Attention-deficit hyperactivity disorder (ADHD) can have a significant social impact on patients’ lives, causing disruption at school, work, home and in relationships.1-7
Families of children and adolescents with attention-deficit hyperactivity disorder (ADHD) may be indirectly affected by the disorder; parent-reported impact on themselves or the family may include: parental stress; parental emotional/mental health problems; sibling conflict; disruption to family cohesion; and less time available to spend on family activities.1-3
Symptoms of ADHD — hyperactivity, impulsivity and inattentiveness — may negatively impact functioning and behaviour in children and adolescents in school, and adults in the workplace.
- In a Swedish cohort study of 544 children, considerable association was observed between symptoms of inattentiveness (as measured by the Conners 10-item scale) in children aged 7 and 10 years and academic underachievement at age 16 years4
- Adolescents and adults with ADHD have been found to be less likely to have achieved a further education degree.5,6
Results of the large, cross-sectional, European Lifetime Impairment Survey (sponsored by Shire), which assessed parent-reported impairment and symptoms of ADHD in children and adolescents with ADHD (n=535) compared with children and adolescents without ADHD (n=424),7 indicated that more parents of children with ADHD tended to report impairment at school compared with parents of children without ADHD (Figure).
Impairment at school: statements that more parents/caregivers of children with ADHD agreed with compared with parents of children without ADHD in the European Lifetime Impairment Survey7
Figure developed from Adamou et al. 201311
Adults with ADHD have been found to have occupational difficulties which may impact on their productivity in the workplace and their reputation as an employee, with high job turnover or unemployment frequently observed.5,8-10 Employment problems may lead to financial difficulties.
- A US community-based study of 1001 adults found that adults with self-reported ADHD were less likely to be in full-time employment compared with healthy adults (34% vs 57%, respectively; p≤0.001).5
A consensus conference statement developed by an international committee of experts (sponsored by Shire) summarised the challenges that adults with ADHD may face in obtaining and maintaining employment, and potential solutions to address these challenges (Figure):11
Occupational challenges that may be associated with ADHD in adults and potential solutions from an international consensus statement11
ADHD in children, adolescents and adults may impact on the relationships that they share with family, friends, teachers, partners or colleagues, with evidence of peer rejection, and difficulty in maintaining friendships or family/romantic relationships.1,3,5,8,12-14
- In a US study, adults with self-reported ADHD (n=500) reported less stability and significantly higher rates of divorce in marital/cohabiting relationships compared with controls (p≤0.001); in addition, they were significantly less likely to have a good current relationship with their parents compared with controls (p≤0.001)5
- Another US study found that young adult couples with one partner with ADHD displayed greater negativity during a conflict resolution task compared with couples without ADHD in either partner, indicating relationship impairment associated with ADHD15
- A small exploratory study of partners of adults with ADHD (n=8) reported uncertainty about the future of their relationship and how to provide support.16
These difficulties are becoming recognised in management of ADHD; a recent Swedish pilot study reported preliminary findings of the feasibility and efficacy of a psychoeducational treatment programme for adults with ADHD and their partner/spouse.17
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Shifrin JG, Proctor BE, Prevatt FF. Work performance differences between college students with and without ADHD. J Atten Disord 2010; 13: 489-496.
- Adamou M, Arif M, Asherson P, et al. Occupational issues of adults with ADHD. BMC Psychiatry 2013; 13: 59.
- Bagwell CL, Molina BS, Pelham WE Jr., et al. Attention-deficit hyperactivity disorder and problems in peer relations: predictions from childhood to adolescence. J Am Acad Child Adolesc Psychiatry 2001; 40: 1285-1292.
- Biederman J, Faraone SV, Monuteaux MC. Impact of exposure to parental attention-deficit hyperactivity disorder on clinical features and dysfunction in the offspring. Psychol Med 2002; 32: 817-827.
- Schermerhorn AC, D'Onofrio BM, Slutske WS, et al. Offspring ADHD as a Risk Factor for Parental Marital Problems: Controls for Genetic and Environmental Confounds. Twin Res Hum Genet 2012; 1-14.
- Canu WH, Tabor LS, Michael KD, et al. Young Adult Romantic Couples' Conflict Resolution and Satisfaction Varies with Partner's Attention-Deficit/Hyperactivity Disorder Type. J Marital Fam Ther 2014; 40: 509-524.
- Young S, Gray K, Bramham J. A phenomenological analysis of the experience of receiving a diagnosis and treatment of ADHD in adulthood: a partner's perspective. J Atten Disord 2009; 12: 299-307.
- Hirvikoski T, Waaler E, Lindstrom T, et al. Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): an open clinical feasibility trial. Atten Defic Hyperact Disord 2014.
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This document has been developed to inform about the personal and societal impact of ADHD in adulthood
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ADHD is often a lifelong neurobehavioural disorder, which may persist from childhood into adulthood.
Video: Patients' and parents' expectations of treatment – Prof Banaschewski