Kids With ADHD Suffer More Injuries

They have a higher rate of broken bones, burns, concussions

MONDAY, Feb. 3, 2003 (HealthDayNews) -- Here's news that anyone with a child with attention deficit hyperactivity disorder (ADHD) may already know all too well.

Kids with ADHD are more prone to injuries, including fractures, wounds, poisoning, concussions, and burns, new research finds. And some of these injuries have nothing to do with their behavior problems.

What makes the study unique is that it's the first, population-based comparison between kids with ADHD and their peers without the disorder, says Jamie Brehaut, lead author of the study and a postdoctoral fellow at the Ottawa Health Research Institute in Canada.

"The finding that kids who have attention deficit disorder or behavioral problems are at greater risk for injury is one that parents and caregivers of these children would not find surprising," Brehaut says. "But when we went to look through the scientific literature, the evidence for it was not that great. There were a lot of studies, but they were small or had some flaws."

The study appears in the February issue of Pediatrics.

Researchers analyzed the injury rates of all children in British Columbia under age 19 as of December 1996. Out of more than 1 million children, 16,086 children had been prescribed methylphenidate, also known as Ritalin.

A prescription for Ritalin was used as a marker to identify those children with a "childhood behavior disorder." Though not every child with a childhood behavior disorder necessarily had ADHD, the vast majority probably had been diagnosed with it, Brehaut says.

Brehaut and his colleagues found children with a childhood behavior disorder were 1.5 times more likely to suffer a fracture, open wound, poisoning, concussion, or burn.

The causes of those injuries included falls, motor vehicle accidents, being struck by an object, postoperative complications, adverse reaction to a prescribed drug, suffocation, and drowning.

"Kids with ADHD are generally more hyper, and in terms of sheer volume, the more active you are, the more prone you are to injury," says Dr. Andrew Adesman, director of development and behavioral pediatrics at Schneider Children's Hospital in New Hyde Park, N.Y.

"Part of ADHD is also poor impulse control, or not thinking about the consequences of your actions," Adesman says. That may be one reason risk-taking behavior might be increased in kids with ADHD.

But there could be other factors at work. Some evidence shows kids with ADHD tend to have poorer motor agility and are less coordinated, Adesman says.

While many of the injuries, such as fractures, can be easily attributed to hyperactivity or impulsiveness, others cannot, Brehaut says. For instance, researchers aren't sure why kids with ADHD are more likely to have postoperative complications.

One possibility is that kids with ADHD are less likely to follow doctor's orders for rest and self-care after surgery, says Adesman, a member of the board of directors of Children and Adults with Attention Deficit Disorder (CHADD).

One study found kids with ADHD may have a higher pain tolerance than other children, he says.

Another mystery is the adverse reactions to drugs. It's possible researchers are picking up on the already known side effects of Ritalin, Brehaut says, adding that Ritalin is generally a very safe drug.

"What it suggests to us that there may be greater cost to the health-care system associated with this particular group of kids that extended beyond the typical injuries you might expect," Brehaut says.

Indeed, one recent study found precisely that. It said that children with ADHD were more likely to need medical care than children without ADHD.

Researchers looked at the medical histories of more than 4,000 children for nine years. The median medical cost for children with ADHD was $4,306 compared to $1,944 for kids without ADHD.

The U.S. Centers for Disease Control and Prevention recommends these safety tips for preventing injuries in children with ADHD:

  • Ensure bicycle helmet use. Remind children as often as necessary to watch for cars and to avoid unsafe activities.
  • Supervise children when they are involved in high-risk activities or are in risky settings, such as when climbing or when in or around a swimming pool.
  • Keep potentially harmful household products, tools, equipment, and objects out of the reach of young children.
  • Teens with ADHD may need to limit the amount of music listened to in the car while driving; drive without passengers or limit the number of passengers; plan trips well ahead of time; and, of course, avoid alcohol, drug, and cell phone usage.
  • Parents may want to enroll their teens in driving safety courses before they get their driver's license.

More information

The CDC has more on attention deficit hyperactivity disorder.

For help with dealing with ADHD, visit CHADD or the Attention Deficit Disorder Association.

SOURCES: Jamie Brehaut, Ph.D., postdoctoral fellow, Ottawa Health Research Institute, Ottawa; Andrew Adesman, M.D., director of development and behavioral pediatrics, Schneider Children's Hospital, New Hyde Park, N.Y.; February 2003 Pediatrics
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