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23 Jul 2021

Christiansen MS et al. Child Adolesc Psychiatry Ment Health 2021; 15: 34

ADHD is most frequently diagnosed during childhood but is known to affect individuals throughout their lifetime. Through a review of existing literature, this study aimed to examine the association between ADHD in childhood and future employment.

The authors performed a systematic search of MEDLINE, Web of Science, PsycINFO and the Cochrane Library databases to identify prospective longitudinal studies evaluating the impact of childhood diagnosis of ADHD on employment.* Identified references were screened, appraised for quality and data extracted. For inclusion, studies were required to have a population with an ADHD/attention deficit disorder (ADD) diagnosis at age 6–18 years and comparable ADHD/ADD-free controls (age- and sex-matched), and be written in English, Danish, Swedish or Norwegian. No timeframe was set. Studies were excluded if they were performed in low- or middle-income countries, or included adults beyond working age (>60 years). Systematic reviews on similar topics were also screened for relevant studies. Searching was last performed in November 2020.

After all screening processes, six studies (of an initial 2505 identified references) – published between 1993 and 2017 – met the inclusion criteria. The studies included a combined population of 904 individuals with ADHD/ADD and 647 controls, ranging from 6–17 years of age, and had a follow-up period of 16–33 years. One paper, judged to be of poor quality, was subsequently excluded from the assessment of results.

Job attainment and attachment

Overall, a diagnosis of ADHD was found to affect the nature of an individual’s attachment to the labour market. Two studies reported data on ‘job changes’, finding that the number of times a person was fired or had quit was predicted by high baseline ADHD severity score; people with ADHD had twice as many job changes due to being fired or quitting (0.61 vs 0.32; p<0.001) and a significantly shorter average job length (381 vs 422 days; p<0.001) compared with controls. Another study of women with ADHD reported that those with persistent symptoms had significantly worse functioning at work (self-report), and significantly more problems at work than control subjects. Two other studies found that individuals with ADHD had significantly lower occupational levels/rankings than controls. Significantly fewer people with ADHD were employed as professionals (4% vs 21% controls; p<0.001) while rates for lower-ranking positions and among skilled workers were comparable. In contrast, 18% of people with ADHD were owners of small businesses, compared with only 5% of controls.

Earnings

Four studies reported on the economic situation of adults with ADHD diagnosed in childhood. People with ADHD were found to be more likely to be receiving public assistance compared with controls (16% vs 3.2%), with persistent symptoms and higher baseline symptom severity of ADHD associated with the worst outcomes. In contrast, a study of women found no significant differences between those with ADHD and controls in terms of receipt of public assistance or salary levels. Another study reported that men with ADHD were more likely to be financially dependent on their parents than control subjects (26.6% vs 13.3%; p=0.03), and that those who were financially independent had significantly lower personal socio-economic status than controls.

Educational attainment

All five studies presented data on educational attainment at follow-up and found that the level of educational achievement was consistently lower in the group of individuals with ADHD than in controls. One study found that the proportion of patients with high-school education or less was 63% among those with ADHD and 27% among controls, and that those with ADHD had completed 2 years less schooling than controls (p<0.001). Another study reported that 42.1% of controls had a bachelor’s or master’s degree compared with 15.1% of the ADHD group (p<0.001). This was associated with an odds ratio of 1.29 for controls obtaining a degree compared with the ADHD group, with another analysis showing that the chance of a person with ADHD obtaining a degree decreased with greater symptom severity. Consistent with these results, educational functioning (as reported by participants, parents and clinicians) was also found to be higher among controls than people with ADHD, with the lowest scores seen among those with persistent symptoms.

The authors do not cite limitations in this systematic review, but note the scarcity and overall poor quality of studies meeting the inclusion criteria.

Based on findings from five studies, the authors concluded that individuals with ADHD generally experience lower-quality employment than those without ADHD. They note that ADHD is a significant negative predictor for future occupational outcomes, but suggest that some factors (not defined by the review) may act in opposition to positively influence work and educational levels. They suggest further research is warranted to identify factors and interventions that may reduce the long-term vocational effects of childhood ADHD.

Read more about the impact of a childhood diagnosis of ADHD on work-related outcomes in later life here

 

*Search terms used were ‘attention deficit disorder with hyperactivity’, ‘attention deficit disorder’ or ‘ADHD’ combined with ‘adult’ and ‘occupations’, ‘work’, ‘employment’ or ‘workplace’.

Disclaimer: The views expressed here are the views of the author(s) and not those of Takeda.

Christiansen MS, Labriola M, Kirkeskov L, Lund T. The impact of childhood diagnosed ADHD versus controls without ADHD diagnoses on later labour market attachment – a systematic review of longitudinal studies. Child Adolesc Psychiatry Ment Health 2021; 15: 34.

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