Childhood ADHD traits linked to poorer physical health in midlife

People who have ADHD traits at age 10 are more likely than those without such traits to have physical health problems and to report physical health-related disability at age 46, according to a study led by University College London (UCL) and University of Liverpool researchers.

The researchers say the findings likely reflect the impact of a wide range of risk factors for poor health that are linked to attention deficit hyperactivity disorder (ADHD) and society's response to people with ADHD across adulthood.

The new JAMA Network Open paper is one of the largest ever studies, with the most years of follow-up, looking at childhood ADHD traits and later health outcomes.

Senior author Professor Joshua Stott (UCL Psychology & Language Sciences) said: "Here we have added to the concerning evidence base that people with ADHD are more likely to experience worse health than average across their lifespan.

"People with ADHD can thrive with the right support, but this is often lacking, both due to a shortage of tailored support services but also because ADHD remains underdiagnosed, particularly in people in midlife and older, with needs unaddressed."

People with ADHD experience differences in how they focus their attention and/or increased hyperactivity and impulsivity. They can often have high energy and an ability to focus intensely on what interests them, but they may find it difficult to focus on mundane tasks. This can lead to more impulsiveness, restlessness, and differences in planning and time management, which may make it harder to succeed at school and work, leading to longer-term challenges.

ADHD begins in childhood, and while it is increasingly recognised to persist in adults, it is under-treated in adults in the UK compared to in other high-income countries, and support remains under-resourced.

For the study, the researchers analysed data from 10,930 participants of the UCL-led 1970 British Cohort Study, a large longitudinal study of people who have been taking part in research from birth to middle age.

ADHD traits were determined based on child behaviour questionnaires completed by parents and teachers when the study participants were 10 years old, regardless of whether they had ever been diagnosed with ADHD.

The researchers found that people with high scores on the index of ADHD traits at age 10 were more likely to have other health conditions by age 46, with 14% higher odds of reporting two or more physical health problems such as migraine, back problems, cancer, epilepsy or diabetes. Among those with high ADHD traits in childhood, 42% had two or more health problems in midlife, compared to 37% of those without high ADHD traits.

People with high ADHD traits at age 10 were also more likely to experience physical health-related disability (reporting having problems with work or other daily activities as a result of their physical health) at age 46.

Their analysis suggests that the poorer health outcomes were partly explained by increased mental health problems, higher BMI and higher smoking rates among people with ADHD. Other studies have found that people with ADHD are also more likely to experience stressful life events and social exclusion, and are less likely to get timely access to screening and medical care.

The researchers found that the link between childhood ADHD traits and physical health-related disability appeared to be stronger among women than men.

Professor Stott added: "All of these potential explanatory factors align with the fact that ADHD makes impulse control more difficult, the need for instant gratification and reward more intense, and is also associated with worse mental health in part due to the social disadvantage people with ADHD face."

A study published last year by the same research group also found an apparent reduction in life expectancy for adults with diagnosed ADHD, although this was not part of the current study.*

Lead author Dr Amber John, who began the research at UCL before moving to the University of Liverpool, said: "It's important to note that people with ADHD are a diverse group, with a range of different strengths and experiences, and most will lead long, healthy lives.

"However, many face significant barriers to timely diagnosis and appropriate support. This is important because providing the right support for and meeting the needs of people with ADHD can help to improve their physical and mental health outcomes.

"Additionally, public health strategies should consider the needs of people with ADHD, such as by making screening programmes and ongoing health monitoring more accessible for people with ADHD."