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

Dawn E Peleikis,Egil W Martinsen,Ole Klungsoyr,Mats Fredriksen,Alv A Dahl,Stephen V Faraone

doi:10.1007/s12402-014-0126-1

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.

Highlights

Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental condition characterized by age-inappropriate levels of inattention, hyperactivity, and impulsivity (H/I) (Kooij et al 2010)
We found higher nonworking rates in our sample than reported in some other studies of adults with attention deficit hyperactivity disorder (ADHD) (Able et al 2007; Sobanski et al 2007), similar proportions were reported in studies by Halmoy et al (2009) and Gjervan et al (2012)
Severity of ADHD symptoms and a high load of child hyperactive–impulsive symptoms in childhood were associated with dropout from school and fewer years of attained education, indicating an increased risk for unfavorable educational outcomes related to these symptoms in childhood and adolescence

Summary

Introduction

Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental condition characterized by age-inappropriate levels of inattention, hyperactivity, and impulsivity (H/I) (Kooij et al 2010). Adolescents and young adults with childhood ADHD have significantly poorer academic achievement and work performance compared with those who did not have ADHD as children (Barkley et al 2006; Hechtman et al 1984). As adults, they have more comorbid mental disorders, including drug and alcohol abuse (Hechtman and Weiss 1986; Biederman et al 2006). Childhood onset and persistent adult ADHD seem to have serious long-term consequences (Able et al 2007; Adler 2007; De Graaf et al 2008; Kessler et al 2005b). Poor academic achievement and long-term work disability may be considered relevant for adult functioning due to their widespread social, financial, and personal consequences (Biederman et al 2008)

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