Although awareness and recognition of attention-deficit/hyperactivity disorder (ADHD) have increased over the past few decades, particularly through the pandemic years, its effects are still trivialized in the public discourse. The core symptoms are brushed off as stereotyped nuisances of flitting attention, bouncing legs, and misjudged spontaneity, and more exotic but similarly misleading characterizations and “look squirrel” memes that provide clickbait on social media. These misrepresentations create an image of an ADHD diagnosis as divorced from “real-life problems.”
More recent studies continue to shed light on the seriousness of ADHD. The problems are hiding in plain sight, arising early on and persisting and worsening in adulthood in terms of health profiles and life expectancy for individuals with ADHD. There’s no “look diabetes” or “look hypertension” ADHD memes.
A British study tracked more than 17,000 children born in the same week in 1970 for the next 46 years (just under 11,000 participants met criteria for the analyses in the current study).1 In 1980, at 10 years old, 5.5 percent of the sample were identified with ADHD traits using results from parent/teacher ratings that were subsequently adapted to current diagnostic criteria. Follow-up health measures started at 26 years old and continued up to 46 years old.
At 46 years old, childhood ADHD traits were associated with more physical health issues, increased risk for multiple health issues, and disability from physical health issues when compared with the non-ADHD trait group. The study found lower educational attainment, smoking, alcohol use, higher body mass index (BMI), and psychological distress, with larger effects for women than men with ADHD traits.
A separate but similar 40-year birth cohort study of 1,265 children looked at adolescent ADHD (14 to 16 years old; 7.4 percent of the sample) and long-term mental health and functioning during the 18-to-40-year age range.2 Teen ADHD was associated with heightened risk for depression, suicidal ideations, substance use disorder, criminal offenses, and unemployment at some point across adulthood. As adults, teens with ADHD also had lower incomes, were less likely to own a home, had lower living standards, and had less relationship stability. Criminal offending and substance use disorders persisted as significant factors after controlling for co-existing oppositional-defiant and conduct disorders.
Another study out of the UK (by the same research group) used primary healthcare electronic record data from which 30,000+ adults with ADHD (3 percent of the total sample of over 9 million) were then matched with a comparison group of over 300,000 based on age, sex, and primary care practice.3 All health-related issues measured in the study were more common for the ADHD group when compared with non-ADHD matched participants, including diabetes, chronic respiratory disease, smoking, potentially harmful alcohol use, mood and anxiety disorders, and self-harm/suicide, among others. ADHD was associated with a reduced life expectancy of seven years for males and nine years for females compared to life expectancies for the general population.
These results sadly mirror those observed in US children with ADHD who were followed from age 8 to 27 years old.4 Their health-related behavior profile in young adulthood, including smoking, fewer years of education, alcohol use, and driving record, among others, resulted in reduced estimated life expectancies of 8.4 years for children with non-persistent ADHD and 12.7 years for adults with persistent ADHD.
These health-related issues are not from flitting attention or bouncing legs but a direct result of the self-dysregulation (or executive dysfunction), the difficulties organizing behavior over time, particularly to achieve delayed goals, that better characterize ADHD and create the myriad difficulties and frustrations that repeatedly punctuate and upend their best intentions.5 It can be quality-of-life threatening, but, as shown in these studies, also life-threatening.
The encouraging message is that we know the risks and can do something about them. The medical and psychosocial treatments for adult ADHD, individually and combined, are very effective and target the very issues and coping strategies needed to compensate for ADHD’s self-dysregulation. Overall health and well-being, including another common ADHD struggle—sleep—are common treatment goals. There is much good that can be done, but we must take ADHD more seriously in terms of its effects.