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Medication for ADHD Reduces Criminality

Treatment is robustly associated with lower criminal conviction rates for men and women, regardless of medication type or crime.

Attention-deficit/hyperactivity disorder (ADHD) is associated with externalizing disorders and future criminal behavior, and ADHD stimulant treatment reduces conduct problems in children. However, no specific data link treatment with changes in adult criminality. Now, researchers have examined time-varying associations between criminal convictions and treatment periods (defined as intervals with stimulant or nonstimulant prescriptions <6 months apart).

The investigators analyzed Swedish prescription and criminal registry data in 2006–2009 on 16,087 men and 9569 women with an ADHD diagnosis and on general-population controls matched by age, sex, and geographic region. Of men with ADHD, 53.6% had taken ADHD drugs, and 36.6% had been convicted of a crime (vs. 0.2% and 8.9% in controls); of women with ADHD, the percentages were 62.7% and 15.4% (vs. 0.1% and 2.2% in controls).

Treatment periods were associated with lower criminality rates (hazard ratios: men, 0.70; women, 0.78). Analyses within individuals showed similar reductions (HRs: men, 0.68; women, 0.59). In sensitivity analyses, crime in men was 12% higher during their nontreatment versus treatment periods; the order of treatment and nontreatment periods did not matter, ruling out reverse causation. Associations were similar when controlling for comorbid externalizing disorders and in a comparison of stimulants and nonstimulants (but were not significant for selective serotonin reuptake inhibitors).

Comment: Although some experts believe that for many individuals, crime is an ingrained (i.e., trait-like) behavioral pattern not amenable to medication-induced changes in "state," this study convincingly shows that ADHD treatment reduces the propensity of at least some individuals to commit crimes. The results raise the question of whether ADHD treatment in incarcerated adults would reduce future recidivism and support the establishment of consistent treatment early on in children to reduce antisocial behavior.

— Peter Roy-Byrne, MD

Published in Journal Watch Psychiatry November 21, 2012

Citation(s):

Lichtenstein P et al. Medication for attention deficit–hyperactivity disorder and criminality. N Engl J Med 2012 Nov 22; 367:2006.

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• criminality: psychiatric aspects
  Walter Doege, private office, 30 Nov 2012 10:34 AM EST
  Specialty: Psychiatry
  This important article presents interesting results. Although crime is not a psychiatric diagnosis, criminality may be considered a psychiatric disorder... [more]

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