Abstract
BackgroundIndividuals with ADHD have been associated with more employment difficulties in early adulthood than healthy community controls. To examine whether this association is attributable specifically to disturbance of activity and attention (ADHD) or to psychopathology in general, we wanted to extend existing research by comparing the rate of mid-adulthood working disabilities for individuals diagnosed with ADHD as children with the rate for clinical controls diagnosed with either conduct disorder, emotional disorder or mixed disorder of conduct and emotions.MethodsFormer Norwegian child-psychiatric in-patients (n = 257) were followed up 17–39 years after hospitalization by record linkage to the Norwegian national registry of disability pension (DP) awards. Based on the hospital records, the patients were re-diagnosed according to ICD-10. Associations between the diagnoses, other baseline factors and subsequent DP were investigated using Kaplan–Meier survival analyses and logrank testing.ResultsAt follow-up, 19% of the participants had received a DP award. In the logrank testing, ADHD was the only disorder associated with a subsequent DP, with 30% being disabled at follow-up (p = 0.01). Low psychosocial functioning (assessed by the Children’s Global Assessment Scale) at admission uniquely predicted future DP (p = 0.04).ConclusionsADHD in childhood was highly associated with later receiving a DP. Our finding of worse prognosis in ADHD compared with other internalizing and externalizing disorders in mid-adulthood supports the assumption of ADHD being specifically linked to working disability. Assessment of psychosocial functioning in addition to diagnostic features could enhance prediction of children who are most at risk of future disability.
Highlights
Individuals with Attention-deficit/hyperactivity disorder (ADHD) have been associated with more employment difficulties in early adulthood than healthy community controls
Hyperkinetic disorder (ADHD) (F90) was diagnosed in 53 individuals (21%), corresponding to the ADHD of combined type according to the DSM-IV criteria [39], except for three participants who fulfilled only the criteria for ADD
With the exception of the emotional group, which had a greater percentage of females and higher Children’s Global assessment scale (CGAS) scores at admission, there were no significant differences between diagnostic groups with regard to age, gender and CGAS score at admission
Summary
Individuals with ADHD have been associated with more employment difficulties in early adulthood than healthy community controls. The use of healthy controls could make it difficult to determine the extent to which the poor outcome found at follow-up was likely to be a function of the severity of ADHD symptoms rather than a function of impairment related to severity of any mental disorder. This is of special importance in disorders that debut in childhood, as aspects of normal development may be suffering. Few studies have tested the validity of the persistent nature of ADHD by comparing working disabilities in individuals with ADHD with those who have either internalizing or other externalizing disorders
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