Interventions to aide individuals with attention deficit/hyperactivity disorder (ADHD) to increase lifelong occupational success should incorporate comorbid disorders and educational difficulties. These findings were published in PLoS One.

Researchers from Karolinska Institutet in Sweden analyzed data from adolescents (N=1,221,453) who graduated from compulsory school in Sweden between 1998 and 2008. Demographic information of the graduating students was extracted from the Total Population Register, occupational outcomes from the Longitudinal Integration Database for Health Insurance and Labor Market Studies, and health outcomes from the National Patient Register and Prescribed Drug Register.

A total of 2.4% of all graduating adolescents had ADHD. Among those with ADHD, fewer tended to be women (40.9% vs 48.9%; P <.001) or immigrants (6.3% vs 8.1%; P <.001) and were more likely to have a developmental disorder (18.6% vs 0.7%; P <.001), intellectual disability (2.5% vs 0.1%; P <.001), and a higher mortality rate (1.0% vs 0.2%; P <.001). For the 1998 graduating class, 13.9% of the ADHD students and 44.5% of the control students continued onto tertiary education.


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Nominal income was €857 among the cohort with ADHD and €935 among controls the year they graduated from compulsory education; at 15 years after graduation, the ADHD and control individuals earned €15,816 and €23,098, respectively. Disability pensions were given to 11.7% of the ADHD and 0.9% of the control cohorts at 15 years and individuals reported 28.9 and 11.7 days of unemployment, respectively.

Adjusting for demographics, ADHD was associated with a 17% lower income (income ratio [IR], 0.83), 18.99 higher odds of receiving a disability pension (risk difference [RD], 11.0%), and 11.59 more days of unemployment annually.

Individuals with an intellectual disability or developmental disorder and ADHD were associated with a 14% decrease in income (IR, 0.86) and increased odds of 5.68 for a disability pension (RD, 3.0%).

Stratified by educational attainment, ADHD was associated with 19% lower income (IR, 0.81) among those who completed compulsory education, 18% lower (IR, 0.82) among those who completed secondary education, and 26% lower (IR, 0.74) among those who completed tertiary education. ADHD corresponded with an excess of 17.06, 16.65, and 22.47 days of unemployment among those who completed compulsory, secondary, and tertiary education, respectively.

This study may have been limited by the rates of ADHD diagnoses, which increased from 1.7% among the 1998 graduating class to 3.6% among those graduating in 2008. It remains unclear whether there was under or over diagnosis among the earlier or later cohorts.

These data suggested poorer occupational outcomes were associated with increased rates of intellectual disability, developmental disorder, and less educational attainment among individuals with ADHD. Interventions, such as job training or educational assistance, which address all these factors are likely needed to improve income and unemployment disparities.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Jangmo A, Kuja-Halkola R, Pérez-Vigil A, et al. Attention-deficit/hyperactivity disorder and occupational outcomes: The role of educational attainment, comorbid developmental disorders, and intellectual disability. PLoS One. Published online March 17, 2021. doi:10.1371/journal.pone.0247724