Over recent years practitioners have noticed a steep increase in the number of clients presenting with a diagnosis of ADHD and medication prescribed to address the symptoms. Some claim this has been life changing while others report little or no benefit. Practitioners are sometimes chastised for not identifying the problem sooner and may feel constrained to question whether this diagnosis and treatment is the most helpful for their client.
Study Exploring this Issue
A recent study published by JAMA, the journal of the American Medical Association, noted the increase in prescribing rates over the past 20 years and asked the question of whether real-world benefits of ADHD medications had changed with increased prescription rates.
A Swedish population-based study used national registers to identify people who had used ADHD medications in Sweden between 2006 and 2020 and analysed data from October 2023 to November 2024. Comparison of medicated vs non-medicated times were made over three time periods, 2006-2010, 2011 to 2015 and 2016 to 2020 and considered rates of self-harm, unintentional injury, traffic crashes, and crime. Over this time prescriptions for medication increased from 0.6% to 2.8%.
What Did They Find?
The data showed that for people using medication between 2006 and 2020 there was a clear association with lower rates of self-harm, unintentional injury, traffic crashes, and crime across all analysed time periods, age groups, and sexes. However, as prescription rates increased the magnitude of the association between unintentional injury, traffic crashes, and crime with medication use, reduced. The suggestion is that weakening of this effect is attributable to an expansion in prescribing to those with fewer symptoms and less impairment.
An Interesting Effect for Women
The strongest association between medication prescription and real-world effects was observed in women in the 2006-to-2010 time frame. This coincides with the recognition that ADHD presents differently between men and women with the latter more likely to have an inattentive presentation and internalizing symptoms. This is also reflected in the fact that self-harm was the only outcome with more events for women than men. As the difference in diagnosis rates between the sexes has reduced so has the evidence for real world outcomes.
Does it Matter?
It could be argued that the diminution of real-world effects is of no concern if they are still effective for some. However, ADHD medications and particularly stimulants also have side effects including reduced appetite, delayed growth, insomnia, and increased heart rate or blood pressure. The authors note that in clinical practice decisions should be made balancing the risks and benefits for the individual and alternative nonpharmacological approaches either alone or in combination with medication should be considered.
And Perhaps Consider Another Explanation
These results also point to the concern many practitioners, especially those working with children express. The symptoms of ADHD both attentive and inattentive are similar to those associated with anxiety. Sometimes and in some families drawing attention to yourself or slipping into inattention may be preferable than exposure to dangerous and distressing behaviour by those around you. A thorough, open minded assessment and engagement with all key parts of a child’s world may be a better first step than a prescription.
Lin,L. Coghill,D. Sjölander, A., Yao,H., Zhang,L., Kuja-Halkola,R., Brikell,I., Lichtenstein,P., D’Onofrio,B., Larsson, H., Chang, Z. Increased Prescribing of Attention-Deficit/Hyperactivity Disorder Medication and Real-World Outcomes Over Time Published Online: June 25, 2025. doi:10.1001/jamapsychiatry.2025.1281
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