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

 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:

• Neu­ro­feed­back or med­ica­tion to treat ADHD?
• Large study with twins high­lights the lim­it­ed role of genet­ics in men­tal health and the impor­tance of effec­tive ear­ly inter­ven­tions for ADHD
• What are cog­ni­tive abil­i­ties and how to boost them?
• Rates of ADHD diag­no­sis and med­ica­tion treat­ment con­tin­ue to increase substantially