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Attention deficit hyperactivity disorder, physical abuse and methylphenidate treatment in children

Nature Mental Health volume 1, pages 66–75 (2023)Cite this article

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Abstract

A growing number of studies show an association between attention deficit hyperactivity disorder and physical abuse in childhood. We examined temporal associations of physical abuse risk with methylphenidate treatment in children with attention deficit hyperactivity disorder. Using Hong Kong electronic medical records, we conducted a self-controlled case series study in 1,064 children (5–16 years old) who were treated with methylphenidate and also experienced physical abuse. Compared with non-medicated periods, a higher risk of abuse was observed shortly before treatment initiation (incidence rate ratio = 4.49; 95% confidence interval = 3.76–5.36). After treatment initiation, the risk was comparable to that in non-medicated periods (incidence rate ratio = 0.90; 95% confidence interval = 0.63–1.29), followed by a 37% reduction during subsequent treatment. These findings are consistent with the hypothesis that methylphenidate treatment in children with attention deficit hyperactivity disorder is associated with a reduced risk of becoming a victim of physical abuse.

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Fig. 1: Illustration of SCCS study design.
Fig. 2: Flowchart of patient identification.
Fig. 3: Results of direct comparison (90 d before treatment as reference group) from SCCS analysis.
Fig. 4: Sensitivity analysis on exposure periods by adding 1–10 weeks after the end of an exposed period: IRRs of physical abuse in each risk window.

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Data availability

Data cannot be shared as the data custodian—Hong Kong Hospital Authority—did not give permission due to patient confidentiality and privacy concerns. According to the conditions laid down by Hong Kong Hospital Authority, only local academic institutions, government departments or non-governmental organizations may apply for access to data through the Hospital Authority data sharing portal (https://www3.ha.org.hk/data).

Code availability

All relevant analysis codes are available online (https://github.com/legao513/child-abuse).

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Acknowledgements

This study is funded by the Hong Kong Research Grant Council Collaborative Research Fund (grant number C7009-19GF). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. We also thank L. Lam for proofreading the manuscript and acknowledge the support from European Commission Framework Horizon 2020 funding.

Author information

Author notes

  1. These authors contributed equally: Kenneth K. C. Man, Le Gao.

  2. These authors jointly supervised this work: Patrick Ip, Ian C. K. Wong.

Authors and Affiliations

  1. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China

    Kenneth K. C. Man, Le Gao, Wallis C. Y. Lau, Min Fan, Esther W. Chan, Xue Li, Adrienne Y. L. Chan, Rosa S. Wong & Prof Ian C. K. Wong

  2. Research Department of Practice and Policy, UCL School of Pharmacy, London, UK

    Kenneth K. C. Man, Wallis C. Y. Lau, Prof Li Wei, Kirstie H. T. W. Wong & Prof Ian C. K. Wong

  3. Laboratory of Data Discovery for Health, Hong Kong, China

    Kenneth K. C. Man, Wallis C. Y. Lau, Esther W. Chan, Celine S. L. Chui, Xue Li, Adrienne Y. L. Chan, Prof Li Wei & Prof Ian C. K. Wong

  4. Department of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia

    Prof David Coghill

  5. Murdoch Children’s Research Institute, Melbourne, Victoria, Australia

    Prof David Coghill

  6. School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China

    Celine S. L. Chui

  7. School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China

    Celine S. L. Chui & Shiu Lun Au Yeung

  8. Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China

    Xue Li

  9. Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, ‐Epidemiology and ‐Economics, University of Groningen, Groningen, the Netherlands

    Adrienne Y. L. Chan

  10. Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Hong Kong, China

    Prof Terry Lum & Hao Luo

  11. Department of Computer Science, The University of Hong Kong, Hong Kong, China

    Hao Luo

  12. Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China

    Kirstie H. T. W. Wong, Keith T. S. Tung, Rosa S. Wong & Patrick Ip

  13. State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China

    Prof Tatia M. C. Lee

  14. Laboratory of Neuropsychology and Human Neuroscience, The University of Hong Kong, Hong Kong, China

    Prof Tatia M. C. Lee

  15. Faculty of Education, The University of Hong Kong, Hong Kong, China

    Prof Nirmala Rao

  16. Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China

    Prof Yun K. Wing

  17. Aston Pharmacy School, Aston University, Birmingham, UK

    Prof Ian C. K. Wong

Authors
  1. Kenneth K. C. Man
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  2. Le Gao
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  20. Patrick Ip
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Contributions

K.K.C.M., L.G., P.I. and I.C.K.W. designed the study. K.K.C.M., L.G., W.C.Y.L. and M.F. extracted the data, conducted the statistical analyses and cross-checked the analyses. K.K.C.M. and L.G. wrote the first draft of the manuscript. D.C. and P.I. provided critical input to the interpretation of the analyses. P.I. and I.C.K.W. are the principal investigators, providing resources and supervising all aspects of the project. All authors contributed to the interpretation of the analyses and the review and editing of the manuscript, and approved the submission of the final version.

Corresponding authors

Correspondence to Patrick Ip or Prof Ian C. K. Wong.

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Competing interests

K.K.C.M. is the recipient of the CW Maplethorpe Fellowship, and reports grants from the National Institute for Health Research, UK, the European Commission Horizon 2020 Framework, EU, and the Research Grant Council, Hong Kong, and personal fees from IQVIA Ltd., unrelated to the submitted work. W.C.Y.L. reports a research grant from AIR@InnoHK administered by the Innovation and Technology Commission outside the submitted work. D.C. reports personal fees from Shire/Takeda, personal fees from Medice, personal fees from Servier and personal fees from Oxford University Press, outside the submitted work. E.W.C. reports grants from the Research Grants Council (RGC, Hong Kong), grants from the Narcotics Division of the Security Bureau of the Government of the Hong Kong SAR, grants from the Research Fund Secretariat of the Food and Health Bureau, grants from the National Natural Science Fund of China, grants from the National Health and Medical Research Council (NHMRC, Australia), grants from Wellcome Trust, grants from Bayer, grants from Bristol-Myers Squibb, grants from Pfizer, grants from Janssen, grants from Amgen, grants from Takeda and personal fees from Hospital Authority of Hong Kong, outside the submitted work. X.L. received grants from the Health and Medical Research Fund, Food and Health Bureau of the Government of Hong Kong, the Research Grants Council Early Career Scheme (RGC/ECS), Janssen, Pfizer, internal funding from the University of Hong Kong and a consultancy fee from Merck Sharp & Dohme and Pfizer, unrelated to this work. A.Y.L.C. reports a grant from the Innovation and Technology Commission of the Hong Kong Special Administration Region Government for salary at the University of Hong Kong. Y.K.W. reports grants from the Research Grant Council General Research Fund, grants from the Health and Medical Research Fund, personal fees from Eisai Inc., personal fees from Eisai Co., Ltd, and other fees from Lundbeck HK Limited, outside the submitted work. I.C.K.W. reports research funding outside the submitted work from Amgen, Bristol-Myers Squibb, Pfizer, Janssen, Bayer, GSK, Novartis, the Hong Kong RGC, the Hong Kong Health and Medical Research Fund, the National Institute for Health Research in England, the European Commission and the National Health and Medical Research Council in Australia, and also received speaker fees from Janssen and Medice in the previous 3 years. All other authors declare no competing interests.

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Extended data

Extended Data Fig. 1

Histogram of age at the incident physical abuse.

Extended Data Fig. 2 Time from the first physical abuse case to MPH initiation.

Abbreviation: MPH, methylphenidate.

Supplementary information

Supplementary Information

Supplementary Tables 1–4, Discussion, Notes 1 and 2 and equation.

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Man, K.K.C., Gao, L., Lau, W.C.Y. et al. Attention deficit hyperactivity disorder, physical abuse and methylphenidate treatment in children. Nat. Mental Health 1, 66–75 (2023). https://doi.org/10.1038/s44220-022-00008-6

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