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May 5, 2023
ADHD, especially when untreated, impairs patients and creates difficulties in families.
Although these are the proximal targets of treatment, ADHD also burdens society due, for example, to underemployment and the use of health resources. A recent study assessed the economic burden using the Danish population registries, researchers, which link medical information with employment, education, crime, and social care registers while maintaining confidentiality. They identified 5,269 adults with adult ADHD who had not been diagnosed with ADHD in childhood and, we can assume, were probably not treated for the disorder. They excluded patients with other psychiatric diagnoses and cases without a same-sex sibling free of any diagnosed psychiatric diagnoses. That left 460 pairs of same-sex siblings, one with an adult with ADHD and the other with no psychiatric diagnosis. They selected the non-ADHD sibling closest in age to the ADHD sibling. Using siblings mitigated the effects of genetics and upbringing between the ADHD group and normally developing controls.
Looking at personal income (combining work income and public transfers), adults with ADHD on average brought home about 12,000 Euros less - almost a third less - than their sibling counterparts. They also paid 40% less tax. Balancing that out, their after-tax income was roughly 7,500 Euros less than their siblings. With the additional personal cost of prescribed medication(prescriptions are relatively inexpensive in Denmark, and co-payments even more so) the net personal cost to adults with ADHD was 7,700 Euros.
The net public costs were considerably greater. That was primarily due to the reduction in taxes paid (about 4,500 Euros) and the increase in income replacement transfers (just over 5,500 Euros). The cost of additional crimes committed by adults with ADHD added another 1,000 Euros. Additional primary and secondary health care costs contributed another 1,000 Euros. Subsidies for prescribed medicines added 661 Euros, but that was partly counterbalanced by a reduction of 344 Euros in education costs. There were no significant differences in costs from traffic accidents or adult continuation of foster care. Overall, the net per capita public cost of adults with ADHD was just over 12,400 Euros each year.
Combining public and private costs, the per capita economic burden of adult ADHD was just over 20,000 Euros each year.
The study could not evaluate the extent to which ADHD treatment may reduce the economic burden, but given many studies that show treatment for ADHD reduces impairments, we would expect treatment to have a positive impact on the economic burden. These results are extremely important for policymakers and for those who control the allocation of treatment in healthcare systems. Although treating ADHD incurs costs, not treating it incurs even greater costs in the long run
D. Daley, R.H. Jacobsen, A.-M. Lange, A. Sørensen, J.Walldorf, "The economic burden of adult attention-deficit hyperactivity disorder: A sibling comparison cost analysis," European Psychiatry61(2019) 41-48.
Background:
One of the more persistent concerns among parents of children with ADHD is whether stimulant medications will stunt their child's growth. A large Israeli cohort study now offers some of the most rigorous reassurance to date, and its methodology sets it apart from earlier research.
The question has long been complicated by a more fundamental uncertainty: do growth differences in children with ADHD stem from the condition itself, from stimulant treatment, or from factors present before any medication is ever prescribed? Without a clear answer, clinicians and families have faced a genuine dilemma when weighing the benefits of stimulant therapy against potential long-term physical costs.
Most previous studies compounded this difficulty by comparing group-average heights, which ignores the crucial variable of genetic potential. A child who is short relative to the general population may simply have short parents. Failing to account for this introduces systematic bias and can make medications appear more harmful than they are.
The Study:
The Israeli research team addressed this directly. Using health records from a nationwide provider, they assembled a retrospective cohort of children born between 1995 and 2003, following them through 2023. This amount of time was long enough for all participants to have reached adult stature (defined as 17 or older for females, 19 or older for males). Their sample included 5,671 children with untreated ADHD, 11,846 who received stimulant treatment, and 47,258 non-ADHD controls. Children who took stimulants for only one to two months, or who had chronic medical conditions requiring long-term medication, were excluded to avoid confounding the results.
Crucially, adult height was evaluated not against population norms but against each individual's expected height, calculated from parental heights using the Tanner-Goldstein-Whitehouse method, a standard approach for estimating genetic height potential via mid-parental height.
When the researchers compared adult heights across the three groups using analysis of variance (ANOVA), they did find statistically significant differences. But statistical significance, particularly in studies with tens of thousands of participants, does not automatically translate into clinical significance. The effect sizes were consistently very small, and the absolute differences were under one centimeter, which is a margin considered clinically negligible.
Their conclusion is measured but clear: after accounting for genetic growth potential, neither an ADHD diagnosis nor stimulant treatment was associated with meaningful reductions in adult height. The findings, they argue, support prioritizing behavioral and functional outcomes when making treatment decisions, since the risk of clinically significant height loss appears to be minimal.
The Take-Away:
For families navigating ADHD treatment, the practical implication is significant: concerns about permanent growth suppression, while understandable, should not be the primary driver of whether or how long a child receives stimulant therapy.
A recent meta-analysis examined how well cognitive behavioral therapy (CBT) improves not just symptoms, but everyday functioning and quality of life in adults with ADHD.
The Background:
ADHD in adults affects far more than attention or impulsivity. It often disrupts key areas of life:
These broad impacts highlight a key issue: reducing symptoms does not automatically translate into better day-to-day functioning.
CBT is a structured, skills-based therapy that helps people:
While both medication (especially stimulants) and CBT improve core ADHD symptoms, CBT is particularly aimed at improving real-world functioning.
The Study:
The researchers analyzed studies involving adults diagnosed with ADHD (or showing clinically significant symptoms). They included:
They focused specifically on outcomes beyond symptoms:
The Results:
1. Strongest Effects: Occupational functioning
CBT showed consistently strong improvements in work-related functioning compared to control groups, both immediately after treatment and at follow-up. This was the most robust finding across domains.
2. Moderate Improvement: Global Functional Impairment
CBT led to moderate improvements in overall daily functioning, with some evidence that gains persist over time. In studies tracking individuals over time, improvements were even stronger at follow-up.
3. Modest Gains: Social Relationships
CBT produced small to moderate improvements in social functioning. Benefits were present both after treatment and at follow-up, but were less pronounced than in work-related outcomes.
4. Limited Effects: Academic Functioning
There were moderate short-term gains when CBT was compared to control groups, but these did not persist at follow-up. Within-subject studies showed only small improvements overall.
5. Modest and Inconsistent Effects: Quality of Life
Improvements in quality of life were small when compared to control groups and often did not last. However, studies tracking individuals over time showed moderate improvements, suggesting some benefit that may not always show up clearly in between-group comparisons.
Overall, the findings suggest:
One notable nuance: CBT did not always outperform other active treatments (like medication or other therapies). This suggests that while CBT is effective, its benefits may partly overlap with broader therapeutic or support effects rather than relying on a single, unique mechanism.
The Take-Away:
CBT is a valuable, evidence-based treatment for adults with ADHD, especially for improving work functioning and overall daily life management. However, its impact on relationships, academic outcomes, and quality of life is more limited and less consistent, pointing to the need for more targeted or combined approaches in those areas.
The Background:
ADHD and epilepsy are the two most common neurological disorders in children and adolescents. Additionally, they appear as co-diagnoses more often than chance would predict. Roughly a quarter of children with epilepsy also have ADHD, and children with ADHD face a 2.5-times greater risk of developing epilepsy than their peers.
Clinicians have long suspected that carrying both diagnoses compounds cognitive difficulties, but no rigorous quantitative review has mapped out exactly how much, or in what ways. This new meta-analysis now fills that gap.
The Study:
The team pooled data from peer-reviewed studies that included children and adolescents diagnosed with both conditions alongside at least one comparison group: children with neither condition, children with epilepsy alone, or children with ADHD alone. To capture the breadth of thinking skills, they constructed a general intelligence factor drawing on six cognitive domains:
The Results:
Across eleven studies (995 participants), children and adolescents with both conditions scored moderately lower on general intelligence than those with epilepsy alone. The same pattern held across all six cognitive domains. Seven studies (785 participants) comparing the dual-diagnosis group with those who had ADHD alone found an equally consistent moderate deficit, replicated in every domain.
The clearest signal emerged when researchers compared children and adolescents carrying both diagnoses to typically-developing peers. Seven studies covering 427 individuals revealed a substantially larger gap in general intelligence, with the effects of the two conditions appearing to be roughly additive, meaning the combined burden was approximately equal to the sum of each condition's individual impact. This pattern held across five of the six domains.
The Interpretation:
The results come with meaningful caveats. Variability across individual studies was moderate in the first two comparisons and high in the third, reflecting real differences in how studies were designed, which populations they sampled, and how they measured cognition. While there was no sign of publication bias in the first group, it was not assessed in two of the three analyses.
The authors describe “a widespread profile of cognitive dysfunction” in children and adolescents with both epilepsy and ADHD, while underscoring that the substantial variability between studies warrants caution in drawing overly precise conclusions. The findings nonetheless carry practical weight: children managing both conditions may need more intensive cognitive screening and support than current clinical practice routinely provides.
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