ADHD medication use and risk of self-harm: a multinational self-controlled case series study - Report - MDSpire
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Association Between ADHD Medication and Self-Harm Risk: A Multinational Self-Controlled Case Series Analysis

  • By

  • Adrienne Y L Chan

  • Kebede Beyene

  • Sohee Park

  • Chin-Yao Shen

  • Andrew S C Yuen

  • Kirstie H T W Wong

  • Shiu Lun Au Yeung

  • Esther W Chan

  • David Coghill

  • Celine S L Chui

  • Sharon Cook

  • Stephen Crystal

  • Patrick Ip

  • Tatia M C Lee

  • Wallis C Y Lau

  • Xue Li

  • Terry Y S Lum

  • Hao Luo

  • Nirmala Rao

  • Andrew Tomlin

  • Li Wei

  • Yun K Wing

  • Amy H Y Chan

  • Edward Chia-Cheng Lai

  • Ju-Young Shin

  • Kenneth K C Man

  • Ian C K Wong

  • September 12, 2026

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Clinical Report: Association Between ADHD Medication and Self-Harm Risk

Overview

This study evaluates the risk of self-harm associated with ADHD medication use across multiple healthcare systems. Findings indicate that self-harm risk peaks before treatment initiation and decreases during treatment.

Background

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder that can lead to significant impairments in various life domains. The relationship between ADHD medication and self-harm remains unclear, with conflicting evidence from previous studies.

Data Highlights

PeriodPooled Adjusted IRR95% CI
90 days preceding initiation2.582.12 to 3.13
Initial 90 days of treatment1.781.23 to 2.57
Later treatment period1.271.01 to 1.60

Key Findings

  • Among 461,024 individuals, 6,847 experienced an incident self-harm event during the observation period.
  • Self-harm risk peaked in the 90 days before treatment initiation (pooled adjusted IRR: 2.58).
  • The risk was lower during the initial 90 days of medication exposure (pooled adjusted IRR: 1.78).
  • The lowest risk was observed during the later treatment period (pooled adjusted IRR: 1.27).
  • Findings were consistent across multiple healthcare systems.
  • The elevated pre-treatment risk may be linked to untreated ADHD features rather than the medications themselves.

Clinical Implications

These findings indicate an association between ADHD medications and self-harm, but do not establish causation.

Conclusion

The study highlights the timing of self-harm risk in relation to ADHD medication use.

Related Resources & Content

  1. MDSpire News, 2023 -- ADHD Medication Use Shows Different Outcome Rates
  2. BMJ Mental Health, 2023 -- ADHD medication discontinuation and non-adherence: a Norwegian population-based register study
  3. BMJ Mental Health, 2023 -- Psychiatric and neurological predictors of early ADHD medication discontinuation across the lifespan: a multinational study
  4. Clinical Care of ADHD in Children | Attention-Deficit / Hyperactivity Disorder (ADHD) | CDC
  5. BMC Psychiatry (Springer) — Comorbid Conditions and Concurrent Medications in ADHD Patients: A Nationwide Analysis from Denmark
  6. Increased Prescribing of Attention-Deficit/Hyperactivity Disorder Medication and Real-World Outcomes Over Time - PubMed
  7. ADHD drug treatment and risk of suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials
  8. Clinical Care of ADHD in Children | Attention-Deficit / Hyperactivity Disorder (ADHD) | CDC
  9. Attention-Deficit/Hyperactivity Disorder Medications and Work Disability and Mental Health Outcomes | Attention Deficit/Hyperactivity Disorders | JAMA Network Open | JAMA Network
  10. Pharmacotherapies for Attention-Deficit/Hyperactivity Disorder and Risk of Suicidal Behavior: A Within-Individual Study of Stimulants, Atomoxetine, and Alpha-2 Agonists - PMC
  11. Benefits and harms of ADHD interventions: umbrella review and platform for shared decision making

Original Source(s)

ADHD medication use and risk of self-harm: a multinational self-controlled case series study

  • by Adrienne Y L Chan, Kebede Beyene, Sohee Park, Chin-Yao Shen, Andrew S C Yuen, Kirstie H T W Wong, Shiu Lun Au Yeung, Esther W Chan, David Coghill, Celine S L Chui, Sharon Cook, Stephen Crystal, Patrick Ip, Tatia M C Lee, Wallis C Y Lau, Xue Li, Terry Y S Lum, Hao Luo, Nirmala Rao, Andrew Tomlin, Li Wei, Yun K Wing, Amy H Y Chan, Edward Chia-Cheng Lai, Ju-Young Shin, Kenneth K C Man, Ian C K Wong

  • September 12, 2026

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