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9 Jul 2018

Baggio S et al. Int J Public Health 2018; Epub ahead of print

Young people with ADHD may experience difficulties when transitioning into adulthood due to increased responsibilities and demands for organisation and self-regulation. However, few studies have investigated how ADHD affects the transition into adulthood. Using a population-based sample of young Swiss men, this study examined how the level of ADHD symptoms affects the experiences of emerging adults transitioning into adulthood.

This study was a subanalysis of data collected in the Cohort Study on Substance Use and Risk Factors, which was a longitudinal study designed to assess addictive behaviours and associated risk factors in young Swiss men enrolled between 2010 and 2011 during the conscription in three Swiss military recruitment centres.* The Adult ADHD Self-Report Scale (ASRS-v1.1.) Screener was used to assess adult symptoms of ADHD at baseline (T0) and the Inventory of Dimension of Emerging Adulthood short form (IDEA) scale was used to assess psychological issues of emerging adulthood at ~15 months after baseline (T1; 2012–2013) and ~49 months after T1 (T2; 2016–2017). A total score (ranging from 0 to 5) of markers§ of adulthood was computed at T0, T1 and T2; a score of 5 indicated that participants had transitioned into all social roles of adulthood. The following demographic covariates were also included in the analyses: age, language (French- or German-speaking), parental financial situation at T0 and use of ADHD medication in the previous 12 months. Descriptive statistics were first computed for all variables, and subsequently multi-level modelling for repeated measures was used to assess the relationship between ADHD and measurements of emerging adulthood.

In total, 4681 participants completed online or written questionnaires at each follow-up stage. The mean age of participants at T0, T1 and T2 was 20.0, 21.3 and 25.4 years, respectively. More participants spoke French (55.9%) than German (44.1%), and 45.1% of participants reported their parents’ financial situation as being “above average”.

A total of 188 (4.0%) participants met the ASRS-v1.1 Screener criteria for adult ADHD; the mean scores for inattentive symptoms and hyperactive symptoms were 0.85±0.73 and 1.14±1.00, respectively. At T2, 83 (1.8%) participants reported having ADHD medications. At T0, participants had an average of 0.64±0.91 adulthood markers, which increased to 1.14±1.04 at T1 and then to 1.79±1.23 at T2, such that time was significantly associated with the number of adulthood markers (p<0.001). A higher level of ADHD symptoms was associated with a lower number of adulthood markers, with significant interactions observed between adulthood markers and ADHD whole score (b = –0.02; p < 0.001) and inattentive score (b = –0.15; p < 0.001), but not ADHD hyperactive score (b = 0.03; p = 0.232). A higher level of ADHD symptoms was also associated with a higher IDEA score for the ADHD whole score (b = 0.02; p < 0.001), the ADHD inattentive score (b = 0.12; p < 0.001) and the ADHD hyperactive score (b = 0.02; p < 0.001); but there was no significant effect of time on either IDEA score (b = –0.02; p = 0.072) or ADHD scores (b ≥ –0.02; p ≥ 0.272). These data suggest that in this study, the level of ADHD symptoms was associated with an impaired transition into adulthood, as participants with high ADHD scores had a lower number of adulthood markers and had high IDEA scores.

This study had some limitations. The first limitation was that the participants were all male and, although ADHD is more prevalent in males compared with females, there is evidence to suggest that presentation of inattentive symptoms of ADHD and persistence of ADHD into adulthood may be more likely in females; therefore, collection of data from females is required to confirm the findings of this study in both genders. Secondly, this study used data from participants enrolled from 21 of the 26 cantons of Switzerland, and information on the demographics and clinical characteristics of participants from the five remaining cantons was not available, therefore this study sample was not representative of Switzerland as a whole. Thirdly, in this study, ADHD was assessed using the ASRS-v1.1 self-report Screener and not via a formal diagnosis. ADHD treatment was also not controlled for, and the authors suggested that future studies should control for and distinguish between ADHD treatments. Finally, psychiatric comorbidities, cognitive level and general functioning were not assessed in this study, and the authors suggested that these factors should be taken into consideration in future studies.

The authors concluded that this study showed that the level of ADHD symptoms may delay the transition into adulthood. They suggested that evidence-based treatments are needed to help emerging adults with ADHD symptoms during the transition into adulthood, as this may reduce the impairments that adults with ADHD may experience in their personal and professional life.

Read more about the transition into adulthood in emerging adults with ADHD symptoms here


*All young men ~20 years old were eligible for the conscription process; enrolment in the study was independent from the military recruitment
The ASRS-v1.1 Screener covers 6 symptoms, based on the Diagnostic and Statistical Manual of Mental Disorders – 4th Edition criteria for ADHD. ADHD symptoms are reported on a 5-point scale, with a total score ranging from 0 to 24. In this study, scores ≥14 indicated that an individual fulfilled the ASRS-v1.1 Screener criteria for ADHD
Participants answered 8 questions related to identity exploration, optimistic lifeview, and instability and uncertainty associated with emerging adulthood. A mean score was computed for all questions and ranged from 1 to 4, with higher scores indicating that participants were transitioning into adulthood and lower scores indicating that participants had not yet started to transition or that they had not reached adulthood
§Markers of adulthood included: completed education (have completed education or not); living arrangements (independent living from parents or not); financial independence (cover living expenses or not); stable relationship (live with a partner or not); and parenthood (have children or not)

Baggio S, Struder J, Fructuoso A, et al. Dose level of attention deficit-hyperactivity disorder symptoms predicts poor transitioning into adulthood? Int J Public Health 2018; Epub ahead of print.

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