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S010-4

Methylphenidate and Traumatic Brain Injury among Children with
Attention-Deficit/Hyperactivity Disorder: A nationwide Population-Based Study
in Taiwan

Vincent Chin-Hung Chen1, Yin-To Liao2, Tzu-Chin Lin2, Yao-Hsu Yang3

1Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan ; Department of Psychiatry, Chang
Gung University, Taiwan 2Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan;
Department of Psychiatry, Chung Shan Medical University, Taichung, Taiwan 3Department for Traditional Chinese
Medicine, Chang Gung Memorial Hospital, ChiaYi, Taiwan; Center of Excellence for Chang Gung Research
Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan; Institute of Occupational Medicine and Industrial
Hygiene, National Taiwan

Background/Objective: Attention-deficit hyperactivity disorder (ADHD) is associated with higher
risk of injury. Whether the medical treatment for ADHD would lessen the risk remains unclear. We
sought to investigate methylphenidate treatment as well as treatment duration on the risk of traumatic
brain injury in a large national sample.

Method: Cases less than 18 years old were identified from Taiwan’s National Health Insurance
Research Database with a new primary diagnosis of ADHD (ICD-9:314) between 2000 and 2007.
Total 4548 cases of ADHD were included as the study cohort. The comparing groups were defined as
cases receiving prescription more than 90 days, prescription less than 90 days and no drug
prescription (reference group). All groups were followed until the end of 2009 for first diagnoses of
traumatic head injury. Competing risk adjusted Cox regression analyses were applied, adjusting for
sex, age, residence, seizure, autism, intellectual disability and BZD/hypnotic use.

Result: The medical treatment more than 90 days was associated with lower risk of traumatic brain
injury in the adjusted model. The adjusted hazard ratio was 0.43 (95% Confidence interval: 0.
30-0.63). The reduced risk was not evident for treatment lasting less than 90 days (AHR:1.16, 95%
Confidence interval:0.85-1.58).

Conclusion: Medical treatment decreased the risk of fracture among ADHD patient. The protective
effect was evident only when the treatment lasted for more than 90 days.