Association of Attention-Deficit/Hyperactivity Disorder Diagnosis With Adolescent Quality of Life

Key Points

Question

Is an attention-deficit/hyperactivity disorder (ADHD) diagnosis in childhood or early adolescence associated with quality of life in adolescents compared with age-, sex-, and behavior-matched individuals without a diagnosis?

Findings

In this cohort study, 393 adolescents with an ADHD diagnosis reported similar quality of life overall and on 3 subdomains but significantly worse outcomes for 5 other aspects of quality of life compared with 393 matched adolescents with similar levels of hyperactive/inattentive behaviors but no ADHD diagnosis.

Meaning

These findings suggest that childhood ADHD diagnosis may not result in any improvements in quality of life measures in adolescents and may negatively impact some outcomes, such as risk of self-harm.

Abstract

This cohort study examines quality of life in adolescents who have received a diagnosis of attention-deficit/hyperactivity disorder compared with peers with matched hyperactive/inattentive behaviors but who have not received a diagnosis.

Abstract

Importance

Appropriate diagnosis of attention-deficit/hyperactivity disorder (ADHD) can improve some short-term outcomes in children and adolescents, but little is known about the association of a diagnosis with their quality of life (QOL).

Objective

To compare QOL in adolescents with and without an ADHD diagnosis.

Design, Setting, and Participants

This cohort study followed an emulated target trial design using prospective, observational data from the Longitudinal Study of Australian Children, a representative, population-based prospective cohort study with biennial data collection from 2006 to 2018 with 8 years of follow-up (ages 6-7 to 14-15 years). Propensity score matching was used to ensure children with and without ADHD diagnosis were well matched on a wide range of variables, including hyperactive/inattentive (H/I) behaviors. Eligible children were born in 1999 to 2000 or 2003 to 2004 and did not have a previous ADHD diagnosis. All incident ADHD cases were matched with controls. Data were analyzed from July 2021 to January 2022.

Exposures

Incident parent-reported ADHD diagnosis at age 6 to 7, 8 to 9, 10 to 11, 12 to 13, or 14 to 15.

Main Outcomes and Measures

Quality of life at age 14 to 15 was measured with Child Health Utility 9D (CHU9D) and 8 other prespecified, self-reported measures mapped to the World Health Organization’s QOL domains. Pooled regression models were fitted for each outcome, with 95% CIs and P values calculated using bootstrapping to account for matching and repeat observations.

Results

Of 8643 eligible children, a total of 393 adolescents had an ADHD diagnosis (284 [72.2%] boys; mean [SD] age, 10.03 [0.30] years; mean [SD] H/I Strengths and Difficulties Questionnaire score, 5.05 [2.29]) and were age-, sex-, and H/I score–matched with 393 adolescents without ADHD diagnosis at time zero. Compared with adolescents without diagnosis, those with an ADHD diagnosis reported similar QOL on CHU9D (mean difference, −0.03; 95% CI, −0.07 to 0.01; P = .10), general health (mean difference, 0.11; 95% CI, −0.04 to 0.27; P = .15), happiness (mean difference, −0.18; 95% CI, −0.37 to 0.00; P = .05), and peer trust (mean difference, 0.65; 95% CI, 0.00 to 1.30; P = .05). Diagnosed adolescents had worse psychological sense of school membership (mean difference, −2.58; 95% CI, −1.13 to −4.06; P < .001), academic self-concept (mean difference, −0.14; 95% CI, −0.02 to −0.26; P = .02), and self-efficacy (mean difference, −0.20; 95% CI, −0.05 to −0.33; P = .007); displayed more negative social behaviors (mean difference, 1.56; 95% CI, 0.55 to 2.66; P = .002); and were more likely to harm themselves (odds ratio, 2.53; 95% CI, 1.49 to 4.37; P < .001) than adolescents without diagnosis.

Conclusions and Relevance

In this cohort study, ADHD diagnosis was not associated with any self-reported improvements in adolescents’ QOL compared with adolescents with similar levels of H/I behaviors but no ADHD diagnosis. ADHD diagnosis was associated with worse scores in some outcomes, including significantly increased risk of self-harm. A large, randomized clinical trial with long-term follow-up is needed.