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About 5% of all children in the Western world fulfill diagnostic criteria for attention deficit–hyperactivity disorder (ADHD),1 and a large proportion of such children are treated pharmacologically.2 ADHD has been associated with criminality3,4 and externalizing disorders.5Beneficial short-term effects of ADHD medication on symptoms of ADHD and associated conduct problems have been shown in numerous randomized, controlled studies involving children6-8 and adults.9-11 ADHD symptoms are largely persistent from childhood into adulthood,12 but one prominent feature of ADHD treatment is that the discontinuation of medication is common,13,14especially in adolescence and early adulthood.15 The importance of treatment discontinuation for criminality and other longer-term outcomes is largely unknown.
The Multimodal Treatment of Attention Deficit–Hyperactivity Disorder (MTA) study is the largest randomized clinical trial of ADHD medication with long-term follow-up.16-19 The most sensitive measures of treatment (a composite of ADHD symptoms, as rated by parents and teachers) suggested that the benefit of medication at the 14-month assessment had diminished at 36 months.20 No association was observed with early delinquency and substance use at 36 months.19Although the study did not suggest long-term effects of medication, high rates of treatment discontinuation, a lack of placebo-treated controls, and a limited range of outcomes mean that the longer-term effects of ADHD medication remain uncertain. In this study, we used Swedish population-based data to investigate the association between the use of ADHD medication and criminality. Click here to read the full study: http://www.nejm.org/doi/full/10.1056/NEJMoa1203241#t=articleBackground