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Real-life instability in ADHD from young to middle adulthood: a nationwide register-based study of social and occupational problems
Örebro University, School of Medical Sciences.ORCID iD: 0000-0003-4206-8401
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Neuropsychiatry, Region Stockholm, Stockholm, Sweden.
Takeda Pharma AB, Stockholm, Sweden.
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2023 (English)In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 23, no 1, article id 336Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Studies using self-reports indicate that individuals with ADHD are at increased risk for functional impairments in social and occupational settings, but evidence around real-life instability remains limited. It is furthermore unclear if these functional impairments in ADHD differ across sex and across the adult lifespan.

METHOD: A longitudinal observational cohort design of 3,448,440 individuals was used to study the associations between ADHD and residential moves, relational instability and job shifting using data from Swedish national registers. Data were stratified on sex and age (18-29 years, 30-39 years, and 40-52 years at start of follow up).

RESULTS: 31,081 individuals (17,088 males; 13,993 females) in the total cohort had an ADHD-diagnosis. Individuals with ADHD had an increased incidence rate ratio (IRR) of residential moves (IRR 2.35 [95% CI, 2.32-2.37]), relational instability (IRR = 1.07 [95% CI, 1.06-1.08]) and job shifting (IRR = 1.03 [95% CI, 1.02-1.04]). These associations tended to increase with increasing age. The strongest associations were found in the oldest group (40-52 years at start of follow). Women with ADHD in all three age groups had a higher rate of relational instability compared to men with ADHD.

CONCLUSION: Both men and women with a diagnosis of ADHD present with an increased risk of real-life instability in different domains and this behavioral pattern was not limited to young adulthood but also existed well into older adulthood. It is therefore important to have a lifespan perspective on ADHD for individuals, relatives, and the health care sector.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023. Vol. 23, no 1, article id 336
Keywords [en]
Adult-ADHD, Attention/Deficit-Hyperactivity/Disorder, Instability
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-105959DOI: 10.1186/s12888-023-04713-zISI: 000988229100003PubMedID: 37173664Scopus ID: 2-s2.0-85159158560OAI: oai:DiVA.org:oru-105959DiVA, id: diva2:1757178
Available from: 2023-05-16 Created: 2023-05-16 Last updated: 2025-02-12Bibliographically approved
In thesis
1. The extent to which neurodevelopmental disorders are associated with functional and physical outcomes, and why?
Open this publication in new window or tab >>The extent to which neurodevelopmental disorders are associated with functional and physical outcomes, and why?
2025 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism (ASD) are two neurodevelopmental conditions with early onset in the developmental period, high heritability and relatively high stability through the lifespan. The evi-dence base for these findings is considerable. Less researched, however, is the extent to which neurodevelopmental conditions are associated with func-tional and physical outcomes. The impact of ADHD/ASD on physical out-comes like height, obesity, and real-life functional outcomes such as relational instability, job shifting, and residential moves remain unclear. There is also a knowledge gap to what extent there is sex differences in these associations and if the associations are present through the life span. And lastly, a detailed un-derstanding about why these associations is present is also lacking. The overarching goal of this thesis was therefore to advance the understanding of the extent to which neurodevelopmental disorders are associated with functional and physical outcomes, and why. In study I-IV, we used data from Swedish population registers. We found that individuals with ASD and their relatives are at increased risk for obesity, and that the risk is partly familial in nature (study I). Further, our findings suggest that ADHD, rather than ADHD medication, is associated with shorter height and that the association between ADHD and shorter height is partly due to a shared familial liability (study II). We also found that both men and women (from young to older adulthood) with ADHD have a higher rate of residential moves, relational instability and job shifting (study III). Finally, we found that individuals with ADHD have an increased risk of sleeping disorders, from childhood to older adulthood (study IV).

The findings from this thesis highlight the importance of a life-span per-spective of neurodevelopmental disorders, and importantly - a focus that ex-tends beyond the core ADHD symptoms to include psychiatric and physical comorbidity as well as real-life functional outcomes. Thus, our findings also point to the need for integrated care between psychiatric and physical care and helping people with neurodevelopmental conditions to navigate across health care and social systems for their functional and physical problems.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2025. p. 76
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 314
Keywords
ADHD, Autism, Functional impairments, Somatic problems
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-117316 (URN)9789175296289 (ISBN)9789175296296 (ISBN)
Public defence
2025-03-06, Örebro universitet, Campus USÖ, hörsal X1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2024-11-13 Created: 2024-11-13 Last updated: 2025-03-06Bibliographically approved

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Ahlberg, RickardLarsson, HenrikGarcia-Argibay, Miguel

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