Teenagers with ADHD more likely to self-harm, research shows

New research has highlighted the higher risk of self-harm and suicide among teenagers with ADHD and the need for better-tailored intervention strategies.

Australian children diagnosed with attention-deficit/hyperactivity disorder (ADHD) are more likely to self-harm and exhibit suicidal behavior as teenagers, research shows.

Children diagnosed with ADHD by age 10 have elevated risks of self-harm as well as suicidal thoughts, planning or attempts by age 14, with the association substantially more pronounced for boys than girls.

The study, led by UNSW Sydney and published in the July issue of Psychiatry Research, highlights the mental health hurdles faced by adolescents with ADHD and the need for better-tailored intervention for those with neurodevelopment disorders.

Researchers analyzed the data of almost 3,700 young people who participated in The Longitudinal Study of Australian Children, 3.6% (133) of whom had been diagnosed with ADHD.

Although still uncommon, adolescents with childhood ADHD diagnoses were roughly 11-times more likely to report suicidal thoughts, plans, or attempts by age 14, compared to their peers. They were about 25 times more likely to self-harm.

UNSW Adjunct Associate Professor and lead study author Dr. Daniel Lin said while the findings were in line with his expectations, the magnitude of the increased likelihood was a surprise.

"What concerned me is that maybe children with ADHD struggle more than we thought ... these vulnerable children might need more attention than we anticipated," Dr. Lin said.

The study was based on self-reporting at the age of 14 of any thoughts or attempts of suicide or self-harm in the previous year and accounted for variables such as socioeconomic status, ADHD medication history and experiences of bullying and depression.

The pathway from ADHD to increased self-harm risk

The researchers put forward that ADHD symptoms may cause depressed mood and exposure to bullying, resulting in psychological distress and behavioral consequences, potentially leading to feelings of defeat or hopelessness. However, they stressed this only accounted for a small part of the increased risk.

"Kids with a diagnosis of ADHD for many, many different reasons, may become depressed later on, maybe because of learning problems at school, maybe because of peer relationships, and their depressed mood will predispose them to increased suicidal ideation in adolescence," Dr. Lin said.

Previous research has shown those with ADHD were also more likely to have issues with drug abuse, alcoholism and even criminal behavior, without proper treatment, he noted.

Risk greater for boys than girls with ADHD

The higher risk of self-harm and suicidal behavior was more pronounced for boys than girls, which Dr. Lin said could relate to greater impulsivity and poorer judgment among young men.

"Girls with ADHD mostly suffer with symptoms of inattention instead of hyperactivity so one might argue that ... it could be hyperactivity instead of hyperattention which is contributing to the higher risk."

The findings highlighted the need for gender-tailored intervention and prevention strategies, Dr. Lin said, noting that the greater difficulty in diagnosing girls with ADHD could also be affecting the results.

More research on driving factors needed

More research needs to be done on the association between ADHD and self-harm and suicidal behavior, Dr. Lin said. Although there was a possibility of causation, that would be difficult to prove, particularly as there were some genetic risk factors which meant they could co-occur to some degree.

Future research would be key to confirming the link between the two and shedding light on how to improve suicide prevention, Dr. Lin said.

The focus should be on assessing how treatment and the severity of ADHD affected the risk of self-harm and suicidality, then determining what symptoms were driving the increased risk.

"Symptoms of ADHD include impulsivity, attention and cognition issues, difficulty with social communication and more. We need to determine which components are actually driving suicidality, as this has not been properly answered yet."