Attention deficit hyperactivity disorder (ADHD) medications are linked to a variety of real-world benefits, including preventing one in four self-harm incidents and one in seven traffic accidents among users, according to new research that tracked nearly a quarter of a million patients over 14 years.

However, the strength of this real-world benefit has been weakening over time as prescription rates have increased, prompting the authors to call for ongoing research to better understand how ADHD medications affect different groups of patients and to support informed treatment decisions.

The findings come as prescription rates for ADHD medications have sparked intense debate. In Sweden, where the study was conducted, ADHD medication use has increased nearly fivefold over the past two decades, from 0.6 percent to 2.8 percent of the population. The Scandinavian country now shows some of the highest ADHD rates in the world.

Tracking Individual Patients Over Time

The research, recently published in JAMA Psychiatry, analyzed health records from nearly 250,000 patients aged 4 to 64 who used ADHD medications between 2006 and 2020.

Researchers employed a self-controlled case series design, a method that compares people’s outcomes during times they are medicated with outcomes during times they are not. This approach eliminated personal differences that might influence behavior independently of medication, allowing scientists to isolate the drugs’ actual effects.

Specifically, they found about a 23 percent reduction in self-harm incidents, a 14 percent decrease in traffic accidents, and a 17 percent drop in criminal behavior during periods when patients were on ADHD medication compared with when they were not.

“However, the associations between ADHD medication use and lower risks of unintentional injury, traffic crashes, and crime appear to weaken over time as prescription rates increased,” the authors wrote.

The medications, which typically include stimulants such as methylphenidate or amphetamines, work by increasing dopamine and norepinephrine levels in the brain—neurotransmitters crucial for focus and impulse control.

Why Benefits Have Diminished

Researchers found that while protective effects persisted throughout the study period, their strength diminished as prescription rates increased over time. This pattern suggests that as ADHD diagnosis has expanded to include people with milder symptoms, the average benefits may be declining.

The increase in prescribing has been especially pronounced among adults and females—populations historically underdiagnosed for ADHD.

“The rise in ADHD prescriptions—particularly among adults and females—reflects better recognition of previously missed cases and evolving diagnostic practices,” Rahul Bansal, a board-certified pediatric and adult psychiatrist not involved in the study, told The Epoch Times.

“I’ve seen ADHD underdiagnosed in the past, especially in women. But as awareness has grown, we’re also seeing more diagnoses in individuals with milder symptoms.”

Growing Concerns Over Diagnosis Quality

The surge in prescriptions has raised concerns about diagnostic accuracy. ADHD affects an estimated 11.3 percent of U.S. children ages 5 to 17, with boys showing higher rates (14.5 percent) than girls (8 percent). Roughly 6 percent of U.S. adults live with the condition.

Dr. Cooper Stone, psychiatrist at Thomas Jefferson University, attributes the increase to multiple factors, including social media awareness campaigns that can spread both helpful information and misinformation about ADHD symptoms.

“The end result is the same—a significant number of people who never otherwise would have gone to receive an evaluation will then go on to seek an evaluation and receive a diagnosis,” Stone said.

Many prescriptions now come from primary care providers, whose limited time and training in mental health can lead to oversimplified assessments, experts warn.

“Combined with aggressive pharmaceutical marketing, this increases the risk of overdiagnosis and undermines the seriousness of the condition for those who truly need treatment,” Bansal said.

Stone noted that ADHD medications have become “highly sought after” drugs, with some companies facing legal trouble for essentially functioning as “on-demand pill mills.”

Different Approaches to Treatment

While the Swedish study supports medication benefits, some experts advocate for addressing underlying causes before turning to pharmaceuticals.

Evidence-based alternatives include behavioral therapy, cognitive behavioral therapy, regular exercise, and mindfulness practices. The main reason for this is that both practices help teach the brain to pause before it acts—a useful skill when impulsivity is a problem, said Sanam Hafeez, a neuropsychologist in New York City.

“Breathwork, or other forms of guided meditation, can help train the mind to stay present and not be distracted,” she said.

According to her, regular exercise increases levels of the same brain chemicals—dopamine and norepinephrine—that ADHD medications target.

“Even short daily workouts can improve mental clarity and mood,” she said.

Dr. Aruna Tummala, board-certified adult and geriatric psychiatrist and founder of Trinergy Health in New Berlin, Wisconsin, and not involved in the study, told The Epoch Times that as a holistic psychiatrist, she has a radically different approach to treating ADHD. She said she doesn’t believe that ADHD is a true diagnosis, but rather a description of a symptom.

In general, she has found that there are only three root causes of any disease, including ADHD: diet and lifestyle, trauma, and toxins.

“So ADHD brain is an inflamed, traumatized, nutrient-depleted, and toxic brain,” Tummala said. “When these root causes are addressed, the symptoms resolve.”

Balancing Benefits and Risks

The study provides compelling evidence that ADHD medications can prevent serious harm, but underscores the importance of accurate diagnosis and appropriate treatment in an era of rapidly expanding prescription rates.

For patients considering reducing medication dependence, Stone recommended starting with adequate sleep, since untreated insomnia can mimic ADHD symptoms. He also suggested regular exercise, healthy eating, and omega-3 fatty acid supplements, although he noted that these benefits are often “only modest.”

“It’s important to remember ADHD is a neurodevelopmental disorder,” Stone said. “While some of these methods may help improve symptoms, they are not cures.”

Stone noted that a comprehensive evaluation is essential to rule out other conditions that can mimic ADHD but require different treatments, such as obstructive sleep apnea.