A diagnosis of attention-deficit/hyperactivity disorder (ADHD) during childhood was associated with worse self-harm, self-efficacy, and academic self-concept outcomes in adolescence compared with adolescents who had no formal ADHD diagnosis but had similar hyperactive or inattentive behaviors. These study findings were published in JAMA Network Open.
Children and adolescents born between 1999 and 2000 (n=4983) or 2003 and 2004 (n=5107) were recruited at the University of Sydney for the Longitudinal Study of Australian Children. The study participants were evaluated for health outcomes at 5 biennial follow-ups. Those with parent-reported ADHD (n=393) were matched in a 1:1 ratio with children without ADHD who had similar hyperactive or inattentive behaviors (n=393), and the effect of ADHD on quality of life was assessed.
The ADHD cohort was mean age 10.03 (SD, 0.30) years, 72.2% were boys, and the average Strengths and Difficulties Questionnaire Hyperactive or Inattentive (SDQ H/I) score was 5.05 (SD, 2.29).
Patients both with and without ADHD did not differ significantly for Child Health Utility 9D (mean difference [MD], -0.03; 95% CI, -0.07 to 0.01; P =.10), global health (MD, 0.11; 95% CI, -0.04 to 0.27; P =.15), overall happiness (MD, -0.18; 95% CI, -0.37 to 0.00; P =.05), and peer trust (MD, 0.65; 95% CI, 0.00-1.30; P =.05) scores.
A diagnosis of ADHD was associated with a greater prevalence of self-harm (MD, 2.53; 95% CI, 1.49-4.37; P <.001), lower psychological sense of school membership (MD, -2.58; 95% CI, -4.06 to -1.13; P <.001), worse self-efficacy (MD, -0.20; 95% CI, -0.33 to -0.05; P =.007), greater negative social behaviors (MD, 1.56; 95% CI, 0.55-2.66; P =.002), and poorer academic self-concept (MD, -0.14; 95% CI, -0.26 to -0.02; P =.02) compared with control participants.
Differences in these quality of life outcomes were generally smaller among participants with the greatest hyperactive or inattentive behaviors. Generally, girls had poorer quality of life than boys regardless of diagnosis. Stratified by age of ADHD diagnosis, the children with the most unfavorable outcomes were diagnosed between ages 6 and 7 years.
The study is limited by the small sample size.
Study authors conclude, “This cohort study found that adolescents with a prior ADHD diagnosis did not report better quality of life at age 14 to 15 years compared with matched adolescents without diagnosis and with similar H/I behaviors. This raises important questions about the long-term effectiveness and safety of diagnosing children and adolescents with ADHD, especially for those with low-risk or borderline H/I behaviors. Our findings provide a rationale for a well-designed, large, randomized trial with long-term follow-up.”
Kazda L, McGeechan K, Bell K, Thomas R, Barrat A. Association of attention-deficit/hyperactivity disorder diagnosis with adolescent quality of life. JAMA Netw Open. Published online October 13, 2022. doi:10.1001/jamanetworkopen.2022.36364