ADHD Costs Adults $77 Billion in Lost Income

Adult ADHD Affects Income and Educational Achievement in U.S.

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Sept. 9, 2004 (New York) -- Attention deficit hyperactivity disorder (ADHD) not only affects adults' mental health, but it may also hurt their wallets. A new study suggests that adult ADHD is responsible for an estimated $77 billion in lost household income in the U.S. each year.

With the economic burden of drug abuse estimated at about $58 billion and alcohol abuse at $86 billion annually, researchers say that cost estimate for ADHD puts the disorder among the most costly medical conditions in the U.S.

The survey showed that, on average, people with ADHD have household incomes that are $10,791 lower for high school graduates and $4,334 lower for college graduates compared with those who do not have the disorder.

Although ADHD is widely thought of as a disorder that affects children and adolescents, researchers say about half of children with ADHD will carry it into adulthood. They say an estimated 8%-11% of American adults suffer from the symptoms of ADHD, such as inattention, impulsivity, and hyperactivity.

Untreated ADHD can affect a person's financial health by making it more difficult to hold on to a job, causing more lost work days, and making it harder to get the education needed to obtain high-paying jobs, says researcher Joseph Biederman, MD, professor of psychiatry at Harvard Medical School.

"About 50% of the people with ADHD who had jobs in the survey said they lost work directly related to their ADHD symptoms," says Biederman, who presented the study today at an American Medical Association briefing on ADHD in New York City. "The symptoms of ADHD are very difficult for employers to deal with."

Biederman treats many adult professionals with ADHD in his practice and says their employee evaluations often read like an ADHD textbook.

"Cannot follow through with instructions, talks out of turn, etc. These are many of the same things we see in childhood ADHD, but we're seeing it in the workplace," says Biederman.

These ADHD symptoms make it difficult for adults to be successfully employed -- a fact Biederman says was echoed by many of the survey participants who said they were always the last one to be considered for promotion or were consistently under-employed according to their abilities.

Putting a Price Tag on Adult ADHD

In the April-May 2003 survey, researchers interviewed 500 adults by telephone who said they had been diagnosed with ADHD and 501 adults of the same age and sex who did not have ADHD. Researchers asked the participants about their education, work history, income, and other aspects of their lives.

Of those with ADHD, about half said they were diagnosed with ADHD as a child before they were 13 years old. But more than a third (35%) had not been diagnosed until after age 18. Thirty-six percent of adults in the survey with ADHD said they were taking a prescription medication for their disorder.

The study showed that adults with ADHD were less likely to have a full-time job (34% vs. 57%) and had a job turnover rate that was twice as high over the last 10 years compared with those without ADHD.

Biederman estimates that ADHD's effect on the ability to hold down a full-time job indirectly accounts for about 17% of the projected $77 billion in annual household income losses due to the disorder.

Researchers also found that adults with ADHD were less likely to finish high school or get a college or graduate degree. But the study showed that even when adults with ADHD had attained the same educational levels as others, they still had lower incomes.

"When you look at the average income by education level, we found that even if you have a graduate degree there was a big difference in what you bring home at the end of the day," says Biederman.

In addition, the study showed that ADHD had a major effect in many other aspects of the participants' lives. Compared with adults who don't have ADHD, those with ADHD:

  • Had higher divorce rates
  • Were more likely abuse alcohol or drugs
  • Were less likely to have a positive self-image or be optimistic
  • Reported lower levels of satisfaction with all aspects of their lives

Early Treatment May Prevent Economic Loss

Although as many as 8 million adults in the U.S. have the symptoms of ADHD, studies show that only about 15% of adults with ADHD are aware of their condition, and only a fraction of those receive treatment.

Experts say early identification and treatment of ADHD in young adults can help prevent some of the most significant effects the disorder can have on their educational achievement.

"Seventy-five percent of millionaires in this country have an undergraduate degree," says David Goodman, MD, assistant professor of psychiatry at the Johns Hopkins University School of Medicine, who also spoke at the briefing. "If you don't finish college because of your ADHD and not being treated, you significantly limit your financial and occupational future."

"That's why it's critical for these folks to be identified so they can reach their maximum potential and improve their quality of life," says Goodman.

While treatment cannot change a person's educational past, researchers say treatment of ADHD at any age can help adults maintain employment and secure their financial future.

But they say biggest problems in treating adult ADHD is getting people to recognize the disorder in themselves.

"In childhood, it's other people who identify the child with ADHD. In adulthood, who is going to identify the adult who spent the last 20 years in this mindset and doesn't have a basis of comparison?" says Goodman. "They don't know that life can be any different. They just figure everybody is chaotic and forgetful, and they don't come into a physician's office and say, 'I have a problem.'"

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SOURCES: Joseph Biederman, MD, professor of psychiatry, Harvard Medical School; chief of clinical and research programs in pediatric psychopharmacology and adult ADHD, Massachusetts General Hospital. David Goodman, MD, assistant professor of psychiatry, Johns Hopkins University School of Medicine.

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