Pediatric patients with attention deficit and hyperactivity disorder and accidental injuries: a cohort study
DOI:
https://doi.org/10.18203/2349-3291.ijcp20260394Keywords:
Attention deficit disorder with hyperactivity, Accidents, Emergency department, Hospital, Risk factorsAbstract
Background: Attention deficit and hyperactivity disorder (ADHD) is linked to a higher risk of injuries, especially in childhood and adolescence. This study compares emergency department (ED) visits between pediatric patients with ADHD and healthy controls, identifying potential risk factors and differences in injury severity.
Methods: Retrospective cohort study including patients diagnosed with ADHD at a Neurodevelopment Clinic, and a control group of patients born at the same hospital. Medical records were reviewed for clinical data (number of ED accidents since birth and severity outcomes such as splints, hospitalization, surgeries, inter-hospital transfers and sequelae). Parametric measurements were used due to the sample size and absence of skewness. Negative binomial regression accounted for overdispersion in incidence rates.
Results: We analyzed 316 ADHD cases and 316 controls. Mean age was 11.9 years (SD 2.4), similar to controls (p=0.998), with 66.5% males in both groups. ADHD patients had 537 unintentional injury ED visits (controls: 387), an incidence rate ratio (IRR) of 1.36 (95% CI: 1.11-1.67). The IRR was higher for episodes ≥6 years (IRR 1.48; 95% CI: 1.16-1.88). Severity outcomes were similar (p=0.257). Lower parental education was associated with more episodes (IRR 1.39; 95% CI: 0.989-1.96). Comorbidities did not affect injury incidence (p=0.425), but patients without comorbidities required more procedures and transfers (p=0.018 and p=0.013, respectively). 79.7% of cases had most/all ED visits before starting psychostimulants.
Conclusions: Our study supports the increased risk of injuries among pediatric ADHD patients. While injury severity was comparable to controls, ADHD patients without comorbidities had greater severity. Psychostimulants suggested a protective effect.
Metrics
References
Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Washington, DC: American Psychiatric Association. 2013. Available at: https://psycnet.apa.org/record/2013-14907-000. Accessed on 06 November 2025.
Brunkhorst-Kanaan N, Libutzki B, Reif A, Larsson H, McNeill RV, Kittel-Schneider S. ADHD and accidents over the life span – a systematic review. Neurosci Biobehav Rev. 2021;125:582-91. DOI: https://doi.org/10.1016/j.neubiorev.2021.02.002
Libutzki B, Neukirch B, Kittel-Schneider S, Reif A, Hartman CA. Risk of accidents and unintentional injuries in men and women with attention deficit hyperactivity disorder across the adult lifespan. Acta Psychiatr Scand. 2023;147(2):145-54. DOI: https://doi.org/10.1111/acps.13524
Prasad V, West J, Sayal K, Kendrick D. Injury among children and young people with and without attention-deficit hyperactivity disorder in the community: the risk of fractures, thermal injuries, and poisonings. Child Care Health Dev. 2018;44(6):871-8. DOI: https://doi.org/10.1111/cch.12591
Bonander C, Beckman L, Janson S, Jernbro C. Injury risks in schoolchildren with attention-deficit/hyperactivity or autism spectrum disorder: results from two school-based health surveys of 6- to 17-year-old children in Sweden. J Safety Res. 2016;58:49-56. DOI: https://doi.org/10.1016/j.jsr.2016.06.004
Chou IC, Lin CC, Sung FC, Kao CH. Attention-deficit-hyperactivity disorder increases risk of bone fracture: a population-based cohort study. Dev Med Child Neurol. 2014;56(11):1111-6. DOI: https://doi.org/10.1111/dmcn.12501
Sass AC, Stang A. Population-based incidences of non-fatal injuries: results of the German-wide telephone survey 2004. BMC Public Health. 2013;13:376. DOI: https://doi.org/10.1186/1471-2458-13-376
Amiri S, Sadeghi-Bazargani H, Nazari S, Ranjbar F, Abdi S. Attention deficit/hyperactivity disorder and risk of injuries: a systematic review and meta-analysis. J Inj Violence Res. 2017;9(2):95-105. DOI: https://doi.org/10.5249/jivr.v9i2.858
Pai MS, Yang SN, Chu CM, Lan TY. Risk of injuries requiring hospitalization in attention deficit hyperactivity disorder and the preventive effects of medication. Psychiatry Clin Neurosci. 2022;76(12):652-8. DOI: https://doi.org/10.1111/pcn.13471
Jin YT, Chwo MJ, Chen CM, Huang SH, Huang YC, Chung CH, et al. Relationship between injuries and attention-deficit hyperactivity disorder: a population-based study with long-term follow-up in Taiwan. Int J Environ Res Public Health. 2022;19(7):4058. DOI: https://doi.org/10.3390/ijerph19074058
Nguyen QUP, Saynina O, Pirrotta EA, Huffman LC, Wang NE. Epidemiology and outcomes of pediatric unintentional falls in US emergency departments: a retrospective observational cohort study. Injury. 2021;52(8):2244-50. DOI: https://doi.org/10.1016/j.injury.2021.05.017
Shmueli D, Razi T, Almog M, Menashe I, Mimouni Bloch A. Injury rates among children with autism spectrum disorder with or without attention-deficit/hyperactivity disorder. JAMA Netw Open. 2025;8(2):e2459029. DOI: https://doi.org/10.1001/jamanetworkopen.2024.59029
Asarnow RF, Newman N, Weiss RE, Su E. Association of attention-deficit/hyperactivity disorder diagnoses with pediatric traumatic brain injury: a meta-analysis. JAMA Pediatr. 2021;175(10):1009-16. DOI: https://doi.org/10.1001/jamapediatrics.2021.2033
Goodon H, Gawaziuk JP, Comaskey B, Afifi TO, Château D, Brownell M, et al. Social determinants of health and injury among children. JAMA Netw Open. 2025;8(6):e2513584. DOI: https://doi.org/10.1001/jamanetworkopen.2025.13584
McClure R, Kegler S, Davey T, Clay F. Contextual determinants of childhood injury: a systematic review of studies with multilevel analytic methods. Am J Public Health. 2015;105(12):e37-43. DOI: https://doi.org/10.2105/AJPH.2015.302883
Xie Y, Yu X, Wu X, Zhang W, Feng Z, Xiao F, et al. Association between the guardians’ educational levels and unintentional injuries in children aged 6–18 in Shenzhen, China. BMC Public Health. 2024;24(1):2344. DOI: https://doi.org/10.1186/s12889-024-19748-4
Cortese S. Pharmacologic treatment of attention deficit–hyperactivity disorder. N Engl J Med. 2020;383(11):1050-6. DOI: https://doi.org/10.1056/NEJMra1917069
Downloads
Published
How to Cite
Issue
Section
