Objective. To evaluate the relationship between
attention-deficit hyperactivity disorder (
ADHD) and
injuries and to verify whether
methylphenidate (MPH), is associated with decreasing the risk of
injuries. Methods. A retrospective cohort study using the computerized database of Maccabi Healthcare Services. The
ADHD cohort included all children between 12 and 20 years of age, newly diagnosed with
ADHD between 2003 and 2013. The comparison cohort was composed of children who were not diagnosed with
ADHD. The primary outcome was traumatic
injuries. A Cox proportional hazard regression analysis was conducted to estimate
ADHD effects on the risk of
injuries. We also conducted a nested case-control study to examine how MPH influences this relationship. Results. A total of 59 798 children were included in the cohort study; 28 921 were classified as exposed (
ADHD cohort) and 30 877 were unexposed. The traumatic
injuries incidence in the exposed group was significantly higher (adjusted hazard ratio = 1.63 [95% confidence interval = 1.60-1.66]). Similar increased risk was documented also for severe
injuries (adjusted hazard ratio = 1.72 [1.59-1.86]). MPH use was significantly associated with 28% lower injury events.
Therapy groups were significantly associated with 29% to 40% lower
injuries rate for medium- or long-acting MPH. The intensity of
therapy was significantly associated with 29% to 33% lower injury rate when the intensity was lower than 0.69 mg/kg/day. Conclusion. Children with
ADHD have a 60% increased odds of experiencing an injury. Treatment with MPH reduced the risk by up to 28%. The individual and financial cost secondary to
injuries, underscores the public health significance of this problem. Injury prevention should be considered in clinical evaluation of MPH risks and benefits, beyond the conventional consideration of enhancing academic achievements.