Recent concerning findings in a British study of more than 30 000 adults diagnosed with attention deficit hyperactivity disorder (ADHD) showed that on average, they were dying earlier than their counterparts in the general population – around seven years earlier for men, and around nine for women.
The research, published in The British Journal of Psychiatry, is believed to be the first to use all-cause mortality data to estimate life expectancy in people with ADHD. Previous studies have pointed to an array of risks associated with the condition, among them poverty, mental health disorders, smoking and substance abuse.
The authors cautioned that ADHD is substantially under-diagnosed and that the people in their study – most of them diagnosed as young adults – might be among the more severely affected. Still, they described their findings as “extremely concerning”, highlighting unmet needs that “require urgent attention”, reports The New York Times.
“It’s a big number, and it is worrying,” said Joshua Stott, a professor of ageing and clinical psychology at University College London and an author of the study. “I see it as likely to be more about health inequality than anything else. But it’s quite a big health inequality.”
The study did not identify causes of early death among people with ADHD but found that they were twice as likely as the general population to smoke or abuse alcohol and had far higher rates of autism, self-harming behaviour and personality disorders than the general population.
In adulthood, Stott said, “they find it harder to manage impulses, and have more risky behaviours”.
He said healthcare systems might need to adjust to better serve people with ADHD, who may have sensory sensitivity or difficulty managing time or communicating with clinicians during brief appointments. He said he hoped treatments for substance abuse or depression could be adapted for these patients.
“If it’s about systems, it’s malleable,” he said. “This doesn’t have to be.”
Previous studies have pointed to an unusual number of early deaths for people with ADHD. A 2022 meta-analysis in JAMA Paediatrics found that deaths from unnatural causes, such as accidents or suicide, were 2.81 times higher among those diagnosed with ADHD than in the general population.
A 2019 study that used actuarial tables to predict life expectancy concluded that adults diagnosed with ADHD in childhood had an 8.4-year reduction in life expectancy compared with the general population, something the authors attributed to reduced education and income, higher rates of smoking and alcohol consumption and reduced sleep.
Dr Russell Barkley, the lead author of that study, said the data made it clear that ADHD should not be seen as a childhood disorder, like bed-wetting, but as a lifelong problem.
“To me, the best analogue is diabetes,” said Barkley, a retired professor of clinical psychology at Virginia Commonwealth University. “This is a disorder that you’ve got to manage, like high blood pressure, like cholesterol and diabetes. You’ve got to treat this for life.”
The study examined 9 561 450 patients in Britain’s National Health Service (NHS) primary care practices, among whom 30 039 had been diagnosed with ADHD. Each person in the ADHD group was matched with 10 peers without the disorder for the purposes of comparison. Among those with ADHD, 193 male patients and 148 female patients died during the follow-up period, which lasted from 2000 to 2019.
Stephen Hinshaw, a professor of psychology at the University of California-Berkeley, who studies ADHD but was not involved in the research, described the study as “a major finding”, the first analysis of deaths of subjects diagnosed with the disorder. He said it was unfortunate that the subjects’ causes of death were not included.
“There are risk factors to work on,” he said. “That is the key limitation of the study, because it would be really important to know, in terms of prevention, should we be focused on suicidality? Better diet and exercise? Depression?”
Diagnosis of ADHD has shifted in recent years, as clinicians concluded that many older people, especially women and people of colour, had gone undiagnosed early in life and could benefit from treatment. As first-time diagnoses surged among older people, prevalence has remained consistent among children, at around 11% in the United States and 5% in Britain.
Stott said he hoped that, as these demographic changes took hold, healthcare systems would make more effort to identify the needs of neurodivergent patients. In past decades, he said, they may have been viewed dismissively by caregivers, as “the naughty kid at school”.
“If you’re constantly told, as a kid, sit down, stop being so naughty – if you talk to people with ADHD, that is their experience – stop talking, go and sit outside,” he said. “It’s all of these things that wear down at your life chances, in many ways.”
Study details
Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study
Elizabeth O'Nions, Céline El Baou ,Josh Stott et al.
Published in the British Journal of Psychiatry on 23 January 2025
Abstract
Background
Nearly 3% of adults have attention-deficit and hyperactivity disorder (ADHD), although in the UK, most are undiagnosed. Adults with ADHD on average experience poorer educational and employment outcomes, worse physical and mental health and are more likely to die prematurely. No studies have yet used mortality data to examine the life expectancy deficit experienced by adults with diagnosed ADHD in the UK or worldwide.
Aims
This study used the life-table method to calculate the life-expectancy deficit for people with diagnosed ADHD using data from UK primary care.
Method
A matched cohort study using prospectively collected primary care data (792 general practices, 9 561 450 people contributing eligible person-time from 2000–2019). We identified 30 039 people aged 18+ with diagnosed ADHD, plus a comparison group of 300 390 participants matched (1:10) by age, sex and primary care practice. We used Poisson regression to estimate age-specific mortality rates, and life tables to estimate life expectancy for people aged 18+ with diagnosed ADHD.
Results
Around 0.32% of adults in the cohort had an ADHD diagnosis, ~1 in 9 of all adults with ADHD. Diagnoses of common physical and mental health conditions were more common in adults with diagnosed ADHD than the comparison group. The apparent reduction in life expectancy for adults with diagnosed ADHD relative to the general population was 6.78 years (95% CI: 4.50 to 9.11) for males, and 8.64 years (95% CI: 6.55 to 10.91) for females.
Conclusions
Adults with diagnosed ADHD are living shorter lives than they should. We believe that this is likely caused by modifiable risk factors and unmet support and treatment needs in terms of both ADHD and co-occurring mental and physical health conditions. This study included data from adults with diagnosed ADHD; the results may not generalise to the entire population of adults with ADHD, the vast majority of whom are undiagnosed.
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