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Study: Having ADHD costs $1.1 million in lower lifetime earnings, even when “treated”

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Rel­a­tive­ly few stud­ies have exam­ined the impact of child­hood ADHD on long-term finan­cial out­comes, even though becom­ing self-sup­port­ing and attain­ing finan­cial inde­pen­dence is an impor­tant devel­op­men­tal task.

An espe­cial­ly com­pre­hen­sive look at this issue is pro­vid­ed in a study by Pel­ham et al pub­lished recent­ly in the Jour­nal of Con­sult­ing and Clin­i­cal Psy­chol­o­gy.

The Study:

Par­tic­i­pants were 364 adults who were diag­nosed with ADHD in child­hood along with 264 demo­graph­i­cal­ly matched con­trols. All par­tic­i­pants with ADHD had attend­ed an inten­sive sum­mer treat­ment pro­gram and 90% had been treat­ed with stim­u­lant med­ica­tion at some time.

Par­tic­i­pants were fol­lowed over a 20-year peri­od, and infor­ma­tion relat­ed to their finan­cial sta­tus, edu­ca­tion­al attain­ment, and ADHD symp­toms were obtained at age 25 and again at age 30. This enabled the researchers to exam­ine 4 ques­tions:

1. How did finan­cial out­comes at age 30 com­pare for ADHD par­tic­i­pants and con­trols? To what extend did this depend on their edu­ca­tion­al attain­ment and the degree to which ADHD symp­toms had per­sist­ed?

2. How did the finan­cial tra­jec­to­ry of par­tic­i­pants with and with­out ADHD dif­fer from age 25 to 30?

3. What were the pro­ject­ed dif­fer­ences in life­time earn­ings?

4. What were the pro­ject­ed dif­fer­ences in net worth at retire­ment?

The Results:

Finan­cial out­comes at age 30 - At age 30, par­tic­i­pants with child­hood ADHD were more like­ly to be unem­ployed (22% vs. 13%) and to be liv­ing at home (33% vs. 12%). On aver­age, their month­ly earn­ings were 37% less and they had 66% less mon­ey in sav­ings.

They were also less like­ly to own a home (22% vs. 42%), their par­ents were more like­ly to be reg­u­lar­ly sup­port­ing them (23% vs. 8%), and they were more like­ly to be receiv­ing reg­u­lar sup­port from a non-par­ent adult (21% vs. 7%).

Were finan­cial out­comes bet­ter for indi­vid­u­als no longer diag­nosed with ADHD as adults? Not real­ly. Even among adults who no longer met diag­nos­tic cri­te­ria for ADHD, near­ly all finan­cial out­comes remained sig­nif­i­cant­ly below those of con­trols.

And, even when ADHD symp­toms appeared to have ful­ly remit­ted, they still fared worse than con­trols on mul­ti­ple out­comes, e.g., more like­ly to be liv­ing with parents/family, to be reg­u­lar­ly receiv­ing mon­ey from parents/family, to be receiv­ing finan­cial assis­tance from a non­par­ent adult, and hav­ing less mon­ey in sav­ings.

Were dif­fer­ences in finan­cial out­comes explained by dif­fer­ences in edu­ca­tion­al attain­ment? Not ful­ly. As expect­ed, par­tic­i­pants with ADHD in child­hood had low­er edu­ca­tion­al attain­ment at age 25 than con­trols. Not sur­pris­ing­ly, edu­ca­tion­al dif­fer­ences were a sig­nif­i­cant con­trib­u­tor to dif­fer­ences in finan­cial out­comes.

How­ev­er, even after con­trol­ling for edu­ca­tion­al attain­ment dif­fer­ences, sev­er­al finan­cial out­comes dif­fer­ences remained sig­nif­i­cant. These dif­fer­ences reflect adverse impacts of ADHD on finan­cial out­comes that are not explained by edu­ca­tion­al attain­ment.

How did the finan­cial tra­jec­to­ry of par­tic­i­pants with and with­out ADHD dif­fer from age 25 to 30? Those in the ADHD group made few­er financial/ inde­pen­dent liv­ing gains than peers. This includ­ed a small­er reduc­tion in the per­cent­age liv­ing at home — a decline of 40% to 33% for ADHD group vs. 28% to 12&% for con­trols.

Their month­ly income increased less — $285 vs. $974 — as did their cumu­la­tive sav­ings — an increase of $1508 in sav­ings for the ADHD group vs. $3722 for con­trols. And, the per­cent who received reg­u­lar finan­cial con­tri­bu­tions from par­ents actu­al­ly increased slight­ly dur­ing this peri­od while it declined sig­nif­i­cant­ly for con­trols.

How did pro­ject­ed life­time earn­ings dif­fer? Pro­jec­tions based on edu­ca­tion and age 30 employ­ment sta­tus sug­gest­ed that con­trol par­tic­i­pants would earn $1.10 mil­lion more dur­ing their life­time than those in the ADHD group, ($2.26 mil­lion vs. $3.36 mil­lion, a 49% dif­fer­ence),

What were the pro­ject­ed dif­fer­ences in net worth at retire­ment? Pro­ject­ed net worth at retire­ment indi­cat­ed mean net worth would be 35% low­er in the ADHD group — $410,000 vs. $630,000 — reflect­ing a deficit of $220,000. The pro­ject­ed net worth dif­fer­ence var­ied sub­stan­tial­ly as a func­tion of the assumed sav­ings rates and return on invest­ment. Under any set of assump­tions, how­ev­er, the pro­ject­ed net worth was always low­er in the ADHD group.

Summary and implications:

Results from this study indi­cat­ed that at age 30, adults with ADHD in child­hood were far­ing worse than non-affect­ed peers on mul­ti­ple finan­cial indi­ca­tors, includ­ing income, sav­ings, employ­ment sta­tus, and depen­dence on par­ents and oth­er adults. More often than not, they remained finan­cial­ly depen­dent on par­ents and/or oth­ers.

This was true when they no longer met diag­nos­tic cri­te­ria for ADHD and even when they dis­played no sig­nif­i­cant ADHD as adults. Between ages 25 and 30, dif­fer­ences in finan­cial out­comes between the groups actu­al­ly increased and pro­jec­tions of life­time earn­ings and net worth at retire­ment were dra­mat­i­cal­ly dif­fer­ent.

Giv­en the con­cern­ing nature of these find­ings, it would have been help­ful to know whether the qual­i­ty and dura­tion of treat­ment that par­tic­i­pants received over their devel­op­ment mate­ri­al­ly impact­ed their finan­cial out­comes.

For exam­ple, did more sus­tained med­ica­tion treat­ment, or par­tic­i­pa­tion in oth­er inter­ven­tions, lead to bet­ter finan­cial results? This is a very impor­tant ques­tion but ana­lyz­ing the data in this way was not done.

It is also impor­tant to remem­ber that the find­ings report­ed reflect aver­age dif­fer­ences between par­tic­i­pants with and with­out ADHD. Cer­tain­ly, a num­ber of those in the ADHD group were liv­ing inde­pen­dent­ly and had attained pos­i­tive finan­cial out­comes. Thus, one should cer­tain­ly not assume that finan­cial chal­lenges are an inevitable result of hav­ing ADHD as they are not.

One impor­tant fac­tor con­tribut­ing to greater finan­cial dif­fi­cul­ties among indi­vid­u­als with ADHD was their ten­den­cy to have low­er edu­ca­tion­al attain­ment. Pro­mot­ing aca­d­e­m­ic suc­cess in youth with ADHD is essen­tial for this as well as oth­er rea­sons. Unfor­tu­nate­ly, how­ev­er, aca­d­e­m­ic sup­ports avail­able to those with ADHD in many pub­lic school sys­tems tend to decline as stu­dents move from ele­men­tary, to mid­dle, to high school. This is a real prob­lem.

In sum­ma­ry, results sug­gest there is great need for inter­ven­tions that can improve finan­cial func­tion­ing as chil­dren with ADHD reach young adult­hood. Unfor­tu­nate­ly, there has been very lit­tle work com­plet­ed in this area and this would be impor­tant to exam­ine in fol­low up research to this impor­tant study.

– Dr. David Rabin­er is a child clin­i­cal psy­chol­o­gist and Direc­tor of Under­grad­u­ate Stud­ies in the Depart­ment of Psy­chol­o­gy and Neu­ro­science at Duke Uni­ver­si­ty. He pub­lish­es the Atten­tion Research Update, an online newslet­ter that helps par­ents, pro­fes­sion­als, and edu­ca­tors keep up with the lat­est research on ADHD.

The Study in Context:

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Categories: Attention and ADD/ADHD, Cognitive Neuroscience, Education & Lifelong Learning, Health & Wellness

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As seen in The New York Times, The Wall Street Journal, BBC News, CNN, Reuters,  SharpBrains is an independent market research firm tracking how brain science can improve our health and our lives.

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