Impact of ADHD

Children and adolescents with attention-deficit hyperactivity disorder (ADHD) can experience persistent symptoms and functional impairments into adulthood; persistence can be predicted from psychosocial adversity and psychiatric comorbidity.1-3

At each stage of life, the impact of ADHD on functioning may vary (Table).4

  Children        Adolescents Adults
  Hyperactivity may dominate in pre-school, with inattentiveness becoming more prominent in school years During adolescence, hyperactivity is less common and may be confined to internal feelings of restlessness In adults, impulsivity may remain problematic, even if hyperactivity has diminished
Inattention
  • Often makes careless mistakes or fails to finish schoolwork
  • Is disorganised/loses things
  • Has difficulty remaining focussed during lectures
  • Is often distracted by irrelevant thoughts
  • Has difficulty keeping appointments
  • Often loses keys or wallet
  • Often forgets to pay household bills
Hyperactivity/impulsivity 
  • Is always ‘on the go’
  • Runs about or climbs in situations where inappropriate
  • Interrupts or intrudes on others
  • Unable to play quietly
  • Feels an inner restlessness or impatience
  • Fidgets
  • Feels an inner restlessness
  • Is impulsive

The impact of ADHD on many areas of life is an important consideration, especially as ADHD affects not only the lives of the patients themselves, but also their families and carers.5,6

A patient-centred management approach that recognises the diversity of ADHD should be available, that includes both non-pharmacological and pharmacological treatment options.7-10

The impact of ADHD can be felt at home,5,6,11 at school,12,13 and in the workplace,15-18  and may put a strain on relationships5,6 with family, friends, teachers and colleagues. ADHD can also be associated with substantial financial burden for individuals, families and societal healthcare services.19

Lifetime impairment

The large, cross-sectional, European Lifetime Impairment Survey (sponsored by Shire) assessed the impairment and symptoms of ADHD in children and adolescents from six European countries (France, Germany, Italy, Spain, the Netherlands and the UK). Parents/caregivers of children and adolescents with ADHD (n=535) and parents/caregivers of children and adolescents without ADHD (n=424) participated in the online survey.14

Parents/caregivers of children and adolescents with ADHD reported a perceived negative impact on various aspects of their child’s life, including life at school (45%), daily life and activities (35%) and social life (34%) (Figure).14

Perceived negative impact (strong and moderate) of ADHD on everyday life as reported by parents/caregivers of children and adolescents with ADHD in the European Lifetime Impairment Survey14 

Perceived negative impact (strong and moderate) of ADHD on everyday life as reported by parents/caregivers of children and adolescents with ADHD in the European Lifetime Impairment Survey
 

The Lifetime Impairment Survey also assessed the impact of ADHD in childhood and adolescence as recalled by adults with ADHD (n=588) compared with adults without ADHD (n=736).20 Adults with ADHD recalled similar impact from their childhood, as indicated by a lower degree of agreement with positive statements related to daily life and relationships compared with adults without ADHD (Figure).20

Adult-recalled impairment at home in the European Lifetime Impairment Survey20

Adult-recalled impairment at home in the European Lifetime Impairment Survey

ADHD-associated impairment over the lifetime can have a significant impact on quality of life.5,21


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  1. Biederman J, Petty CR, Clarke A, et al. Predictors of persistent ADHD: An 11-year follow-up study. J Psychiatr Res 2011; 45: 150-155.
  2. Lara C, Fayyad J, de Graaf R, et al. Childhood predictors of adult attention-deficit/hyperactivity disorder: results from the World Health Organization World Mental Health Survey Initiative. Biol Psychiatry 2009; 65: 46-54.
  3. Biederman J, Petty CR, O'Connor KB, et al. Predictors of persistence in girls with attention deficit hyperactivity disorder: results from an 11-year controlled follow-up study. Acta Psychiatr Scand 2012; 125: 147-156.
  4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013.
  5. Cussen A, Sciberras E, Ukoumunne OC, et al. Relationship between symptoms of attention-deficit/hyperactivity disorder and family functioning: a community-based study. Eur J Pediatr 2012; 171: 271-280.
  6. Davis CC, Claudius M, Palinkas LA, et al. Putting families in the center: family perspectives on decision making and ADHD and implications for ADHD care. J Atten Disord 2012; 16: 675-684.
  7. NICE (2008) Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults. NICE clinical guideline 72. Available at www.nice.org.uk/CG72 [NICE guideline]. Last accessed May 2015.
  8. Kooij SJ, Bejerot S, Blackwell A, et al. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC Psychiatry 2010; 10: 67.
  9. Taylor E, Döpfner M, Sergeant J, et al. European clinical guidelines for hyperkinetic disorder – first upgrade. Eur Child Adolesc Psychiatry 2004; 13 Suppl 1: i7-i30.
  10. The Canadian Attention Deficit Hyperactivity Disorder Resource Alliance (CADDRA). Canadian ADHD Practice Guidelines (CAP-Guidelines) Third Edition. 2011. Available at: http://caddra.ca/practice-guidelines/download. Last accessed March 2015.
  11. Klassen AF, Miller A, Fine S. Health-related quality of life in children and adolescents who have a diagnosis of attention-deficit/hyperactivity disorder. Pediatrics 2004; 114: e541-e547.
  12. Kuriyan AB, Pelham WE Jr., Molina BS, et al. Young Adult Educational and Vocational Outcomes of Children Diagnosed with ADHD. J Abnorm Child Psychol 2012; 27-41.
  13. Holmberg K, Bolte S. Do Symptoms of ADHD at Ages 7 and 10 Predict Academic Outcome at Age 16 in the General Population? J Atten Disord 2012; 1-11.
  14. Caci H, Doepfner M, Asherson P, et al. Daily life impairments associated with self-reported childhood/adolescent attention-deficit/hyperactivity disorder and experiences of diagnosis and treatment: Results from the European Lifetime Impairment Survey. Eur Psychiatry 2013; 1-8.
  15. Biederman J, Faraone SV, Spencer TJ, et al. Functional impairments in adults with self-reports of diagnosed ADHD: A controlled study of 1001 adults in the community. J Clin Psychiatry 2006; 67: 524-540.
  16. Brod M, Pohlman B, Lasser R, et al. Comparison of the burden of illness for adults with ADHD across seven countries: a qualitative study. Health Qual Life Outcomes 2012; 10: 47.
  17. de Graaf R, Kessler RC, Fayyad J, et al. The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative. Occup Environ Med 2008; 65: 835-842.
  18. Shifrin JG, Proctor BE, Prevatt FF. Work performance differences between college students with and without ADHD. J Atten Disord 2010; 13: 489-496.
  19. Le HH, Hodgkins P, Postma MJ, et al. Economic impact of childhood/adolescent ADHD in a European setting: the Netherlands as a reference case. Eur Child Adolesc Psychiatry 2014; 23: 587-598.
  20. Caci H, Asherson P, Donfrancesco R, et al. Daily life impairments associated with childhood/adolescent attention-deficit/hyperactivity disorder as recalled by adults: results from the European Lifetime Impairment Survey. CNS Spectr 2015; 20: 112-121.
  21. Steinhausen HC, Nøvik TS. ADORE Study Group. Co-existing psychiatric problems in ADHD in the ADORE cohort. Eur Child Adolesc Psychiatry 2006; 15: i25-i29.

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