dc.contributor.author | Widding-Havnerås, Tarjei | |
dc.date.accessioned | 2023-10-27T09:21:40Z | |
dc.date.available | 2023-10-27T09:21:40Z | |
dc.date.issued | 2023-11-07 | |
dc.date.submitted | 2023-10-16T19:21:01.630Z | |
dc.identifier | container/f3/61/d2/ae/f361d2ae-2cad-466c-90c4-2e34b6feb739 | |
dc.identifier.isbn | 9788230841266 | |
dc.identifier.isbn | 9788230844335 | |
dc.identifier.uri | https://hdl.handle.net/11250/3099111 | |
dc.description.abstract | Attention-deficit/hyperactivity disorder (ADHD) er den vanligste nevropsykiatriske lidelsen hos barn og unge. Store geografiske variasjoner i diagnostisering og medisinering av ADHD har bidratt til bekymringer om under- og overbehandling. Det er behov for mer kausal kunnskap om hvordan farmakologisk behandling av ADHD påvirker virkelige utfall for personer med mildere symptomer som behandles eller ikke behandles avhengig av behandlers preferanser. Denne avhandlingen estimerer effekter av farmakologisk behandling av ADHD på kriminalitet og ulykker, og undersøker geografisk variasjon i diagnoser og symptombelastning for ADHD basert på norske register- og surveydata. Variasjon i klinikeres behandlingspreferanse for pasienter i «gråsonen» (eller på marginen) for behandling anvendes som en kvasieksperimentell randomisering til ADHD medisin for ellers like pasienter i et instrumentvariabeldesign. Behandlingsestimatene gjelder pasienter hvor klinikeres behandlingsbeslutninger varierer, og inkluderer ikke pasienter med lav eller høy symptombelastning der det er klinisk konsensus.
Jeg finner beskyttende effekter av farmakologisk behandling på vold- og orden- og integritetsrelatert kriminalitet, men ikke andre typer kriminalitet. Jeg finner ikke klar støtte for behandlingseffekter på ulykker. Videre er den geografiske variasjonen i ADHD-diagnoser betydelig større enn det som kan forklares av variasjon i symptombelastning. Avhandlingen bidrar til tre områder innen ADHD-forskningen: debatten om under- og overbehandling, kausal inferens, og langtidseffekter for kriminalitet og ulykker.
Kliniske behandlingsbeslutninger er basert på en helhetlig vurdering. Avhandlingen viser at farmakologisk behandling reduserer noen typer kriminalitet, men ikke ulykker, for den understuderte pasientgruppen i «gråsonen» for behandling, og utvider dermed evidensgrunnlaget til klinikers beslutninger for to viktige utfall. Samtidig vises hvordan kvasieksperimentelle design og registerdata kan kombineres for å gi effektestimater som ikke kan oppnås med randomiserte eksperimenter grunnet etikk eller observasjonsstudier grunnet uobservert konfundering. | en_US |
dc.description.abstract | Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and adolescents. Large geographical variations in diagnosis and medication for ADHD have raised concerns about under- and overtreatment. There is demand for more causal knowledge about how pharmacological treatment of ADHD impacts real-life outcomes among otherwise similar patients who receive treatment due to varying provider preference for treatment. This thesis estimates effects of pharmacological treatment of ADHD on crime and injuries and examines geographical variation in diagnoses and symptom load of ADHD based on Norwegian population-wide registry and survey data. Variation in providers’ (i.e., clinicians) treatment preference for patients on the margin of treatment is used as quasi-experimental randomization to pharmacological treatment in an instrumental variable design. The treatment effects concern patients where providers differ in treatment decisions, and do not include patients with a very low or high symptom burden where there is clinical consensus.
I find protective effects of pharmacological treatment on violence- and public-orderrelated crimes, but not other types of crime. I do not find clear evidence for treatment effects on overall injuries. Furthermore, the geographical variation in diagnoses of ADHD is much larger than what can be explained by variation in symptom load. The thesis contributes to three areas in ADHD research: the debate on under- and overtreatment, causal inference, and long-term effects on crime and injuries.
Clinical treatment decisions are based on a holistic assessment where many outcomes are considered. This thesis shows that pharmacological treatment reduces some types of crimes, but not overall injuries, for the understudied patient group on the margin of treatment, and this expands the evidence base for clinicians’ decisions for two important real-life outcomes among people with ADHD. The methodological approach illustrates how quasi-experimental designs and registry data can be combined to estimate treatment effects that cannot be obtained in randomized experiments due to ethics nor observational studies due to unobserved confounding. | en_US |
dc.language.iso | eng | en_US |
dc.publisher | The University of Bergen | en_US |
dc.relation.haspart | Paper I: Tarjei Widding-Havneraas, Henrik Daae Zachrisson, Simen Markussen,
Felix Elwert, Ingvild Lyhmann, Ashmita Chaulagain, Ingvar Bjelland, Anne Halmøy,
Knut Rypdal, Arnstein Mykletun. Effect of Pharmacological Treatment of Attention-Deficit/Hyperactivity Disorder on Criminality. Journal of the American Academy of Child & Adolescent Psychiatry. 2024. 63(4): 433-442. The article is available at: <a href=" https://hdl.handle.net/11250/3099106" target="blank"> https://hdl.handle.net/11250/3099106</a> | en_US |
dc.relation.haspart | Paper II: Tarjei Widding-Havneraas, Felix Elwert, Simen Markussen, Henrik Daae Zachrisson, Ingvild Lyhmann, Ashmita Chaulagain, Ingvar Bjelland, Anne Halmøy, Arnstein Mykletun. Effect of ADHD medication on risk of injuries: a preference-based instrumental variable analysis. European Child & Adolescent Psychiatry. 2024. 33: 1987-1996. The article is available at: <a href="https://hdl.handle.net/11250/3099108" target="blank">https://hdl.handle.net/11250/3099108</a> | en_US |
dc.relation.haspart | Paper III: Tarjei Widding-Havneraas, Simen Markussen, Felix Elwert, Ingvild Lyhmann, Ingvar Bjelland, Anne Halmøy, Ashmita Chaulagain, Eivind Ystrøm, Arnstein Mykletun, Henrik Daae Zachrisson. Geographical variation in ADHD: do diagnoses reflect symptom levels? European Child & Adolescent Psychiatry. 2023. 32: 1795-1803. The article is available at: <a href="https://hdl.handle.net/11250/3010312" target="blank">https://hdl.handle.net/11250/3010312</a> | en_US |
dc.rights | In copyright | |
dc.rights.uri | http://rightsstatements.org/page/InC/1.0/ | |
dc.title | Effect of ADHD Medication on Criminality and Injuries : Quasi-Experimental Evidence for Patients on the Margin of Treatment | en_US |
dc.type | Doctoral thesis | en_US |
dc.date.updated | 2023-10-16T19:21:01.630Z | |
dc.rights.holder | Copyright the Author. All rights reserved | en_US |
dc.contributor.orcid | 0000-0002-5823-7508 | |
dc.description.degree | Doktorgradsavhandling | |
fs.unitcode | 13-24-0 | |