The impact of ADHD symptoms and global impairment in childhood on working disability in mid-adulthood: a 28-year follow-up study using official disability pension records in a high-risk in-patient population.
BACKGROUND
Individuals with ADHD have been associated with more employment difficulties in early adulthood than healthy community controls. To examine whether this association is attributable specifically to disturbance of activity and attention (ADHD) or to psychopathology in general, we wanted to extend existing research by comparing the rate of mid-adulthood working disabilities for individuals diagnosed with ADHD as children with the rate for clinical controls diagnosed with either conduct disorder, emotional disorder or mixed disorder of conduct and emotions.


METHODS
Former Norwegian child-psychiatric in-patients (n = 257) were followed up 17-39 years after hospitalization by record linkage to the Norwegian national registry of disability pension (DP) awards. Based on the hospital records, the patients were re-diagnosed according to ICD-10. Associations between the diagnoses, other baseline factors and subsequent DP were investigated using Kaplan-Meier survival analyses and logrank testing.


RESULTS
At follow-up, 19% of the participants had received a DP award. In the logrank testing, ADHD was the only disorder associated with a subsequent DP, with 30% being disabled at follow-up (p = 0.01). Low psychosocial functioning (assessed by the Children's Global Assessment Scale) at admission uniquely predicted future DP (p = 0.04).


CONCLUSIONS
ADHD in childhood was highly associated with later receiving a DP. Our finding of worse prognosis in ADHD compared with other internalizing and externalizing disorders in mid-adulthood supports the assumption of ADHD being specifically linked to working disability. Assessment of psychosocial functioning in addition to diagnostic features could enhance prediction of children who are most at risk of future disability.
Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4959, Nydalen 0424, Oslo, Norway. marianne.mordre@medisin.uio.no
Marianne
M
Mordre
Berit
B
Groholt
Berit
B
Sandstad
Anne Margrethe
AM
Myhre
D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000523:psychology*; D002648:Child; D019955:Conduct Disorder / Q000523:psychology*; D006233:Persons with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data; D004651:Employment / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients / Q000523:psychology* / Q000706:statistics & numerical data; D018868:Insurance, Disability / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009664:Norway; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011996:Records; D013997:Time Factors