At a glance

What did we already know about this topic?

• Attention deficit / hyperactivity disorder (ADHD) affects 5-7% of school children.
• ADHD influences a child’s emotions and behaviours, including their ability to manage and communicate their feelings, being more restless and inattentive than other children their age, and sometimes, behaving impulsively and aggressively. This spectrum of behaviours is often referred to as ‘externalising symptoms’ in the clinical world.
• Children with externalising symptoms are also more likely to experience suicidal thoughts and behaviours — but it is important to note that most children with ADHD and externalising symptoms will not have suicidal thoughts and behaviours.
• So why are externalising symptoms linked to an increase in suicidal thoughts and behaviours? While the exact causal link is not fully understood, some evidence points to poor emotion regulation in which a child is not being able to manage and cope with feelings in productive ways. In addition, externalising symptoms can be viewed as disruptive by others and can have negative consequences — such as being punished by teachers, disliked by other peers — that hinder a child’s sense of belongingness and increase feelings of isolation and burdensomeness, which can contribute to suicidal thoughts.
• There have been a few large studies that examined teenagers with ADHD and suicidal risk, that saw ADHD medication as a mediator — that is, those with ADHD who were treated (with medication) reported less suicidal thoughts and behaviours than those who had ADHD but were not treated with medication.

What does this study aim to do and why is it important?

• Our objective in this study was to determine the association between externalising symptoms, suicidal risk, and whether the child was treated with ADHD medication or not.
• We specifically wanted to look at younger children because past research had mostly focused on adolescents and young adults, even though externalising symptoms occur the most in elementary school years. ADHD medication is also increasingly being used in younger children, and so we wanted to clarify the potential role ADHD medication has on externalising symptoms and suicidal risk.

What did the study find?

• 11,000 children aged 9 and 10 years old was followed up with over a period of one year. We found that at baseline, 8.5% of children reported having current (or past) suicide thoughts and behaviours, and 8.8% of children were on some type of ADHD medication.