January 15, 2024

Nationwide population studies: atomoxetine not associated with birth defects

Treatment for ADHD among women of reproductive age is increasingly common. 

That means we need to know whether ADHD medications have any tendency to increase the risk of birth defects. Previous studies have looked mostly at ADHD medications that are central nervous system stimulants, especially methylphenidate and amphetamines.

Atomoxetine is the most widely prescribed non-stimulant for treating ADHD. It acts indirectly, by selectively inhibiting the removal of norepinephrine, a neurotransmitter that mobilizes the brain and body for action. 

To explore whether atomoxetine might be associated with any higher risk of birth defects, an international study team examined nationwide population data from four Nordic countries with universal single-payer health insurance systems – Denmark, Norway, Sweden, and Iceland – along with nationwide data from the U.S. Medicaid system, which is likewise single-payer, and covers roughly half of all births in the U.S.

They compared the prevalence of major birth defects among infants born to women exposed to atomoxetine in the first trimester (three months) of pregnancy to the prevalence among infants born to women not exposed to any ADHD drug during the period beginning three months before their last menstrual period and concluding at the end of the first trimester.

The team adjusted for maternal characteristics such as maternal age, calendar year of delivery, childbirth and medical characteristics, psychiatric conditions, high blood pressure, diabetes, kidney disease, obesity, and smoking.

In more than 2.4 million births in the four Nordic countries, and almost 1.8 million births in the U.S., there was absolutely no sign of increased prevalence of major infant malformations among infants born to mothers taking atomoxetine. 

More specifically looking at heart defects, there was again no significant association with maternal atomoxetine use, either in the Nordic population, the U.S. population, or the combined populations.

For limb malformations, there was again no significant association between maternal atomoxetine use and birth defects in the combined populations. There was an appearance of a significant association in the Nordic population, but that was based on only 5 instances, and because there were zero instances in the U.S. population, there was no net association at all in the combined population of more than 4.2 million.

The team concluded, “We found no increased prevalence of major congenital malformations overall associated with atomoxetine use in early pregnancy. The increased prevalence of limb malformations in the Nordic countries was not observed in the US. … Given the low absolute risk of both of these outcomes, these results are reassuring from a public health perspective and provide important information in the consideration of whether to continue treatment with atomoxetine during pregnancy.”

Gabriella Bröms, Sonia Hernandez-Diaz, Krista F. Huybrechts, Brian T. Bateman, Eskild Bendix Kristiansen, Kristjana Einarsdóttir, Anders Engeland, Kari Furu, Mika Gissler, Pär Karlsson, Kari Klungsøyr, Anna-Maria Lahesmaa-Korpinen, Helen Mogun, Mette Nørgaard, Johan Reutfors, Henrik Toft Sørensen, Helga Zoega, MA, and Helle Kieler, “Atomoxetine in Early Pregnancy and the Prevalence of Major Congenital Malformations: A Multinational Study,” Journal of Clinical Psychiatry (2023) 84(1): 22m14430, https://doi.org/10.4088/JCP.22m14430.

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Undiagnosed ADHD May Be Undermining Diabetes Control in Adults with Type 1 Diabetes

Our recent study, published in the Journal of Clinical Medicine, aims to shed light on an under-recognized challenge faced by many adults with Type 1 diabetes (T1D): attention-deficit/hyperactivity disorder (ADHD) symptoms.

We surveyed over 2,000 adults with T1D using the Adult Self-Report Scale (ASRS) for ADHD and analyzed their medical records. Of those who responded, nearly one-third met the criteria for ADHD symptoms—far higher than the general population average. Notably, only about 15% had a formal diagnosis or were receiving treatment.

The findings are striking: individuals with higher ADHD symptom scores had significantly worse blood sugar control, as indicated by higher HbA1c levels. Those flagged as "ASRS positive" were more than twice as likely to have poor glycemic control (HbA1c ≥ 8.0%). They also reported higher levels of depressive symptoms.

As expected, ADHD symptoms decreased with age but remained more common than in the general public. No strong links were found between ADHD symptoms and other cardiometabolic issues.

This study highlights a previously overlooked yet highly significant factor in diabetes management. ADHD-related difficulties—such as forgetfulness, inattention, or impulsivity—can make managing a complex condition like T1D more difficult. The researchers call for more screening and awareness of ADHD in adults with diabetes, which could lead to better mental health and improved blood sugar outcomes.

Takeaway: If you or a loved one with T1D struggles with focus, organization, or consistent self-care, it may be worth exploring whether ADHD could be part of the picture. Early identification and support are crucial to managing this common comorbidity. 

July 10, 2025

Norwegian Population Study Finds ADHD Associated with Much Higher Odds of Contact with Child Welfare Services

Background:

This nationwide population study by a Norwegian team aimed to evaluate the relationship between ADHD and various types of child welfare services contacts over a long-term period of up to 18 years among children and adolescents aged 5 to 18 years diagnosed with ADHD, in comparison to the general population within the same age group. 

Norway has a single-payer national health insurance system that fully covers virtually the entirety of its population. In combination with a system of national population and health registers, this facilitates nationwide population studies, overcoming the limitations of relying on population sampling. 

Study:

The study population included all 8,051 children and adolescents aged 5 to 18 who were diagnosed with ADHD for the first time in the Norwegian Patient Registry between 2009 and 2011. 

The study also included a comparison sample of 75,184 children and adolescents aged 5–18 with no child welfare services contact during 2009–2011. 

The interventions delivered by child welfare services in Norway are largely divided into two primary categories: supportive intervention and out-of-home placement. 

Supportive interventions include improving parenting skills, promoting child development, providing supervision and control, facilitating cooperation with other services, assessments and treatments by other institutions, and offering housing support. 

Norway uses foster homes or child welfare institutions as a last resort. When supportive interventions fail to meet the child’s needs, the child welfare services can temporarily place the child in these facilities. If parents disagree, the county social welfare board decides based on a municipal request. 

The team adjusted for potential confounders: sex, age, parental socioeconomic status (father’s and mother’s education and income level), and marital status. 

Results:

With these adjustments, children and adolescents diagnosed with ADHD were over six times more likely to have any contact with child welfare services than their general population peers. This was equally true for males and females.  

Children and adolescents diagnosed with ADHD were also over six times more likely to receive supportive interventions from child welfare services. Again, there were no differences between males and females. 

Finally, children and adolescents diagnosed with ADHD were roughly seven times more likely to have an out-of-home placement than their general population peers. For males this rose to eight times more likely. 

Conclusion:

The team concluded, “This population-based study provides robust evidence of a higher rate and strong association between ADHD and contact with CWS [Child Welfare Service] compared to the general population in Norway.” 

July 8, 2025

Swedish nationwide population study identifies top predictors of ADHD diagnoses among preschoolers

Most preschool-aged children diagnosed with ADHD also exhibit comorbid mental or developmental conditions. Long-term studies following these children into adulthood have demonstrated that higher severity of ADHD symptoms in early childhood is associated with a more persistent course of ADHD. 

The Study: 

Sweden has a single-payer national health insurance system that covers virtually all residents, facilitating nationwide population studies. An international study team (US, Brazil, Sweden) searched national registers for predictors of ADHD diagnoses among all 631,695 surviving and non-emigrating preschoolers born from 2001 through 2007.  

Preschool ADHD was defined by diagnosis or prescription of ADHD medications issued to toddlers aged three through five years old.  

Predictors were conditions diagnosed prior to the ADHD diagnosis. 

A total of 1,686 (2.7%) preschoolers were diagnosed with ADHD, with the mean age at diagnosis being 4.6 years. 

The Numbers:

Adjusting for sex and birth year, the team reported the following predictors, in order of magnitude: 

  • Previous diagnosis of autism spectrum disorder increased subsequent likelihood of ADHD diagnosis twentyfold. 
  • Previous diagnosis of intellectual disability increased subsequent likelihood of ADHD diagnosis fifteenfold. 
  • Previous diagnosis of speech/language developmental disorders and learning disorders, as well as motor and tic disorders, increased subsequent likelihood of ADHD diagnosis thirteen-fold. 
  • Previous diagnosis of sleep disorders increased subsequent likelihood of ADHD diagnosis fivefold. 
  • Previous diagnosis of feeding and eating disorders increased subsequent likelihood of ADHD diagnosis almost fourfold. 
  • Previous diagnosis of gastroesophageal reflux disease (GERD) increased subsequent likelihood of ADHD diagnosis 3.5-fold. 
  • Previous diagnosis of asthma increased subsequent likelihood of ADHD diagnosis 2.4-fold. 
  • Previous diagnosis of allergic rhinitis increased subsequent likelihood of ADHD diagnosis by 70%. 
  • Previous diagnosis of atopic dermatitis or unintentional injuries increased subsequent likelihood of ADHD diagnosis by 50%. 

The Conclusion: 

This large population study underscores that many conditions present in early childhood can help predict an ADHD diagnosis in preschoolers. Recognizing these risk factors early may aid in identifying and addressing ADHD sooner, hopefully improving outcomes for children as they grow

July 2, 2025