Self-harm risk peaks in the months before ADHD medication starts, not after
BMJ Mental Health, published Sep 12 (news coverage Oct 23)
DOI 10.1136/bmjment-2026-302819
Self-controlled case series, more than 460,000 people in 5 health systems
Summary: Some families and prescribers worry that ADHD medication might raise the risk of self-harm. This study used health records from Hong Kong, New Zealand, South Korea, Taiwan, and the UK covering 2001–2020. Each person was compared with themselves across different time periods: the 90 days before starting medication, the first 90 days on it, and the time after. In all five health systems, self-harm risk was highest in the 90 days before medication began. Risk was lower after treatment started, though still above the person’s own baseline. The authors conclude that the medication doesn’t appear to be the main driver of self-harm, and they point to the period before treatment as a time of higher risk.
Takeaways for clinicians
Suggests the period around diagnosis and treatment start, when symptoms are often worsening, is a higher-risk window.
Comparing each person with themselves helps control for stable individual differences.
Takeaways for families
Self-harm risk was highest before medication started, which doesn’t fit the idea that the medication causes it.
The months when struggles are building toward an evaluation may be an especially hard time.
