Childhood and persistent ADHD symptoms associated with educational failure and long-term occupational disability in adult ADHD

Abstract

Few studies have examined the impact of childhood attention deficit hyperactivity disorder (ADHD) symptoms on adult ADHD functional outcomes. To address this issue dimensionally, ADHD symptoms in childhood and adulthood and their relation to educational deficits and work disability are studied in a clinical sample of adult patients with previously untreated ADHD. About 250 adults diagnosed systematically with ADHD according to DSM-IV were prospectively recruited. Primary outcomes were high school dropout and being out of the work last year. Childhood ADHD symptoms, sex differences, comorbidities of other mental disorders, and adult ADHD symptoms were examined by historical data, clinician interviews, and questionnaires. High levels of ADHD symptom severity in childhood were related to dropping out of high school [odds ratio (OR) = 3.0], as were higher numbers of hyperactive–impulsive symptoms in childhood. Significantly, more women than men were long-term work disabled (OR = 2.0). After adjusting for age and gender, persisting high levels of ADHD inattention symptoms in adulthood (OR = 2.5), number of comorbid disorders, and particularly anxiety disorders were significantly related to long-term work disability. Childhood hyperactive–impulsive symptoms and overall severity of childhood ADHD symptoms were associated with high school dropout rates; however, persisting ADHD inattention symptoms and comorbid mental disorders in adulthood were more correlated to occupational impairment. These findings underline proposals for studies on early recognition and interventions for ADHD and psychiatric comorbidity. They further suggest that inattentive symptoms be a focus of adult ADHD treatment and that workplace interventions be considered to prevent long-term work disability.

A longitudinal examination of dyadic distress patterns following a skills intervention for carers of adolescents with anorexia nervosa

“…The clinical heterogeneity of ADHD is further attested by the fact that categories were identified from all nine chapters in the activities and participation component. Consistent with previous research and the operationalization of ADHD, this study supported difficulties in general demands of life, social relationships and school [7][8][9][10]52]. These challenges could be described here in more detail through the use of the IC-CY standardized system.…”

“…ADHD is also characterized by cognitive difficulties [6], and impacts significantly on management of daily routines [7], school [8], work [9] and social relationships [10]. In addition, ADHD is associated with an increased risk for other neurodevelopmental and psychiatric conditions [11,12], poorer quality of life [13], and premature mortality [14].…”

Standardised assessment of functioning in ADHD: consensus on the ICF Core Sets for ADHD

“…The activities and participation categories that were identified as characteristic of living with ADHD were diverse. They range from challenges with social relationships and interactions [8,40] to academic achievement [6,7], occupational functioning [7], and self-care [41]. Contrary to activities and participation, the body function categories were less heterogeneous, consisting mainly of b1 mental function categories.…”

“…ADHD is associated with challenges to functioning in daily life, including academic and vocational difficulties [6,7], social exclusion [8], and delinquency [9,10]. Co-exiting psychiatric issues are also common [11,12].…”

Pharmacological Treatment of Adult Attention-Deficit/Hyperactivity Disorder (ADHD) in a Longitudinal Observational Study: Estimated Treatment Effect Strengthened by Improved Covariate Balance

“…Baseline characteristics of the sample have been thoroughly described previously [11] [13], and constitute demographics, measures of functioning, mental distress, ADHD symptom-level, and comorbid anxiety, depression, bi-polar disorder, and drug and alcohol use disorders. To be diagnosed with ADHD, patients must retrospectively have endorsed at least 6 out of 9 DSM-IV symptoms of inattention and/or hyperactivity/impulsivity in childhood, and currently been assessed by two board certified psychiatrists using the Norwegian version of the Diagnostic Interview for ADHD in Adults, second edition (DIVA 2.0) [14] with at least 5 out of 9 DSM-IV symptoms of inattention and/or hyperactivity/impulsivity for the last 6 months (according to diagnostic threshold for ADHD in adults in DSM-5 [12], and with their ADHD symptoms related to significant impairment in social, academic, or occupational functioning.…”