With Pediatric ADHD Diagnosis, Lower Quality of Life Measures Reported

Mental Health | A pediatric attention-deficient/hyperactivity disorder (ADHD) diagnosis was associated with negative impacts on some quality of life (QOL) measures such as risk of self-harm, self-efficacy, and sense of school membership, a study published in JAMA Network Openfound.

“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 hyperactive/inattentive (H/I) behaviors,” Luise Kazda, MPH, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia, and co-authors wrote in the study.

Following an emulated target trial design, researchers used data from the Longitudinal Study of Australian Children, a population-based prospective cohort study, to evaluate children born between 1999 and 2000 (n=4983) or 2003 and 2004 (n=5107). Eligible children without a previous ADHD diagnosis were included. Participants with parent-reported ADHD (n=393) were matched 1:1 with controls defined as children without ADHD who had similar hyperactive or inattentive behaviors (H/I) (n=393). The mean age of the ADHD cohort was 10.03 years, 73% boys, and had a mean score of 5.05 on the H/I Strengths and Difficulties Questionnaire.

“Other studies in this field have typically used clinically referred samples in which symptomatic participants with documented diagnoses are compared with controls without diagnosis and without symptoms, making it impossible to disentangle the effects of the disorder itself from those of the intervention in QOL,” researchers discussed in the study.

At ages 14 and 15, researchers measured QOL with Child Health Utility 9D (CHU9d) and 8 other prespecified, self-reported measures—academic self-concept, global health, negative social behaviors, overall happiness, peer trust, psychological sense of school membership, self-efficacy, and self-harm. 

Those with an ADHD diagnosis reported similar QOL on CHU9d (mean difference [MD], -.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, compared to controls.

Compared with controls, those with a pediatric ADHD diagnosis reported worse self-efficacy (MD, -0.20; 95% CI, -0.33 to -0.05; P =.007), an increased risk of self-harm (MD, 2.53; 95% CI, 1.49-4.37; P <.001), greater negative social behaviors (MD, 1.56; 95% CI, 0.55-2.66; P =.002), lower psychological sense of school membership (MD, -2.58; 95% CI, -4.06 to -1.13; P <.001), and poorer academic self-concept (MD, -0.14; 95% CI, -0.26 to -0.02; P =.02).

“These results also emphasize the requirement for a cautious clinical approach to ADHD diagnosis in children and adolescents, while underscoring the need for more targeted support to increase QOL in girls and in children with high-risk levels of H/I behaviors, whether diagnosed or not,” researchers wrote. “Policy makers, researchers, and clinicians are urged to work together to develop more systemic solutions to overcome inequities in education and other settings that disadvantage youths because of their gender or neurodiversity, rather than solely relying on medicalizing and labeling them.”

Researchers urge for a well-designed, large, randomized trial with long-term follow-up to further investigate these findings.