12.7-year reduction in Estimated Life Expectancy (ELE) for persons with Adult ADHD

The persistence of ADHD to adulthood is linked to a 12.7-year reduction in ELE. Childhood ADHD-C predicts a significantly reduced ELE by adulthood, which is further reduced by the persistence of ADHD to adult follow-up, Barkley et al., 2018

Introduction

Estimated life expectancy (ELE) refers to the estimated number of years of life remaining at a specific age and is based on actuarial life tables of large population samples, such as those provided by the U.S. Social Security Administration. ELE can then be further adjusted by disability conditions and health-related variables based on their demonstrated impact on life expectancy in population samples apart from age and sex effects. These adjustments are known as Disability Adjusted Life Years (DALY) and Health Adjusted Life Years (HALY) calculations of ELE.

Study design and participants

This study utilized 158 children determined as having hyperactive (H) child syndrome (the diagnostic term for ADHD-C at the time) and a matched community control (CC) group (N=81) followed concurrently.

The groups were originally evaluated in 1979-80 when they were ages 4 to 12 years (Barkley, Karlsson, Strzelecki, & Murphy, 1984).Most (Hyperactive N = 123, or 78%; Normal N = 66, or 81%) were evaluated again as teens in 1987-88 when they were 12 to 20 years of age (mean age 14 yrs.) (Barkley, Fischer, Edelbrock, & Smallish, 1990). The participants were re-assessed at early adulthood in 1992-96 at 19-25 years of age (mean age of 20 years)(Barkley, Fischer, Smallish, & Fletcher, 2002). The final follow-up serving as the basis for this article was in adulthood ages 24-32 (mean age of 27) conducted from 1998 to 2004 (Barkley et al., 2008).

Determining the Presence of ADHD in Adulthood

A structured interview involving DSM-IV criteria for ADHD (American Psychiatric Association, 2001) was created and employed at follow-up given that no structured interview using precisely these criteria then existed for use with adults to evaluate the presence of this disorder. Symptoms of ADHD were reviewed twice, once for current functioning (past 6 months) and a second time for childhood between 5 and 12 years of age with the requirement that the symptom only be endorsed if it occurred often or more frequently. A symptom count was calculated from each symptom list. The age of onset of symptoms was also determined. Six domains of impairment (functional ineffectiveness) were also reviewed with impairment having to occur often or more frequently and at what age each domain became impaired.The domains were: occupational, home, social, community activities, education, and dating/marriage. The interview has been used successfully in other studies of adult ADHD (Barkley et al., 2008).

Conclusion

The study demonstrated that childhood ADHD-C (hyperactive child syndrome) is associated with reduced ELE by young adulthood, including nearly a decade of reduction in healthy remaining years of life, as well as an increased period of unhealthy estimated years of remaining life.

This reduction in ELE is worse when ADHD is persistent into adulthood. The reduced ELE linked to ADHD was found to be a function of the first order, more proximal variables of less education, less annual income, greater consumption of alcohol and tobacco, diminished sleep, and poorer overall health status relative to the control group.

Moreover, ELE was also shown to be a function of the second order, more distal traits of deficient behavioral inhibition in daily life, and much less so, to low verbal IQ, greater interpersonal hostility, and deficient nonverbal fluency.

Our findings in general are consistent with research showing that various mental disorders have adverse effects on ELE (Chesney, Goodwin, & Fazel, 2014; Nordentoft et al., 2013).

Our results extend this earlier work by adding ADHD to this list. Nevertheless, our findings may also argue for the potential value of adding recommendations regarding health and lifestyle related self-improvement programs to the usual package of evidencebased treatments applied to ADHD across development given the apparent modifiability of many of these risk factors linked to reduced ELE.

References

Barkley, R. A., & Fischer, M. (2018). Hyperactive Child Syndrome and Estimated Life Expectancy at Young Adult Follow-Up: The Role of ADHD Persistence and Other Potential Predictors. Journal of Attention Disorders. https://doi.org/10.1177/1087054718816164

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