improves serotonergic transmission, it may be useful for some of ADHD’s comorbidities (see our new article for evidence about serotonin’s role in these disorders).

Keep in mind that centanafadine for ADHD is still investigational, so participation in clinical trials remains the only access route.

August 5, 2025

“Do I Have ADHD?”: Diagnosis of ADHD in Adulthood and Its Mimics in the Neurology Clinic

A recent in-depth clinical review published by the American Academy of Neurology examines how ADHD manifests in adulthood and how neurologists can differentiate it from other causes of attention problems. 

Recognition of ADHD in adults by clinicians is often delayed or misdiagnosed due to overlapping symptoms with anxiety, depression, sleep disorders, and life stressors. Conversely, as ADHD in adults becomes more widely acknowledged, largely due to increased public awareness and social media trends, clinicians need to take extra care not to incorrectly diagnose patients with ADHD. This publication aims to shine a light on both sides of this issue and highlight the importance of clinicians being trained in proper ADHD screening. 

ADHD Symptom Overlaps and Differential Diagnosis 

The article highlights how many adults come to neurology clinics convinced they have ADHD after online quizzes or watching others get diagnosed. True ADHD must be differentiated from issues with shared signs and symptoms such as poor sleep, anxiety, depression, or even OCD or Bipolar Disorder. This is a high-level clinical skill called differential diagnosis.

  • Sleep Issues- This is one of the most common causes of attention and focus problems that resemble ADHD in adults. Chronic sleep deprivation can lead to issues like distractibility, forgetfulness, and emotional instability, which may be mistaken for ADHD symptoms, especially if people don’t realize how long-term sleep loss has affected them. Clinicians are encouraged to ask about sleep habits and use tools like the Epworth Sleepiness Scale.

  • Anxiety Disorders- Anxiety is common in adults with ADHD, but a patient with anxiety who does not have ADHD may present with signs and symptoms that overlap with ADHD. A key difference between anxiety and ADHD is that people with ADHD often get distracted even when relaxed or doing something enjoyable without realizing it. Those with anxiety usually feel tense, guilty, and very aware of their distraction.

  • Depression- Depression can cause trouble with focus, energy, and motivation, again, often overlapping with or mimicking symptoms of ADHD. Since both conditions are common, they can also occur together, making it important to look at when symptoms started. If attention problems were present before any depressive episodes, it may point to ADHD, but in unclear cases, treating depression first and then reassessing can help clarify the diagnosis.

  • OCD- Some people with ADHD experience distressing, repetitive thoughts that feel like OCD, even if they haven’t been diagnosed with it. These thoughts can cause anxiety or sadness, even when the person knows they’re unlikely or irrational, but unlike OCD, there are no compulsive behaviors. In some cases, ADHD medication helps reduce these thoughts by improving focus and emotional regulation.

  • Autism- Adults with ASD are more likely to also have ADHD, and in some cases, ADHD symptoms, such as missing social cues or acting impulsively, can be mistaken for autism. This overlap can sometimes make diagnosis more complicated.

The author of the article, Dr. Mierau, provides detailed clinical strategies such as asking open-ended questions, exploring how symptoms show up at home and at work, and watching for patterns like chronic lateness or emotional overeating. (This paper points out that, while not included in the DSM-VI, food cravings and binge behaviors are commonly found in patients with ADHD.)

This review correctly emphasizes that neuropsychological testing is not necessary for diagnosis. Instead, a thorough clinical interview, including a detailed family history and behavioral observation, can be more telling. 

Conclusion: Real Barriers to Proper ADHD Diagnosis

The review article closes with a call to action: the biggest obstacle isn’t diagnosing or treating ADHD, it’s access. Adults struggle with pharmacy shortages, no-refill laws, and insurance hurdles, despite research showing treatment reduces mortality and improves life quality. Dr. Mierau argues for more trained providers, better public education, and policy changes to reduce stigma and expand access.

July 31, 2025