The Impacts Associated With Having ADHD: An Umbrella Review

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterized by persistent inattention, hyperactivity, and impulsivity.

While these core symptoms are well-known, ADHD can have far-reaching impacts on an individual’s life beyond these primary features.

It can affect mental and physical health, academic and occupational performance, social relationships, and overall quality of life.

Individuals with ADHD may experience challenges in daily functioning, increased risk of certain health conditions, difficulties in personal relationships, and struggles with self-esteem.

Understanding these wide-ranging impacts is crucial for providing comprehensive support and improving outcomes for those affected by ADHD.

French, B., Nalbant, G., Wright, H., Sayal, K., Daley, D., Groom, M. J., Cassidy, S., & Hall, C. L. (2024). The impacts associated with having ADHD: an umbrella review. Frontiers in psychiatry, 15, 1343314. https://doi.org/10.3389/fpsyt.2024.1343314

Key Points

• The primary impacts of ADHD identified through this umbrella review include mental health issues (e.g., addiction, mood disorders, suicide risk), physical health problems (e.g., obesity, sleep disorders, injuries), and social/lifestyle challenges (e.g., academic/occupational difficulties, relationship problems, criminality).
• Factors like comorbid mental health conditions, physical health issues, and social/environmental circumstances significantly affect the long-term outcomes and quality of life for individuals with ADHD.
• While comprehensive, the research has limitations such as variability in review quality, potential publication bias, and a focus primarily on negative outcomes associated with ADHD.
• This review highlights the wide-ranging impacts of ADHD beyond core symptoms, underscoring its importance as a public health and societal issue requiring a holistic approach to care and support.

Rationale

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting approximately 5% of children, with symptoms often persisting into adulthood (Polanczyk et al., 2007).

While the core symptoms of inattention, hyperactivity, and impulsivity are well-established, there is growing recognition that ADHD has wide-ranging impacts on many aspects of an individual’s life.

Previous research has identified associations between ADHD and various adverse outcomes related to mental health, physical health, academic/occupational functioning, and social relationships (Harpin, 2005; Nigg, 2013).

However, the breadth of research on ADHD-related outcomes makes it challenging to synthesize findings comprehensively.

While some previous reviews have attempted to summarize long-term outcomes in ADHD (e.g., Shaw et al., 2012), they have often been limited in scope or focused primarily on treated vs untreated ADHD.

There is a need for an up-to-date, comprehensive synthesis of the wide-ranging impacts associated with ADHD across the lifespan.

This umbrella review aimed to address this gap by systematically reviewing and synthesizing findings from existing reviews on the various risks and impacts associated with having ADHD.

By taking this “review of reviews” approach, the authors sought to provide a broad overview of the current state of evidence regarding ADHD-related outcomes across multiple domains of functioning.

This comprehensive synthesis can inform clinical practice, policy development, and future research directions related to ADHD.

Method

This study utilized an umbrella review methodology, following PRISMA guidelines for systematic reviews.

Five major databases were searched: PsycINFO, Embase, Scopus, Medline, and ERIC. The search was conducted in July 2023 without date restrictions.

Search strategy and terms:

The search strategy was adapted for each database but generally included terms related to ADHD and associated risks/impacts.

A sample search strategy for Medline is provided in the supplementary materials.

Inclusion criteria:

• Published reviews of any design (e.g., systematic reviews, meta-analyses, narrative reviews)
• Focus on impacts, long-term outcomes, or risks associated with ADHD
• Peer-reviewed publications
• Reviews including individuals (adults or children) meeting criteria for or diagnosed with ADHD

Exclusion criteria:

• Unpublished or grey literature
• Non-English language publications
• Primary studies (not reviews)
• Reviews on prevalence, assessment, interventions, management, or treatment of ADHD
• Reviews on biological features (e.g., genetics, brain correlates)
• Reviews not reporting a direct link between ADHD and risks/impacts

Statistical measures:

Due to the heterogeneity of included reviews, a narrative synthesis approach was used rather than quantitative meta-analysis.

Two reviewers independently extracted data and assessed the methodological quality of included reviews using standardized tools (JBI critical appraisal checklist for systematic reviews or SANRA for narrative reviews).

Results

The search identified 16,675 records, of which 125 reviews met inclusion criteria after screening. The included reviews covered three key domains of ADHD-related impacts:

Mental Health (42 reviews):

• Addiction: Strong associations were found between ADHD and various addictions, including substance use disorders, internet/gaming addiction, and gambling.
• Suicide and self-harm: Consistent evidence of increased risk of suicidal behaviors and self-harm in individuals with ADHD.
• Mood and personality disorders: Increased rates of depression, bipolar disorder, and borderline personality disorder in ADHD populations.
• Other disorders: Associations found with eating disorders, psychotic disorders, and obsessive-compulsive disorder.

Physical Health (51 reviews):

• Sleep: Consistent evidence of sleep disturbances and disorders in both children and adults with ADHD.
• Oral health: Higher rates of dental problems and injuries in children with ADHD.
• Weight: Increased risk of obesity in both children and adults with ADHD.
• Accidents and injuries: Higher rates of accidents, injuries, and mortality risk associated with ADHD.
• Other health issues: Associations found with various conditions including asthma, migraines, and cardiovascular disease.

Social and Lifestyle (32 reviews):

• Offending and criminality: Increased risk of criminal behaviors and incarceration in individuals with ADHD.
• Education and employment: Poorer academic outcomes and occupational functioning associated with ADHD.
• Quality of life: Consistently lower reported quality of life in individuals with ADHD compared to controls.
• Relationships: Difficulties in social interactions, peer relationships, and intimate partnerships associated with ADHD.
• Risk-taking behaviors: Increased engagement in risky behaviors including dangerous driving and unplanned pregnancy.

Insight

This comprehensive umbrella review provides a broad overview of the wide-ranging impacts associated with ADHD beyond its core symptomatology.

The findings underscore that ADHD is not merely a disorder of attention and hyperactivity/impulsivity, but one that can profoundly affect multiple domains of an individual’s life across the lifespan.

The strong associations found between ADHD and various mental health conditions, particularly addictions and mood disorders, highlight the need for careful assessment and management of comorbidities in ADHD care.

The bidirectional relationships observed between ADHD and some conditions (e.g., sleep disorders) suggest complex interactions that require further investigation.

In the realm of physical health, the consistent links between ADHD and obesity, sleep problems, and accidental injuries point to the importance of addressing lifestyle factors and safety concerns in ADHD management.

The associations with various other health conditions also indicate a need for interdisciplinary approaches to ADHD care involving mental health professionals, primary care providers, and relevant specialists.

The social and lifestyle impacts identified, including academic/occupational difficulties, relationship problems, and increased risk-taking behaviors, emphasize the far-reaching effects of ADHD on daily functioning and quality of life.

These findings underscore the importance of providing comprehensive support for individuals with ADHD that addresses not just core symptoms, but also aims to improve overall life outcomes.

This review extends previous research by providing a more comprehensive synthesis of ADHD-related outcomes across multiple domains.

It highlights the interconnected nature of many ADHD-associated impacts and the potential for cascading effects across different areas of functioning.

Future research should focus on:

1. Elucidating the mechanisms underlying the associations between ADHD and various health/lifestyle outcomes.
2. Investigating protective factors that may mitigate negative outcomes in ADHD.
3. Developing and evaluating holistic intervention approaches that address the multi-faceted impacts of ADHD.
4. Exploring positive outcomes or strengths associated with ADHD, which were underrepresented in the current literature.

Strengths

The study had several methodological strengths, including:

1. Comprehensive search strategy covering multiple databases
2. Clear inclusion/exclusion criteria
3. Independent screening and data extraction by multiple reviewers
4. Quality assessment of included reviews using standardized tools
5. Broad scope covering mental health, physical health, and social/lifestyle outcomes
6. Inclusion of a large number of reviews (125) synthesizing data from over 1,000 primary studies
7. Adherence to PRISMA guidelines for systematic reviews

Limitations

Despite its strengths, this umbrella review has several limitations:

1. Variability in the quality of included reviews, with some rated as poor or moderate quality
2. Potential for publication bias in the included reviews
3. Exclusion of non-English language publications, potentially limiting cultural diversity in findings
4. Focus primarily on negative outcomes associated with ADHD, with limited exploration of potential positive aspects or strengths
5. Inability to conduct quantitative meta-analysis due to heterogeneity of included reviews
6. Potential for overlap in primary studies across multiple reviews
7. Lack of individual-level data, limiting ability to examine factors moderating outcomes

These limitations may affect the generalizability and comprehensiveness of the findings. The variability in review quality highlights the need for caution in interpreting results, particularly from lower-quality reviews.

The potential for publication bias and focus on negative outcomes may lead to an overestimation of adverse impacts associated with ADHD.

Implications

The findings of this umbrella review have significant implications for clinical practice, policy, and future research related to ADHD:

1. Clinical practice:
   • Need for comprehensive assessment of ADHD patients, screening for comorbid mental health conditions, physical health issues, and lifestyle factors
   • Importance of interdisciplinary care involving mental health professionals, primary care providers, and relevant specialists
   • Development of holistic treatment plans addressing not just core ADHD symptoms, but also associated health and lifestyle factors
   • Increased focus on preventive strategies for known risk factors (e.g., obesity, accidental injuries)
2. Policy:
   • Recognition of ADHD as a complex disorder with wide-ranging impacts requiring comprehensive support services
   • Development of policies to improve educational and occupational support for individuals with ADHD
   • Consideration of ADHD in public health initiatives related to mental health, obesity, and injury prevention
   • Allocation of resources for interdisciplinary ADHD care and support services
3. Research:
   • Need for longitudinal studies to better understand causal relationships and developmental trajectories of ADHD-associated outcomes
   • Investigation of mechanisms underlying associations between ADHD and various health/lifestyle outcomes
   • Exploration of protective factors and positive outcomes associated with ADHD
   • Development and evaluation of holistic intervention approaches addressing multiple domains of functioning
4. Public awareness:
   • Education about the wide-ranging impacts of ADHD beyond core symptoms
   • Efforts to reduce stigma by highlighting the complex nature of ADHD and its effects on multiple life domains

The real-world significance of these findings lies in their potential to improve outcomes for individuals with ADHD by promoting more comprehensive approaches to assessment, treatment, and support.

By addressing the multi-faceted impacts of ADHD, interventions may be able to more effectively improve overall quality of life and long-term outcomes for affected individuals.

References

Primary reference

French, B., Nalbant, G., Wright, H., Sayal, K., Daley, D., Groom, M. J., Cassidy, S., & Hall, C. L. (2024). The impacts associated with having ADHD: an umbrella review. Frontiers in psychiatry, 15, 1343314. https://doi.org/10.3389/fpsyt.2024.1343314

Other references

Harpin, V. A. (2005). The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Archives of disease in childhood, 90(suppl 1), i2-i7.

Nigg, J. T. (2013). Attention-deficit/hyperactivity disorder and adverse health outcomes. Clinical psychology review, 33(2), 215-228. https://doi.org/10.1016/j.cpr.2012.11.005

Polanczyk, G., De Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American journal of psychiatry, 164(6), 942-948. https://doi.org/10.1176/ajp.2007.164.6.942

Shaw, M., Hodgkins, P., Caci, H., Young, S., Kahle, J., Woods, A. G., & Arnold, L. E. (2012). A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment. BMC medicine, 10, 1-15. https://doi.org/10.1186/1741-7015-10-99

Keep Learning

Socratic questions for a college class to discuss this paper:

1. How might the wide-ranging impacts of ADHD identified in this review challenge our current conceptualization of ADHD as primarily an attention/hyperactivity disorder?
2. What ethical considerations arise when discussing the increased risk of negative outcomes associated with ADHD? How can we balance raising awareness of these risks with avoiding stigmatization?
3. Given the associations found between ADHD and various health conditions, how might our approach to ADHD treatment need to evolve to address these broader impacts?
4. What factors might explain the consistent finding of lower quality of life in individuals with ADHD? How might this be addressed in clinical interventions?
5. How might societal structures and expectations contribute to some of the negative outcomes associated with ADHD? What systemic changes could potentially improve outcomes for individuals with ADHD?
6. What are the potential implications of these findings for early intervention in ADHD? How might addressing ADHD symptoms early in life impact long-term outcomes across various domains?
7. How might the associations between ADHD and risk-taking behaviors be viewed from both a deficit and a strength-based perspective? What are the potential positive and negative consequences of increased risk-taking tendencies?
8. Given the limitations of this umbrella review, what specific types of studies would be most valuable to further our understanding of ADHD-related outcomes?