Educational and Health Outcomes of Children Treated for Attention-Deficit/Hyperactivity Disorder | Attention Deficit/Hyperactivity Disorders | JAMA Pediatrics | JAMA Network
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1.
Polanczyk  G, de Lima  MS, Horta  BL, Biederman  J, Rohde  LA.  The worldwide prevalence of ADHD: a systematic review and metaregression analysis.  Am J Psychiatry. 2007;164(6):942-948.PubMedGoogle ScholarCrossref
2.
Global Burden of Disease Study 2013 Collaborators.  Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.  Lancet. 2015;386(9995):743-800.PubMedGoogle ScholarCrossref
3.
Biederman  J, Newcorn  J, Sprich  S.  Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders.  Am J Psychiatry. 1991;148(5):564-577.PubMedGoogle ScholarCrossref
4.
Pliszka  SR.  Comorbidity of attention-deficit/hyperactivity disorder with psychiatric disorder: an overview.  J Clin Psychiatry. 1998;59(suppl 7):50-58.PubMedGoogle Scholar
5.
Karande  S, Kulkarni  M.  Poor school performance.  Indian J Pediatr. 2005;72(11):961-967.PubMedGoogle ScholarCrossref
6.
Guevara  J, Lozano  P, Wickizer  T, Mell  L, Gephart  H.  Utilization and cost of health care services for children with attention-deficit/hyperactivity disorder.  Pediatrics. 2001;108(1):71-78.PubMedGoogle ScholarCrossref
7.
Birnbaum  HG, Kessler  RC, Lowe  SW,  et al.  Costs of attention deficit-hyperactivity disorder (ADHD) in the US: excess costs of persons with ADHD and their family members in 2000.  Curr Med Res Opin. 2005;21(2):195-206.PubMedGoogle ScholarCrossref
8.
Rodriguez  A, Järvelin  M-R, Obel  C,  et al.  Do inattention and hyperactivity symptoms equal scholastic impairment? evidence from three European cohorts.  BMC Public Health. 2007;7(1):327.PubMedGoogle ScholarCrossref
9.
Barry  TD, Lyman  RD, Klinger  LG.  Academic underachievement and attention-deficit/hyperactivity disorder: the negative impact of symptom severity on school performance.  J Sch Psychol. 2002;40(3):259-283.Google ScholarCrossref
10.
McConaughy  SH, Volpe  RJ, Antshel  KM, Gordon  M, Eiraldi  RB.  Academic and social impairments of elementary school children with attention deficit hyperactivity disorder.  School Psych Rev. 2011;40(2):200-225.Google Scholar
11.
Willcutt  EG, Doyle  AE, Nigg  JT, Faraone  SV, Pennington  BF.  Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review.  Biol Psychiatry. 2005;57(11):1336-1346.PubMedGoogle ScholarCrossref
12.
Dalsgaard  S, Nielsen  HS, Simonsen  M.  Consequences of ADHD medication use for children’s outcomes.  J Health Econ. 2014;37:137-151.PubMedGoogle ScholarCrossref
13.
Beau-Lejdstrom  R, Douglas  I, Evans  SJW, Smeeth  L.  Latest trends in ADHD drug prescribing patterns in children in the UK: prevalence, incidence and persistence.  BMJ Open. 2016;6(6):e010508.PubMedGoogle ScholarCrossref
14.
Sayal  K, Ford  T, Goodman  R.  Trends in recognition of and service use for attention-deficit hyperactivity disorder in Britain, 1999-2004.  Psychiatr Serv. 2010;61(8):803-810.PubMedGoogle ScholarCrossref
15.
Safer  DJ, Zito  JM, Fine  EM.  Increased methylphenidate usage for attention deficit disorder in the 1990s.  Pediatrics. 1996;98(6, pt 1):1084-1088.PubMedGoogle Scholar
16.
National Institute for Health and Clinical Excellence. Attention deficit hyperactivity disorder (ADHD): clinical guideline [CG72]. www.nice.org.uk/guidance/cg72. Updated February 2016. Accessed March 29, 2017.
17.
Wolraich  M, Brown  L, Brown  RT,  et al; Subcommittee on Attention-Deficit/Hyperactivity Disorder; Steering Committee on Quality Improvement and Management.  ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents.  Pediatrics. 2011;128(5):1007-1022.PubMedGoogle ScholarCrossref
18.
Wood  R, Clark  D, King  A, Mackay  D, Pell  J.  Novel cross-sectoral linkage of routine health and education data at an all-Scotland level: a feasibility study.  Lancet. 2013;382:S10.Google ScholarCrossref
19.
Rucklidge  JJ.  Gender differences in attention-deficit/hyperactivity disorder.  Psychiatr Clin North Am. 2010;33(2):357-373.PubMedGoogle ScholarCrossref
20.
Lillemoen  PK, Kjosavik  SR, Hunskår  S, Ruths  S.  Prescriptions for ADHD medication, 2004-08.  Tidsskr Nor Laegeforen. 2012;132(16):1856-1860.PubMedGoogle ScholarCrossref
21.
Barbaresi  WJ, Katusic  SK, Colligan  RC, Weaver  AL, Jacobsen  SJ.  Long-term school outcomes for children with attention-deficit/hyperactivity disorder: a population-based perspective.  J Dev Behav Pediatr. 2007;28(4):265-273.PubMedGoogle ScholarCrossref
22.
Wu  S-Y, Gau  SS-F.  Correlates for academic performance and school functioning among youths with and without persistent attention-deficit/hyperactivity disorder.  Res Dev Disabil. 2013;34(1):505-515.PubMedGoogle ScholarCrossref
23.
Kent  KM, Pelham  WE  Jr, Molina  BS,  et al.  The academic experience of male high school students with ADHD.  J Abnorm Child Psychol. 2011;39(3):451-462.PubMedGoogle ScholarCrossref
24.
Kuriyan  AB, Pelham  WE  Jr, Molina  BS,  et al.  Young adult educational and vocational outcomes of children diagnosed with ADHD.  J Abnorm Child Psychol. 2013;41(1):27-41.PubMedGoogle ScholarCrossref
25.
Hurtig  T, Ebeling  H, Jokelainen  J, Koivumaa-Honkanen  H, Taanila  A.  The association between hospital-treated injuries and ADHD symptoms in childhood and adolescence: a follow-up study in the Northern Finland Birth Cohort, 1986.  J Atten Disord. 2016;20(1):3-10.PubMedGoogle ScholarCrossref
26.
van den Ban  E, Souverein  P, Meijer  W,  et al.  Association between ADHD drug use and injuries among children and adolescents.  Eur Child Adolesc Psychiatry. 2014;23(2):95-102.PubMedGoogle ScholarCrossref
27.
Pastor  PN, Reuben  CA.  Identified attention-deficit/hyperactivity disorder and medically attended, nonfatal injuries: US school-age children, 1997-2002.  Ambul Pediatr. 2006;6(1):38-44.PubMedGoogle ScholarCrossref
28.
Healthcare Improvement Scotland.  Attention deficit and hyperkinetic disorders: services over Scotland; final report. Edinburgh, UK: NHS Scotland; 2012. http://www.healthcareimprovementscotland.org/our_work/mental_health/adhd_services_over_scotland/stage_3_adhd_final_report.aspx. Accessed 6 December 2016.
Original Investigation
July 3, 2017

Educational and Health Outcomes of Children Treated for Attention-Deficit/Hyperactivity Disorder

Author Affiliations
  • 1Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
  • 2Department of Child Health, University of Aberdeen, Aberdeen, Scotland
  • 3Information Services Division, Edinburgh, Scotland
  • 4ScotXed, Scottish Government, Edinburgh, Scotland
JAMA Pediatr. 2017;171(7):e170691. doi:10.1001/jamapediatrics.2017.0691
Key Points

Question  Do schoolchildren treated for attention-deficit/hyperactivity disorder have worse education and health outcomes than their peers?

Findings  In this population-based cohort study, 766 244 singleton children attended Scottish schools between 2009 and 2013. The 7413 children receiving medication for attention-deficit/hyperactivity disorder had worse education outcomes (unauthorized absence, exclusion, special educational need, lower academic attainment, left school earlier, and higher unemployment) and health outcomes (hospitalizations overall and for injury).

Meaning  Even with medication, children with attention-deficit/hyperactivity disorder fare worse than their peers across a wide range of outcomes relating not only to education but also health.

Abstract

Importance  Attention-deficit/hyperactivity disorder (ADHD) affects 39 million people worldwide; in isolation, it doubles annual health care costs and, when associated with comorbid mental health problems, it quadruples the costs.

Objective  To compare the education and health outcomes of schoolchildren treated for ADHD with their peers.

Design, Setting, and Participants  In this population-based cohort study, individual-level record linkage was performed of 8 Scotland-wide administrative databases covering dispensed prescriptions, admissions to acute and psychiatric hospitals, maternity records, annual pupil census, examinations, school absences and exclusions, and unemployment. The study cohort comprised 766 244 children attending Scottish primary, secondary, and special schools at any point between September 21, 2009, and September 18, 2013. Data analysis was performed from June 1, 2015, to December 6, 2016.

Exposures  Medication approved solely for ADHD treatment.

Main Outcomes and Measures  Special educational needs, academic attainment, unauthorized absence, exclusion, age at leaving school, unemployment after leaving, and hospitalization. Outcomes were adjusted for potential sociodemographic, maternity, and comorbidity confounders.

Results  Of the 766 244 schoolchildren, 7413 (1.0%) were treated for ADHD; 6287 (84.8%) were male. These children had higher rates of unauthorized absence (adjusted incidence rate ratio [IRR], 1.16; 95% CI, 1.14-1.19) and exclusion (adjusted IRR, 5.79; 95% CI, 5.45-6.16), more commonly had a record of special educational need (adjusted odds ratio [OR], 8.62; 95% CI, 8.26-9.00), achieved lower academic attainment (adjusted OR, 3.35; 95% CI, 3.00-3.75), were more likely to leave school before age 16 years (1546 [64.3%] vs 61 235 [28.4%]), and were more likely to be unemployed (adjusted OR, 1.39; 95% CI, 1.25-1.53). Children with ADHD were more likely to require hospitalization overall (adjusted hazard ratio [HR], 1.25; 95% CI, 1.19-1.31) and for injury (adjusted HR, 1.52; 95% CI, 1.40-1.65).

Conclusions and Relevance  Even while receiving medication, children with ADHD fare worse than their peers across a wide range of outcomes relating not only to education but also to health.

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