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December 11, 2021
Taiwan has a single-payer healthcare system that covers virtually every inhabitant (99.5%). That makes it relatively easy to track healthcare issues using its comprehensive National Health Insurance Research Database.
This database maintains a subset, the Longitudinal Health Insurance Database (LHID), consisting of a million persons, with no significant differences in sex, age, or healthcare use from the parent database.
A Taiwanese research team used the LHID to identify 114,486 individuals diagnosed with ADHD from 1997 to 2013. It then compared their motor vehicle (including motorcycles, which are extremely common in Taiwan) crash patterns with 338,261 normally developing controls from the same database.
Adjusting for sex, age, and psychiatric comorbidities, persons with ADHD were about a fifth (19%)more likely to be in traffic crashes. Breaking it down further by sex, women with ADHD were no more likely to be in crashes, but men with ADHD were about a quarter (24%) more likely than their healthy counterparts.
Since the database also tracks pharmaceutical prescriptions, the team also looked into the effect of methylphenidate (MPH), the medication that is the first-line treatment for ADHD under Taiwanese guidelines, and the only approved stimulant. Atomoxetine, a non-stimulant, is used where MPH is either ineffective or not indicated for any other reason and is only used in 4% of all cases.
Of the 114,486 persons diagnosed with ADHD, 89,826 used MPH, and 24,660 did not.
Compared with persons with ADHD who were not on methylphenidate, those with ADHD who were on MPH for 180 days (roughly half a year) or less had 77% fewer accidents, and those on MPH for over 180 days had 93% fewer accidents. This strong dose-response relationship is suggestive of a causal relationship, with MPH perhaps reducing impulsive behavior, particularly among young men with ADHD.
The team also conducted within-person analyses, comparing times when persons with ADHD were taking MPH with periods when they were not. These showed no effect within 30 days of use, rising to a 65%reduction in crashes within 60 to 90 days of use, which was barely outside the 95% confidence interval (p = .07), very likely because of "the extremely low incidence of transport accidence (i.e. 0.6%)enlarged the confidence interval."
The authors concluded, "All registration medical claim data came from the nationally-representative sample of NHI, minimizing the selection and recall bias. By excluding transport accidents before ADHD diagnosis, we have precluded the reverse association between ADHD and road traffic accidents as much as possible. The advantage of the between-subjects comparison was that we were able to examine the MPH effect in different dose groups. However, confounding by indication cannot be eliminated. For example, those with a severe degree of ADHD symptoms, an exhibition of risky behaviors, or comorbid with other psychiatric illnesses were more likely to be prescribed medication. Hence, we also performed within-subject comparisons to adjust for time-invariant factors."
Transport safety thus offers another compelling reason to treat ADHD symptoms. Methylphenidate in particular seems to be especially effective in reducing traffic fatalities and injuries.
Yi-Chun Liu, Vincent Chin-Hung Chen, Yao-Hsu Yang, Yi-LungChe, and Michael Gossop, "Association of psychiatric comorbidities with the risk of transport accidents in ADHD and MPH," Epidemiology and PsychiatricSciences30 (2021), e14, 1-9,https://doi.org/10.1017/S2045796021000032.
ADHD affects both individuals and society in many ways. Children and adolescents with ADHD often struggle with focusing, controlling impulses, and staying organized, which leads to problems with schoolwork, learning, and taking tests. These challenges can cause academic failure and make it harder for them to stay in school.
ADHD symptoms often continue into adulthood, affecting jobs, relationships, and increasing risks for substance abuse and legal problems.
Families of children and adolescents with ADHD face extra stress, with parents more likely to experience depression, anxiety, and relationship difficulties. The economic impact is also large, with billions spent each year on medical care, special education, lost productivity, and other related costs.
Current treatments for ADHD mostly include medication, behavioral therapy, and educational support. While medications like stimulants can help control ADHD symptoms in the short term, they often cause side effects such as loss of appetite, trouble sleeping, slowed growth, cardiovascular risks, and potential substance dependence. These issues can make it hard for children and adolescents to stay on their medication, and about a third either don’t respond well or can’t tolerate the side effects. Once medication is stopped, the benefits fade quickly and do not lead to lasting improvements in executive functions (thinking skills).
Behavioral therapy and parent training can help with behavior problems, but have limited effects on core mental skills like planning and self-control. These approaches also tend to be expensive, require a lot of support from parents and teachers, and are hard to use widely in schools and communities that lack resources.
Recently, exercise interventions have attracted growing interest as a non-pharmacological option. They provide several benefits: no drug-related side effects, easy accessibility, low cost, simple implementation in schools and communities, and enhanced physical and mental health.
Previous meta-analyses examining how exercise interventions affect children and adolescents with ADHD have used traditional univariate models, which treat each study as if it only offers one independent effect size. In contrast, this study used multilevel meta-analysis — a more advanced statistical method modelling both between-study and within-study effects. This approach results in more accurate estimates and more dependable conclusions.
Eligible studies were randomized controlled trials (RCTs) with usual care, no intervention, or waitlist controls, involving children and adolescents aged 5–18 diagnosed with ADHD by internationally recognized diagnostic criteria, and reporting inhibitory control outcomes.
Eleven studies combining 512 children and adolescents met these inclusion standards.
The analysis between experimental and control groups indicated that the exercise intervention group had significantly improved inhibitory control performance compared to the control group, with a medium-to-large effect size. There was very little variation (heterogeneity) in outcome between the studies, and no sign of publication bias.
Within-group analyses showed that experimental groups had significant improvements after the intervention compared to baseline, with large effect sizes and moderate heterogeneity.
By comparison, analyzing control groups over the same period revealed no significant differences, indicating that inhibitory control abilities in these groups remained largely unchanged throughout the observation period. There was little heterogeneity.
Nevertheless, only one of the studies was rated low risk of bias, nine had some concerns, and two were rated high risk of bias. The greatest shortcomings were a lack of blinding and preregistration.
The study authors therefore concluded that the overall evidence quality of this meta-analysis is low, limiting confidence in the results. While exercise interventions seem to improve inhibitory control abilities in children and adolescents with ADHD, significant methodological limitations create uncertainty about the effect size. These require more rigorous future studies to clarify these effects. Despite these caveats, they noted that all included studies reported statistically significant, consistent benefits from exercise interventions, offering preliminary support for their use as an adjunctive approach.
Takeaway
This study lands in the same conversation as the adult ADHD exercise meta-analysis, and together they start to form a coherent picture: exercise appears to support attention and impulse control across the lifespan for people with ADHD, not just in one age group. The honest caveat is that the research quality in this field is still catching up to the enthusiasm — most studies have design weaknesses that limit confidence in the exact size of the effect. But the consistency of findings across studies, age groups, and now two separate meta-analyses is hard to dismiss.
A new study in the respected journal PLOS One analyzes data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to examine trends in the incidence, prevalence, and disability-adjusted life-years associated with ADHD among adolescents and young adults aged 10 to 24 years between 1990 and 2021.
The GBD 2021, released by the Institute for Health Metrics and Evaluation (U.S.), is a comprehensive global analysis of 371 diseases, injuries, and risk factors – such as ADHD – across 204 countries from 1990 to 2021. Its open-source data are publicly available.
First, a distinction. Incidence measures the number of new cases of a disease that develop in a specific population each year. Prevalence measures the total number of existing cases – both new and pre-existing – in a population each year.
The estimated global incidence of ADHD declined marginally from 12.61 per 100,000 population in 1990 to 11.89 per 100,000 population in 2021, representing an average annual decrease of 0.6% in age-standardized incidence. The rates observed were comparable between males and females.
Regional trends varied: Western Europe had the highest rise in ADHD incidence (0.5% annually), while North Africa and the Middle East saw the largest drop (0.7% annually). Overall, a higher Socio-Demographic Index (SDI) is linked to a greater incidence, although it is far from a perfect fit. Nationally, showed the highest increase in ADHD incidence (1.15% annually), while Qatar showed the largest decrease with an annualized reduction of 1.77%.
The estimated global prevalence of ADHD declined marginally from 2.38% in 1990 to 2.17% in 2021. Again, the decline was similar for males and females, and across all age groups (10-14, 15-19, 20-24). Higher SDI was associated with higher prevalence, but inconsistently.
Disability-adjusted life-years (DALYs) combine years lost from early death and years lived with disability to measure disease burden. Globally, the age-standardized DALYs rate for ADHD decreased slightly from 30.3 per 100,000 population to 26.6 per 100,000 population, for an average annual decline of 0.6%. The decline occurred across age groups and was similar between males and females.
The authors concluded that ADHD rates and related health burdens have generally declined over the past quarter century, though recent patterns are less consistent due to factors like socioeconomic changes and evolving diagnostic standards. Continued research is needed to improve the accuracy and accessibility of ADHD diagnosis and treatment to further reduce its global impact.
Take-Away:
The broader takeaway is one of cautious reassurance. Despite rising public awareness and diagnosis rates in many Western countries, the global picture over 25 years shows a gentle decline in ADHD burden among young people as opposed to a crisis of escalating proportions as social media may make one think. That said, the variation between regions suggests that access to diagnosis, cultural factors, and reporting standards are shaping the numbers as much as underlying biology. Progress is real but uneven, and the work of improving equitable access to diagnosis and care is far from finished.
The first few weeks of life are the time when babies are most vulnerable to seizures (known as neonatal seizures). This is partly because of events that can occur during birth, and partly because the newborn brain is naturally in a more excitable state than a mature brain, making it more prone to seizure activity.
Seizures affect roughly 1 to 3 in every 1,000 full-term babies born, and the rate is considerably higher in premature babies, at around 11 to 14 per 1,000. In most cases, seizures at this age are triggered by a specific event or injury affecting the brain. In full-term newborns, the most common cause is a condition called hypoxic-ischemic encephalopathy (HIE), which occurs when the brain is deprived of adequate oxygen and blood flow around the time of birth. Other causes include genetic or metabolic conditions, stroke, bleeding in the brain, and structural abnormalities in how the brain developed. In very premature babies, bleeding into the fluid-filled spaces of the brain (known as intraventricular hemorrhage) is the leading culprit.
Diagnosing seizures in newborns is tricky because many normal or abnormal movements and behaviors in this age group can look like seizures without actually being them. For this reason, monitoring the baby’s brain activity using an electroencephalogram (EEG) – a test that records electrical signals in the brain – is essential to confirm whether a seizure is truly occurring.
Sweden’s single-payer health system provides universal coverage, with national registers linking healthcare and population data. Researchers tracked infants with EEG/aEEG-confirmed seizures born between 2009 and 2020 and compared them to controls without neonatal seizures.
Altogether, 1062 infants with neonatal seizures were matched with 5310 controls.
The team adjusted for birth, mode of delivery, sex, birth weight, and Apgar scores – quick, standardized assessments used to evaluate newborns’ health minutes after birth.
With these adjustments, infants who had neonatal seizures were twice as likely to subsequently be diagnosed with ADHD and three times as likely to be subsequently diagnosed with autism spectrum disorder.
The authors emphasized that because the study was observational, it cannot demonstrate a direct cause-and-effect relationship between neonatal seizures and outcomes. Factors like seizure frequency, genetics, and socioeconomic status are thought to significantly impact the prognosis of affected children, but these could not be included in this study due to data limitations.
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