Young-Adult Social Outcomes of Attention-Deficit/Hyperactivity Disorder

Lucy Riglin, PhD; Andrew Todd, MRCPsych; Rachel Blakey, PhD; Amy Shakeshaft, PhD; Evie Stergiakouli, PhD; George Davey Smith, MD, FRS; Kate Tilling, PhD; Anita Thapar, FRCPsych, PhD

J Clin Psychiatry 2023;84(2):22m14379

ABSTRACT

Objective: Attention-deficit/hyperactivity disorder (ADHD) is associated with a range of adverse outcomes in adult life. However, it is unclear whether the risk pathways to adverse adult outcomes are established during childhood or whether associations are driven by concurrent ADHD symptoms that have persisted to adulthood.

Methods: We examined associations between broadly defined child-limited (remitted) and persistent ADHD (assessed using the ADHD subscale of the Strengths and Difficulties Questionnaire) with negative social outcomes (low emotional and instrumental support, antisocial behavior, employment, receipt of state benefits as an indicator of socio-economic disadvantage, homelessness) at age 25 years in a UK longitudinal population sample, the Avon Longitudinal Study of Parents and Children (age 25 data collected between years 2017 and 2018; total N = 6,439).

Results: Up to 20% of young people with less favorable social outcomes at age 25 had persistent ADHD. Persistent ADHD was associated with an increased likelihood of being not in education, employment, or training (NEET) (OR = 3.71, 95% CI = 2.06 to 6.67, P = 1 × 10⁻⁰⁵) and receiving state benefits (OR = 2.72, 95% CI = 1.62 to 4.57, P = 2 × 10⁻⁰⁴) at age 25 years compared to those without ADHD. We did not find strong evidence of associations between child-limited ADHD and social outcomes (NEET OR = 1.20, 95% CI = 0.54 to 2.69, P = .65; state benefits OR = 1.38, 95% CI = 0.76 to 2.51, P = .29). Persistent ADHD associations with negative social outcomes were observed across family-of-origin income groups and sex and were not explained by comorbidity.

Conclusions: Our findings highlight the importance of continued monitoring and management of ADHD symptoms and related social as well as clinical outcomes across development into adulthood. Future research is needed to identify what factors promote positive social outcomes, including effective treatment of adult ADHD symptoms.

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