The impact of attention-deficit hyperactivity disorder (ADHD), or hyperkinetic disorder (HKD), on many areas of life is an important consideration, especially as ADHD affects not only the lives of the patients themselves, but also their families and carers.1,2
If left untreated, how can ADHD affect the lives of adults on a day-to-day basis? | Dr Joel Young | Rochester Centre for Behavioral Medicine, Michigan, USA
Children and adolescents with ADHD can experience persistent symptoms and functional impairments into adulthood; persistence can be predicted from psychosocial adversity and psychiatric comorbidity.3-5
At each stage of life, the impact of ADHD on functioning may vary (Table).6
Examples of ADHD impact across the lifespan6-8
ADHD can negatively affect:
- Education – children and adolescents with ADHD may perform less well than controls in school-related assessments9-13
- Employment – adult ADHD has been associated with difficulties with workplace productivity and maintaining employment13-18
- Relationships – ADHD symptoms can contribute to misunderstandings in social situations and put strain on relationships with family, friends, teachers and colleagues13,14,19
- Quality of life – patients and their families have reported poorer quality of life than control groups in several studies1,9,20-22
- Finances – ADHD can also be associated with substantial financial burden for individuals, families and societal healthcare services.14,19,23-34
The large, cross-sectional, European Lifetime Impairment Survey (sponsored by Shire) assessed the impairment and symptoms of ADHD in children and adolescents from six European countries (France, Germany, Italy, Spain, the Netherlands and the UK). Parents/caregivers of children and adolescents with ADHD (n=535) and parents/caregivers of children and adolescents without ADHD (n=424) participated in the online survey.9
Parents/caregivers of children and adolescents with ADHD reported a perceived negative impact on various aspects of their child’s life, including life at school (45%), daily life and activities (35%) and social life (34%) (Figure).9
Perceived negative impact (strong and moderate) of ADHD on everyday life as reported by parents/caregivers of children and adolescents with ADHD in the European Lifetime Impairment Survey. Reproduced with kind permission.9
The Lifetime Impairment Survey also assessed the impact of ADHD in childhood and adolescence, as recalled by adults with ADHD (n=588) compared with adults without ADHD (n=736).35 Adults with ADHD recalled similar impact from their childhood, as indicated by a lower degree of agreement with positive statements related to daily life and relationships compared with adults without ADHD (Figure).35
Impact of ADHD in childhood and adolescence as recalled by adults with ADHD in the Lifetime Impairment Survey. Reproduced with kind permission.35
- Cussen A, Sciberras E, Ukoumunne OC, et al. Relationship between symptoms of attention-deficit/hyperactivity disorder and family functioning: a community-based study. Eur J Pediatr 2012; 171: 271-280.
- Davis CC, Claudius M, Palinkas LA, et al. Putting families in the center: family perspectives on decision making and ADHD and implications for ADHD care. J Atten Disord 2012; 16: 675-684.
- Biederman J, Petty CR, Clarke A, et al. Predictors of persistent ADHD: An 11-year follow-up study. J Psychiatr Res 2011; 45: 150-155.
- Biederman J, Petty CR, O’Connor KB, et al. Predictors of persistence in girls with attention deficit hyperactivity disorder: results from an 11-year controlled follow-up study. Acta Psychiatr Scand 2012; 125: 147-156.
- Lara C, Fayyad J, De Graaf R, et al. Childhood predictors of adult attention-deficit/hyperactivity disorder: results from the World Health Organization World Mental Health Survey Initiative. Biol Psychiatry 2009; 65: 46-54.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013.
- Coghill D, Soutullo C, d’Aubuisson C, et al. Impact of attention-deficit/hyperactivity disorder on the patient and family: results from a European survey. Child Adolesc Psychiatry Ment Health 2008; 2: 31.
- Kooij JJ, Francken M.H. Diagnostic Interview for ADHD in Adults (DIVA). Available at: http://www.divacenter.eu/Content/VertalingPDFs/DIVA_2_EN_FORM%20-%20invulbaar.pdf. Last updated 2010. Accessed 05 January 2017.
- Caci H, Doepfner M, Asherson P, et al. Daily life impairments associated with self-reported childhood/adolescent attention-deficit/hyperactivity disorder and experiences of diagnosis and treatment: results from the European Lifetime Impairment Survey. Eur Psychiatry 2014; 29: 316-323.
- Holmberg K, Bölte S. Do symptoms of ADHD at ages 7 and 10 predict academic outcome at age 16 in the general population? J Atten Disord 2014; 18: 635-645.
- Kuriyan AB, Pelham WE, Jr., Molina BS, et al. Young Adult Educational and Vocational Outcomes of Children Diagnosed with ADHD. J Abnorm Child Psychol 2013; 41: 27-41.
- Fredriksen M, Dahl AA, Martinsen EW, et al. Childhood and persistent ADHD symptoms associated with educational failure and long-term occupational disability in adult ADHD. Atten Defic Hyperact Disord 2014; 6: 87-99.
- Biederman J, Faraone SV, Spencer TJ, et al. Functional impairments in adults with self-reports of diagnosed ADHD: a controlled study of 1001 adults in the community. J Clin Psychiatry 2006; 67: 524-540.
- Brod M, Pohlman B, Lasser R, et al. Comparison of the burden of illness for adults with ADHD across seven countries: a qualitative study. Health Qual Life Outcomes 2012; 10: 47.
- de Graaf R, Kessler RC, Fayyad J, et al. The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative. Occup Environ Med 2008; 65: 835-842.
- Shifrin JG, Proctor BE, Prevatt FF. Work performance differences between college students with and without ADHD. J Atten Disord 2010; 13: 489-496.
- Adamou M, Arif M, Asherson P, et al. Occupational issues of adults with ADHD. BMC Psychiatry 2013; 13: 59.
- Halmoy A, Fasmer OB, Gillberg C, et al. Occupational outcome in adult ADHD: impact of symptom profile, comorbid psychiatric problems, and treatment: a cross-sectional study of 414 clinically diagnosed adult ADHD patients. J Atten Disord 2009; 13: 175-187.
- Pitts M, Mangle L, Asherson P. Impairments, diagnosis and treatments associated with attention-deficit/hyperactivity disorder (ADHD) in UK adults: results from the lifetime impairment survey. Arch Psychiatr Nurs 2015; 29: 56-63.
- Grenwald-Mayes G. Relationship between current quality of life and family of origin dynamics for college students with attention-deficit/hyperactivity disorder. J Atten Disord 2002; 5: 211-222.
- Gudjonsson GH, Sigurdsson JF, Eyjolfsdottir GA, et al. The relationship between satisfaction with life, ADHD symptoms, and associated problems among university students. J Atten Disord 2009; 12: 507-515.
- O’Callaghan P, Sharma D. Severity of symptoms and quality of life in medical students with ADHD. J Atten Disord 2014; 18: 654-658.
- Biederman J, Faraone SV. The effects of attention-deficit/hyperactivity disorder on employment and household income. MedGenMed 2006; 8: 12.
- Braun S, Zeidler J, Linder R, et al. Treatment costs of attention deficit hyperactivity disorder in Germany. Eur J Health Econ 2012; 14: 939-945.
- De Ridder A, De Graeve D. Healthcare use, social burden and costs of children with and without ADHD in Flanders, Belgium. Clin Drug Investig 2006; 26: 75-90.
- Hakkaart-van Roijen L, Zwirs BW, Bouwmans C, et al. Societal costs and quality of life of children suffering from attention deficient hyperactivity disorder (ADHD). Eur Child Adolesc Psychiatry 2007; 16: 316-326.
- Hodgkins P, Montejano L, Sasané R, et al. Cost of illness and comorbidities in adults diagnosed with attention-deficit/hyperactivity disorder: a retrospective analysis. Prim Care Companion CNS Disord 2011; 13.
- Le HH, Hodgkins P, Postma MJ, et al. Economic impact of childhood/adolescent ADHD in a European setting: the Netherlands as a reference case. Eur Child Adolesc Psychiatry 2014; 23: 587-598.
- Telford C, Green C, Logan S, et al. Estimating the costs of ongoing care for adolescents with attention-deficit hyperactivity disorder. Soc Psychiatry Psychiatr Epidemiol 2013; 48: 337-344.
- Klora M, Zeidler J, Linder R, et al. Costs and treatment patterns of incident ADHD patients – a comparative analysis before and after the initial diagnosis. Health Econ Rev 2015; 5: 40.
- Kawatkar AA, Knight TK, Moss RA, et al. Impact of mental health comorbidities on health care utilization and expenditure in a large US managed care adult population with ADHD. Value Health 2014; 17: 661-668.
- Hodgkins P, Montejano L, Sasané R, et al. Risk of injury associated with attention-deficit/hyperactivity disorder in adults enrolled in employer-sponsored health plans: a retrospective analysis. Prim Care Companion CNS Disord 2011; 13.
- Flood E, Gajria K, Sikirica V, et al. The Caregiver Perspective on Paediatric ADHD (CAPPA) survey: Understanding sociodemographic and clinical characteristics, treatment use and impact of ADHD in Europe. J Affect Disord 2016; 200: 222-234.
- Kleinman NL, Durkin M, Melkonian A, et al. Incremental employee health benefit costs, absence days, and turnover among employees with ADHD and among employees with children with ADHD. J Occup Environ Med 2009; 51: 1247-1255.
- Caci H, Asherson P, Donfrancesco R, et al. Daily life impairments associated with childhood/adolescent attention-deficit/hyperactivity disorder as recalled by adults: results from the European Lifetime Impairment Survey. CNS Spectr 2015; 20: 112-121.