What Are the Health Outcomes for Youth Diagnosed with ADHD?

What you need to know

• The rate of ADHD diagnosis in youth has increased steadily over time, reaching 12.6% in 2017-2018
• Youth with ADHD have higher rates of other mental health and physical health conditions compared to youth without ADHD
• Youth with ADHD use more healthcare services, especially mental health services, than youth without ADHD
• The mortality rate is higher for youth with ADHD compared to those without, particularly for suicide and trauma-related deaths

Rising Rates of ADHD Diagnosis

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders diagnosed in children and adolescents. This study examined health records for all Quebec residents under age 25 between 2000-2018 to track ADHD diagnosis rates and related health outcomes.

The researchers found that the cumulative prevalence of diagnosed ADHD increased steadily over the study period, reaching 12.6% by 2017-2018. This means that about 1 in 8 youth had received an ADHD diagnosis at some point in their lives by the end of the study.

Boys were diagnosed with ADHD at about twice the rate of girls. The prevalence also varied by age group:

• Ages 1-11: 6.6%
• Ages 12-17: 18.9%
• Ages 18-24: 15.5%

These rising rates are consistent with other studies showing increases in ADHD diagnosis over time. The reasons for this trend are not fully clear, but may include increased awareness and recognition of ADHD, changes in diagnostic criteria, and other factors.

Higher Rates of Other Health Conditions

The study found that youth diagnosed with ADHD had significantly higher rates of other mental health and physical health conditions compared to youth without ADHD. Some key findings:

Mental Health Conditions:

• Anxiety and depression: 30% in youth with ADHD vs. 11.8% without
• Developmental delays: 14.3% vs. 6.8%
• Behavioral disorders: 7.9% vs. 2.2%
• Substance use disorders: 3.5% vs. 1.4%
• Autism spectrum disorders: 3.7% vs. 0.9%

Physical Health Conditions:

• Respiratory diseases: 93.2% vs. 83%
• Injuries/trauma: 74.9% vs. 61.8%
• Infectious diseases: 70% vs. 57.6%
• Genitourinary system diseases: 42.5% vs. 33.7%
• Congenital anomalies: 37.8% vs. 19.9%

These higher rates of co-occurring conditions, known as comorbidities, highlight the complex health needs that many youth with ADHD face. The reasons for these associations are not fully understood, but may relate to shared genetic or environmental risk factors, the impact of ADHD symptoms on overall health, or other factors.

Increased Healthcare Service Use

Not surprisingly given the higher rates of health issues, the study found that youth with ADHD used more healthcare services overall compared to those without ADHD. Some key differences:

• More likely to be hospitalized or seen in emergency settings
• Higher use of mental health services, especially before age 18
• Increased role of family physicians in care after age 18

The researchers noted that mental health service use declined after age 18 for youth with ADHD. This may reflect challenges in transitioning from pediatric to adult mental health care systems, a common issue for youth with chronic health conditions.

Higher Mortality Rates

One concerning finding was that youth diagnosed with ADHD had higher overall mortality rates compared to youth without ADHD. The increased risk was particularly notable for deaths by suicide and trauma-related causes.

While the absolute risk of death was still low, these findings underscore the importance of comprehensive care and support for youth with ADHD, including mental health care and injury prevention strategies.

Implications for Care

This large population-based study provides important insights into the health outcomes associated with ADHD diagnoses in youth. Some key implications for families, healthcare providers, and policymakers include:

• The need for comprehensive health assessments for youth diagnosed with ADHD, given the high rates of other physical and mental health conditions
• The importance of coordinated care across medical and mental health specialties
• Targeted efforts to support the transition from pediatric to adult healthcare systems for youth with ADHD
• Increased focus on suicide prevention and injury prevention strategies
• Ongoing research to better understand the reasons for increased health risks and develop more effective treatments and supports

Study Methods and Limitations

This study used health administrative data for the entire population of Quebec under age 25. The researchers compared health outcomes for youth with at least one ADHD diagnosis in their medical records to those without any ADHD diagnoses.

Strengths of this approach include the very large sample size and the ability to look at trends over time. However, there are also some important limitations to consider:

• The study only captured ADHD diagnoses recorded in medical visits. Youth with ADHD who did not receive medical care would not be included.
• Diagnoses in medical records may not always be accurate or complete.
• The study could not determine causation - it’s not clear if ADHD directly leads to the other health outcomes observed or if there are other explanatory factors.

Despite these limitations, this study provides valuable insights into the real-world health experiences of youth diagnosed with ADHD. The findings highlight opportunities to improve care and support for this population.

Conclusions

• ADHD diagnosis rates in youth have increased substantially over time
• Youth with ADHD face higher rates of other mental and physical health conditions
• Healthcare use is higher among youth with ADHD, especially for mental health services
• Mortality risk is elevated for youth with ADHD, particularly for suicide and trauma-related causes
• Comprehensive, coordinated care approaches are needed to support the complex health needs of youth with ADHD

While an ADHD diagnosis is associated with increased health risks, it’s important to note that many youth with ADHD lead healthy, successful lives. Early diagnosis and appropriate treatment and support can make a big difference. Families concerned about ADHD should speak with their healthcare provider about options for assessment and care.