Comorbid ADHD and ODD Linked to Higher Rates of Unemployment, Lower Income

Symptoms of attention-deficit/hyperactivity disorder (ADHD) and comorbid symptoms ADHD and oppositional defiant disorder (ODD) during adolescence are associated with elevated rates of unemployment and lower incomes in adulthood, according to study results published in the Journal of Attention Disorders.

To date, studies evaluating the association between ADHD symptoms and occupational outcomes have produced mixed evidence. Further, although ODD has been tied to adverse functional outcomes, limited research has explored ODD symptoms and occupational functioning in adulthood. To address this knowledge gap, investigators conducted a population-based follow-up study to determine whether symptoms of ADHD, ODD, or comorbid symptoms ADHD and ODD are associated with occupational outcomes and incomes in adulthood.

The investigators used data from the Northern Finland Birth Cohort 1986, a longitudinal study that evaluated ADHD and ODD symptoms among adolescents aged 15 to 16 years using the Strengths and Weaknesses of ADHD-Symptoms and Normal-Behaviors (SWAN) questionnaire. From the SWAN data, the investigators categorized adolescents into 4 groups based on their reported symptoms: 1) adolescents with ADHD symptoms, 2) adolescents with ODD symptoms, 3) adolescents with ADHD + ODD symptoms, and (4) community controls, who exhibited neither ADHD nor ODD symptoms. Additionally, income data was collected using the register of the Finnish Tax Administration and employment data was extracted from the Finnish Center for Pensions.

A total of 6230 participants were included in the analysis, 5532 of whom served as controls, 360 had symptoms of ADHD, 199 had comorbid symptoms of ADHD + ODD, and 139 had symptoms of ODD. Symptoms of ADHD and comorbid symptoms of ADHD + ODD were most commonly reported by boys, at 66.7% and 54.7%, respectively. The ADHD + ODD cohort had the highest prevalence of other comorbid psychiatric disorders (43.7%) of all 4 study groups.

The investigators found across symptomatic groups, men had significantly greater days of unemployment between 25 and 33 years of age, relative to the control cohort (all P <.05). However, only the ADHD and ADHD + ODD groups were associated with greater days of unemployment among women (all P <.05).

At 30 years of age, men in the control group had a significantly higher income (mean=€30,875; SD, €20,326) than men who had symptoms of ADHD (mean=€27,341; SD, €15,998) or comorbid symptoms of ADHD + ODD (mean=€24,922; SD, €16,323) during adolescence (all P <.05). Similarly, women in the control group had a significantly higher income (mean=€23,013; SD, €14,804) than women who had symptoms of ADHD (mean=€19,949; SD, €11,365) or comorbid symptoms of ADHD + ODD (mean=€18,793; SD, €10,950) during adolescence (all P <.05). For both men and women, the ADHD + ODD groups had the lowest income across the study groups.

When adjusted for psychiatric disorders other than ADHD or ODD, the investigators found that annual incomes for participants at 30 years of age were significantly lower among men who had symptoms of ADHD during adolescence (-9.34%; 95% CI, -14.79% to -3.54%; P <.05) and women who had comorbid symptoms of ADHD + ODD during adolescence (-9.34%; 95% CI, -17.63% to -0.20%; P <.05).

The primary study limitations include the relatively short follow-up time for incomes, the lack of global generalizability of the findings outside of Finland, and the potential bias of self-reported measures of ADHD and ODD symptoms.

These findings indicate that symptoms of ADHD and comorbid symptoms of ADHD during adolescence and ODD are associated with adverse occupational outcomes and income in adulthood. The investigators concluded, “In a clinical context, early recognition of ADHD and ODD symptoms is important due to their long-term impact.”

This article originally appeared on Psychiatry Advisor