Psychiatric Comorbidities Predict Elevated Suicidal Symptoms in Children with ADHD

ABSTRACT Introduction: Suicide in childhood is a growing clinical concern, and Attention Deficit/Hyperactivity Disorder (ADHD) is increasingly recognized as a potential contributor. However, the role of psychiatric comorbidities, particularly depression, anxiety, and bipolar disorders, in shaping suicide risk in children with ADHD remains insufficiently understood. Methods: We analyzed data from 10,862 children aged 8 –11 in the ABCD Study. Descriptive analyses were used to estimate the prevalence of suicidal behaviors and psychiatric comorbidities in children with and without ADHD, stratified by sex. Logistic regression models were applied to assess suicide risk associated with ADHD and comorbid psychiatric diagnoses, adjusting for age and sex. Results: Children with ADHD had significantly higher rates of suicidal behaviors than controls. Passive suicidal ideation was reported in 15.6% of females and 7.6% of males with ADHD, versus 7.0% and 4.7% in controls (p <0.001). Logistic regression identified Major Depressive Disorder (OR ≈10–19) and Bipolar Disorder Type 2 (OR ≈7–13) as the strongest predictors across outcomes. ADHD independently increased risk for most behaviors but moderated risk when comorbid with depression or Generalized Anxiety Disorder. Sex differences showed greater Bipolar Disorder Type 2 and Generalized Anxiety Disorder related risk in females, and greater Bipolar Disorder Type 1 and depression related risk in males. Discussion: Children with ADHD have higher rates of suicidal thoughts and behaviors than controls, with Major Depressive Disorder and Bipolar Disorder Type 2 as the strongest independent predictors. However, ADHD moderates the risk from Major Depressive Disorder and General Anxiety Disorder, likely due to earlier recognition and intervention. Lastly, sex-specific patterns show higher BD2 and GAD related risk in females, BD1 related risk in males. Conclusion: ADHD significantly increases the risk of suicidal ideation in children. However, when present with comorbid conditions, ADHD may offer a clinical advantage by prompting earlier diagnosis and access to care. Improving ADHD recognition in pediatric settings could serve as a critical step in suicide prevention and early psychiatric intervention.