Consequences of ADHD

Author: Ulrich Brennecke
Review (April 2024): Waldemar Zdero, M.A. in Psychology

Untreated ADHD not only causes acute behavioral symptoms but also has severe long-term Consequences that often affect every aspect of the lives of people with ADHD.¹

Health Effects

• A reduction in life expectancy of 7 to 12 years
• Impaired quality of life (in this regard, ADHD is one of the 10 most serious brain disorders in Europe)²
• Increased risk of suicide, (traffic) accidents, serious injuries, and broken bones
• Increased risk of crime and violence

Comorbid Conditions

• Psychiatric disorders such as depression, anxiety disorders, bipolar disorder, and post-traumatic stress disorders are more common
• Physical conditions such as sleep disorders, respiratory diseases, infections, and substance use disorders are more common

Behavioral Problems and Social Consequences

• Increased risk-taking behavior and a higher risk of becoming a victim of abuse and bullying
• Educational problems and occupational disadvantages, including poorer educational opportunities, lower academic performance, reduced employability, and lower income

Benefits of Medication

• Medications such as stimulants and atomoxetine not only improve symptoms but also, by alleviating those symptoms, help protect against the risks mentioned above
• They improve the quality of life for people with ADHD and reduce the need for other medical treatments and healthcare costs

Economic Impact on Society

• People with ADHD have lower incomes and pay less in taxes and social security contributions
• They lead to higher health and education costs, as well as losses resulting from absenteeism, unemployment, disability, and crime

1. Consequential Risks of ADHD¶

People with ADHD have to put up with significant limitations on their quality of life.
Untreated or inadequately treated ADHD has a massive impact throughout a person’s entire life.³⁴
Without treatment, people with ADHD had worse long-term outcomes in all categories than people without ADHD (meta-analysis, k = 351):⁵

• 244 studies (74%) showed worse outcomes
• 89 studies showed comparable results (26%)
• No study has found better results for ADHD

1.1. Life expectancy reduced (by 7 to 12 years)¶

1.1.1. Increased overall mortality (+27% to +360%)¶

• Reduced life expectancy⁶
  • reduced by 8 to 12 years
    • 8.4 years for ADHD in childhood that does not persist⁷⁸⁹
    • 11.1 years⁸⁹ to 12.7 years⁷ for ADHD that persists into adulthood
  • by 6.78 years to 8.64 years in the United Kingdom¹⁰¹¹
    • 6.78 years for men
    • 8.64 years for women
  • possibly due to genetic factors¹²
    • Low income is associated with a life expectancy that is 6 to 8 years shorter¹³, while ADHD is associated with low income (see below).
  • 9.6% died during the first 40 years of life, compared with 3.6% among those not affected⁶
  • also (but not only) due to a lack of diligence⁸
    • The lowest quartile (25%) of conscientiousness is associated with a life expectancy that is 7 to 8 years shorter (even among highly gifted individuals and regardless of ADHD)
    • People with ADHD are among the 5 to 7 percent with the lowest conscientiousness
  • For comparison: with ASA, life expectancy is reduced by 5 to 6 years¹⁴
• 1.27 to 4.6 times higher premature mortality. Depending on the study, between
  • more than 4.6 times (in adults)¹⁵ particularly due to accidents.^{161718192021222324}
  • up to 25 times higher in cases with a high number of additional comorbidities ¹⁵²⁵
  • A 4.25-fold increased risk of premature mortality among adults diagnosed with ADHD for the first time.²⁶
  • 2.85 times (girls and women)²⁶
  • 1.8 times the risk of premature mortality overall²⁷
  • 1.7 times the risk of premature death due to traffic accidents²⁷
  • 1.4 times (children and adolescents)²⁶
  • 1.27 times (boys and men)²⁶
• A 10-fold increased risk of premature mortality among people with ADHD, substance use disorder, ODD, or CD—not due to the disorders themselves, but due to comorbid elevated psychopathic traits²⁸
• Twice the risk of being murdered²⁹

1.1.2. Increased risk of suicide (+130% to +383%)¶

• Increased risk of suicide³⁰³¹ (meta-analysis, k = 40)³²³³ , more pronounced in hyperactivity than in inattention³⁴, but also present in subclinical ADHD³⁵. ADHD is the second most strongly associated psychiatric condition with suicide after depression (depression: d = 0.90; ADHD: d = 0.45; meta-analysis, k = 58, n = 626,486,590)³⁶

  • 4.83 times the overall risk of suicide²⁷

  • Women are 4.1 times more likely to commit suicide³⁷

  • 3.33-fold increased risk of suicide (meta-analysis, k = 9)³⁸

    • 3.95 times the risk of suicidal thoughts
    • 3.34 times the risk of suicide attempts
    • 3.89 times the risk of fatal suicide

  • 2.9 times the risk³⁹

  • A 2.54-fold increased risk of suicide attempts among women with persistently high levels of inattention and hyperactivity-impulsivity between the ages of 6 and 23⁴⁰

  • A 2.4-fold increased risk of suicide among people with ADHD overall³⁷

  • 2.3 times the risk⁴¹

  • A 2.23-fold increased risk of suicide attempts among men whose hyperactivity/impulsivity and inattention decreased over time between the ages of 6 and 23⁴⁰

  • Girls with ADHD are 2.22 times more likely to have suicidal thoughts (15.6% vs. 7%)⁴²

    • Co-occurring severe depression increased the risk by a factor of 10 to 18
    • Comorbid bipolar disorder type 2 increased the risk by 7 to 13 times

  • A 1.81-fold increased risk of suicide attempts among women with high levels of inattention and low levels of hyperactivity-impulsivity between the ages of 6 and 23⁴⁰

  • Boys with ADHD are 1.61 times more likely to have suicidal thoughts (7.6% vs. 4.7%)⁴²

    • Co-occurring severe depression increased the risk by a factor of 10 to 18
    • Comorbid bipolar disorder type 2 increased the risk by 7 to 13 times

  • Even higher in cases of untreated ADHD⁴³⁴⁴

  • Adults with ADHD had a lifetime prevalence of:⁴⁵

    • Suicidal thoughts: 59.5%
      • were associated with the severity of inattention symptoms in adulthood, low self-esteem, and impairments in social functioning
    • Severe suicidal thoughts: 16.2%
    • suicidal behavior: 9.5%
    • self-harming behavior not related to suicide: 10.8%
    • Physical activity had a protective effect

• 33.2% of all children with ADHD (ages 5 to 15) had suicidal thoughts. More severe ADHD was associated with an increased risk of suicidal thoughts.⁴⁶

• Increased suicidal thoughts⁴⁷⁴⁸ and suicide attempts⁴⁹

  • but not in veterans with ADHD⁵⁰

1.2. More Frequent Accidents and Injuries¶

1.2.1. Increased risk of injury (+40% to +250%)¶

• Increased risk of injury⁵¹⁵²

  • by 250% among children and adolescents⁵³
  • a 237% increase among adults for severe injuries⁵⁴
  • by 65% among adults for injuries overall⁵⁴
  • by 41% among young adults⁵⁵

• Increased risk of bone fractures⁵⁶

  • In children and adolescents, particularly in the upper extremities (69%) and especially in ADHD-HI and ADHD-C. ADHD-I had a preventive nature.⁵⁷

  • by 105% among adults⁵⁴

  • for girls: +60%⁵⁸

  • for boys: +40%⁵⁸

  • Stress fractures + 17%⁵⁹

• Concussions

  • twice as common in children with ADHD (+100%)⁶⁰⁶¹
  • more frequent, with a correspondingly longer healing time; healing time is normalized by stimulants⁶²

• Head injuries resulting from certain types of accidents are more than twice as common (> +100%)⁶³ and more than three times as common (> +200%)⁶⁴

• Children with eye injuries were 3.5 times more likely to have ADHD than children without eye injuries (+250%)⁶⁵

• Poisonings (intentional and unintentional)

  • 2.3 times (+130%) in adulthood⁶⁶⁶⁷ for individuals diagnosed with ADHD in childhood or adolescence in the Finnish 1987 birth cohort. The reported prevalence of ADHD is low because ADHD was rarely diagnosed at that time.

• Self-harming behavior

  • 58% more common⁶⁸
  • elevated among 12- to 13-year-olds with ADHD⁶⁹
  • Intentional self-poisoning has increased
    • 1.52 times (+52%)⁶⁸
    • 4.65 times (+365%)⁷⁰

At a trauma center, the risk of having ADHD was twice as high among patients aged 12 to 13.⁶⁹
The risk of visiting an emergency room was higher compared to the control group⁷¹

• in cases of ADHD
  • by 45% overall
  • due to physical injuries, by 18%
• for ASA
  • by 48% overall
  • by 57% due to injuries caused by ingestion or inhalation
  • reduced by 4% due to physical injuries
  • reduced by 22% due to orthopedic injuries
  • reduced by 56% due to animal-related injuries
• in cases of comorbid ADHD and ASD
  • by 29% overall
  • by 80% for injuries caused by ingestion or inhalation
  • reduced by 9% due to physical injuries
  • reduced by 17% due to orthopedic injuries
  • decreased by 8% due to injuries caused by animals

1.2.2. Increased risk of accidents (+57% to +65%)¶

In cases of ADHD, an increased risk of accidents was found to be

• 60 to 89%⁷²
• 65% of n = 18,416 children aged 6 to 17⁷³
• 57% among n = 3,202 schoolchildren aged 15⁷³
• 47% in the parent report, 36% in the teacher report, 53% in the combined parent and teacher report⁷⁴

1.2.2. Traffic Accidents and Accident Damage (+23%)¶

A meta-analysis of 16 studies showed:⁷⁵

• The risk of accidents for drivers with ADHD is 23% higher
• This corresponds to the increased risk associated with cardiovascular disease
• People with ADHD apparently drive more often than persons without ADHD, which is why the actual figure is likely to be somewhat lower than 23%
• The claim that the risk of accidents is nearly four times higher, based on a study by Barkley et al. (1993), is likely attributable to comorbid ODD and/or CD. It cannot be attributed to ADHD itself.
• People with ADHD are more likely to receive citations for speeding, but not for drunk driving or reckless driving

Individual studies:

• Children with ADHD exhibit riskier behavior when crossing the street⁷⁶
• 40% of drivers with ADHD had at least two accidents, compared with 6% of drivers without ADHD.⁷⁷
• 60% of drivers with ADHD were involved in an accident resulting in personal injury, compared with 17% of drivers without ADHD.⁷⁷
  • This is likely due to comorbid ODD and/or CD. A meta-analysis found a 23% increase in the accident rate for ADHD itself.⁷⁵
• The total cost of damage caused by drivers with ADHD was nearly three times that of drivers without ADHD.⁷⁷
• Drivers with ADHD were three times as likely to lose their driver’s license as people with ADHD. This could also result from an impaired ability to defend themselves in court due to disorganization.⁷⁷
• 2.74 times the risk of car accidents resulting in injuries among people aged 65 and older⁷⁸
• A 93% increased risk of traffic accidents among adolescents and young adults with untreated ADHD⁷⁹
• riskier driving behavior⁸⁰
• more errors in driving simulators, particularly in cases of executive function problems⁸¹

1.3. More frequent perpetrators (+160%) and victims (+100%) of violence and bullying¶

People with ADHD are at higher risk for:

• Domestic violence⁸²

  • as the perpetrator:
    • 2.5-fold increased risk (OR 2.5, meta-analysis, k = 6 studies)⁸³
    • 6.4 times more likely to be perpetrators of domestic violence than those not affected⁸⁴
    • increased regardless of gender⁸⁵
  • as a victim:
    • 1.78-fold increased risk (OR 1.78, meta-analysis, k = 4 studies)⁸³
    • increased regardless of gender⁸⁵

• Sexual violence

  • as the perpetrator:
    • 2.73-fold increased risk (OR 2.73, meta-analysis, k = 3 studies)⁸³
  • as a victim:
    • 1.84-fold increased risk (OR 1.84, meta-analysis, k = 6 studies)⁸³
    • 2.01-fold increased risk (OR 2.01)⁸⁶

• Child abuse

  • Studies report an increased risk of child abuse⁸⁷

• Bullying

  • 2.76 to 2.81 times the risk (OR 2.76 to 2.81)⁸⁸
  • Children with ADHD are three times more likely to report having been bullied than children without ADHD.⁸⁹
  • Children with ADHD are bullied more often⁹⁰
  • Students with ADHD are 83% more likely to be bullied⁹¹
  • Children with ADHD are more likely to suffer from anxiety disorders or depression as a result of bullying than people with ADHD.⁹⁰

People with ADHD in the U.S. are seven times more likely to carry a firearm than people without ADHD.⁹¹

1.4. Higher crime rates (+120% to +800%)¶

The crime rate among people with ADHD is significantly higher. 19% of people with ADHD had committed crimes, compared to 0% of the control group (average age 22)⁹². 20% of prison inmates are responsible for 90% of criminal offenses (regardless of gender), which is a concrete application of the Pareto principle.⁹³.

• Risk of imprisonment due to criminal activity
  • 9 times the risk⁹⁴
  • 4.8 times the risk⁹⁵
  • 2.9 times the risk⁹⁶
• Increase in arrests / detentions
  • 21 times higher risk for adults with hyperactivity (21% vs. 1%)⁹⁷
  • 4.18 times higher risk for adolescents with hyperactivity (46% vs. 11%)⁹⁷
  • 2.4-fold increased risk (meta-analysis, k = 98)⁹⁸
  • 2.2 times the risk⁹⁶
  • 2.05 times the risk⁹⁹
  • Boys aged 10 to 17 with ADHD are 2.02 times more likely to commit a first offense¹⁰⁰
• Criminal convictions
  • 3.3 times the risk⁹⁶
  • Men:¹⁰¹
    • 6.03 times the risk of violent crimes
    • 3.57 times the risk of nonviolent crimes
  • Women:¹⁰¹
    • 10.5 times the risk of violent crimes
    • 4.04 times the risk of nonviolent crimes

Sharply Increased Rate of ADHD Among Prison Inmates:

• up to 72% of prison inmates in Asian, Western European, and North American countries¹⁰²

• 14% to 45%¹⁰³¹⁰⁴

• 25.5% (clinical interview) to 43.3% (screening) (meta-analysis, k = 42, n = 26,641)¹⁰⁵

  • Adolescents: 30.1%, +400%
  • Adults 26.1%, +900%

• 31%¹⁰⁶ of juvenile inmates

• 20 to 30 percent of all young adult prison inmates.¹⁰⁷

• 28% of all prisoners in the U.S.¹⁰⁸

• 27.6% of 146 sex offenders studied (n=146, WURS 90 points)¹⁰⁹

• 25% of all prisoners in the U.S.¹¹⁰

• 25%¹¹¹

• 22% of patients in forensic psychiatry (n = 86)¹¹²

• 17.5% of prison inmates (n = 244)¹⁰⁹

• 17.3% of juvenile inmates¹¹³

• 17% of all young men incarcerated for minor to moderate crimes in Lithuania.¹¹⁴ The inmates with ADHD were younger and exhibited more severe behavioral problems in prison. None of them had previously been diagnosed with ADHD.

• 9.1% of 55 Irish inmates surveyed¹¹⁵

Interestingly, amphetamines are the most commonly used drugs among prison inmates with ADHD.¹¹⁶ As is well known, amphetamine is the active ingredient in medication with the greatest effect size against ADHD in adults.

A study on the correlation between ADHD symptoms and criminogenic thought patterns found that¹¹⁷

• Inattention was consistently and strongly associated with criminogenic thought patterns, particularly with
  • Cutoff
  • cognitive inertia
  • Discontinuity
• Impulsivity correlated positively with criminogenic thought patterns, specifically with
  • Power orientation
• Hyperactivity was not associated with criminogenic thought patterns

ADHD medication reduced the crime rate among people with ADHD¹¹⁸

• by 31% among men
• by 41% among women

Adolescents who had come into contact with the juvenile justice system were 12 times more likely to have experienced childhood trauma than those who had not.¹¹⁹¹²⁰ Adolescents with childhood trauma were 3.5 times more likely to engage in criminal behavior.¹²¹ Childhood trauma is a risk factor for ADHD.

1.5. Co-occurring health problems¶

There is evidence that ADHD has a causal effect on an increased risk of:¹²²

• severe clinical depression
• post-traumatic stress disorder
• Suicide attempts
• Anorexia nervosa

No evidence was found of a causal relationship between ADHD and:¹²²

• bipolar disorder
• Anxiety
• Schizophrenia

1.5.1. Mental Illnesses¶

Increased likelihood of inpatient psychiatric treatment. Among 166 psychiatric patients receiving inpatient treatment, 59% were diagnosed with ADHD.¹²³

1.5.1.1. Neurodegenerative diseases (up to +500%)¶

Up to a 5-fold increased risk of neurodegenerative diseases.¹²⁴
According to a meta-analysis, 12 out of 16 studies found that ADHD was associated with an increased risk of neurodegenerative disorders, although the absolute risk was low.¹²⁵

1.5.1.1.1. Dementia (up to +500%)¶

The overall risk of dementia is increased in people with ADHD

• 4-fold¹²⁶ Review: Hedges et al.¹²⁷
• 2.23 times¹²⁸

Vascular dementia causes severe cognitive impairment that affects daily functioning and can be diagnosed through imaging tests.
People with ADHD have a 6-fold higher risk of vascular dementia¹²⁶¹²⁹ , regardless of other risk factors for vascular dementia, such as diabetes, high blood pressure, coronary heart disease, and stroke.
The increased risk of vascular dementia may be due to the significantly poorer cardiovascular and cerebrovascular health of adults with ADHD.

The risk of Lewy body dementia is elevated in ADHD¹³⁰, although the increase in risk has been reported as low as 6%¹²⁹ and, in an earlier publication by the same group of authors, as significantly elevated specifically for Lewy body dementia.¹²⁴
People with Lewy body dementia are 5.1 times more likely to have been diagnosed with ADHD, regardless of age or gender.¹³¹

1.5.1.1.2. Parkinson’s (up to +150%)¶

Parkinson’s:

• 1.5 to 2.5 times¹²⁹
• 2.3 times¹²⁸
• 1.33 times¹³²

People with Parkinson’s disease are 3.7 times more likely to have ADHD, regardless of age or gender.¹²⁹

Among people with ADHD who also have Parkinson’s, Parkinson’s had developed earlier than among people with Parkinson’s who do not have ADHD.¹³²

1.5.1.1.3. Alzheimer’s (+390%)¶

People with Alzheimer’s disease are 4.9 times more likely to have ADHD, regardless of age or gender.¹³¹
A study found a correlation between the ADHD PRS (Polygenic Risk Score) and Alzheimer’s disease.¹³³
In a Swedish cohort study, parents of people with ADHD were found to have a 55% increased risk of Alzheimer’s disease. Among grandparents, the risk was increased to a lesser extent.¹³⁴

1.5.1.2. Depression (up to +450%)¶

• A 5.5-fold increased risk of experiencing a major depressive episode before reaching adulthood. 50% of all people with ADHD experience one.¹³⁵
• Increased risk of depression¹³⁶
• 4.12-fold increased risk (very large study, n = 1,250,000)¹³⁷
• Girls are four times more at risk¹³⁸
• A 3.19-fold increased risk of major depression in cases of ADHD that persist into adulthood¹³⁹
• 2.5 times the risk¹³⁸
• A 2.46-fold increased risk (+146%) in adulthood¹⁴⁰⁶⁷ among individuals diagnosed with ADHD in childhood or adolescence in the Finnish 1987 birth cohort. The reported prevalence of ADHD is low because ADHD was rarely diagnosed at that time.
• 2.3-fold increased risk (meta-analysis, k = 98)⁹⁸
• 2.27-fold increased risk (meta-analysis)¹⁴¹
• 2.2 times the risk of severe depression (meta-analysis)¹⁴¹
• ADHD in children increases the risk of depression during adolescence.¹⁴²
• Comorbidities further increase the risk:
  • A 7.9-fold increased risk of clinically significant symptoms of depression in individuals with ADHD who have experienced a concussion¹⁴³

A meta-analysis (k = 24) found no significant increase in the risk of depression among individuals with ADHD.¹⁴⁴

Women with ADHD had an increased risk of postpartum depression¹⁴⁵

• by 14% 6 weeks after giving birth
• by 21% to 24% 12 months after birth

1.5.1.3. Eating Disorders (up to +260%)¶

• Girls are 3.6 times more likely to develop eating disorders¹⁴⁶
• Obesity (2-fold risk)¹⁴⁷
• ADHD symptoms in early childhood increase the risk¹⁴⁸
  • a 19% increase in BMI during middle childhood
• 1.24 times as much fast food consumption¹⁴⁹

1.5.1.4. Anxiety Disorders (up to +230%)¶

• 1.2 to 3.3 times the risk of anxiety disorders. Lifetime prevalence: 10–15% of the general population;¹⁵⁰ 12 to 50% among those with ADHD⁴⁴
• 1.68 times the risk of specific phobias (meta-analysis)¹⁴¹
• 1.71-fold increased risk of social phobia (meta-analysis)¹⁴¹
• 4.99 times the risk of agoraphobia (meta-analysis)¹⁴¹
• Comorbidities further increase the risk
  • A 16.4-fold increased risk of clinically significant anxiety symptoms in individuals with ADHD who have experienced a concussion¹⁴³

1.5.1.5. Post-Traumatic Stress Disorder, PTSD (+137%)¶

People with ADHD are 2.37 times more likely to develop post-traumatic stress disorder than their siblings who have not been diagnosed with ADHD.¹⁵¹

1.5.1.6. Epilepsy (+365%)¶

A 4.65-fold increased risk (+365%) in adulthood¹⁴⁰⁶⁷ among individuals diagnosed with ADHD in childhood or adolescence in the Finnish 1987 birth cohort. The reported prevalence of ADHD is low because ADHD was rarely diagnosed at that time.

1.5.1.7. Neurotic Disorders (+112%)¶

A 2.12-fold increased risk (+112%) in adulthood¹⁴⁰⁶⁷ among individuals diagnosed with ADHD in childhood or adolescence in the Finnish 1987 birth cohort. The reported prevalence of ADHD is low because ADHD was rarely diagnosed at that time.

1.5.2. Behavioral Characteristics¶

• Increased risk-taking behavior¹⁵²

• Frequent victims of physical and non-physical sexual abuse¹⁵³

1.5.3. Cognitive impairments¶

In a long-term study of children with ADHD, children with subclinical ADHD, children with perinatal risks, and children without such risks, these participants were assessed at age 40 in the areas of verbal reasoning, perceptual ability, memory, working memory, attention, executive functions, and processing speed. The results showed:¹⁵⁴

• Participants who had ADHD as children
  • lower performance in 13 of 21 metrics
  • 23% showed deficits in more than 3 measures (versus 4 to 6% in the other three groups)
• Participants who had subclinical ADHD as children:
  • lower performance in 5 of the 21 metrics

1.5.4. Physical Illnesses¶

• increased risk of most physical illnesses (34 [97 %] of the 35 diseases studied), regardless of gender¹⁵⁵

1.5.4.1. Sexually transmitted diseases (+300%)¶

ADHD is associated with an increased risk of sexually transmitted diseases.¹⁵⁶
People with ADHD were treated for sexually transmitted diseases four times as often as persons without ADHD (16% vs. 4%).¹⁵⁷

1.5.4.2. Respiratory diseases (up to +220%)¶

• Respiratory diseases (2.4- to 3.2-fold increased risk), primarily of genetic origin, e.g.:
  • ’s Asthma
    * Chronic obstructive pulmonary disease

1.5.4.3. Risk of addiction (up to +190%)¶

• Increased drug use, even without drug dependence¹⁵⁸
• Increased alcohol consumption.⁴⁹ The majority of studies on ADHD and alcohol abuse find a positive correlation.¹⁵⁹
• 1.5 to 7.9 times the risk (+50% to +690%), depending on the test substance¹⁶⁰
• Hyperactivity and attention problems at age 11 correlate with the following at age 24:¹⁶¹
  • 4 times the risk of severe alcohol dependence
  • 1.75 times the risk of any alcohol use disorder
  • 2.09 times the risk of symptoms of alcohol dependence
  • 1.63 times the risk of symptoms of alcohol abuse
• Smoking more often^{49162163164136}
  • 8.61 times the risk (+761%)¹⁶⁵
  • 3 times the risk for adolescents (+200%)¹⁶⁶
  • 2.36 times the risk (+136%)¹⁶⁷¹⁶⁶
  • 2.15 times the risk of smoking among adolescents (OR 2.15; +115%)¹⁶⁸
  • A 2.12-fold increased risk of substance use disorder in cases of ADHD that persists into adulthood (OR 2.12; +112%)¹³⁹
  • Twice the risk for adolescents with ADHD (OR = 2; +100%)¹⁶⁹
  • 1.6 to 1.8 times the risk (+60 to 80%)¹⁷⁰
  • 1.5 times the risk (+50%)¹⁶⁹
  • 1.4 times the risk (+40%) in adults ¹⁷¹
  • 1.38-fold increased risk of alcohol consumption among adolescents (OR = 1.38; +138%)¹⁶⁸
  • A study found no link between ADHD symptoms and smoking¹⁷²
  • Conversely, young adult smokers are twice as likely to have ADHD.¹⁷³
• Cannabis
  • Cannabis dependence is 2.85 to 2.91 times higher¹⁷⁴
  • Marijuana use increases¹⁶²
• Substance dependence (addiction)¹⁷⁵
  • A 2.27-fold increased risk (+127%) in adulthood¹⁴⁰⁶⁷ for individuals diagnosed with ADHD in childhood or adolescence in the Finnish 1987 birth cohort. The reported prevalence of ADHD is low because ADHD was rarely diagnosed at that time.
  • 1.77 times the risk¹⁷⁶

1.5.4.4. Infections (up to +180%)¶

• Increased incidence of childhood infections¹⁷⁷
  • Salmonellosis (180% more common)
  • Acute respiratory infections (40% more common)
  • Acute gastroenteritis (30% more common)
  • Urinary tract infections (30% more common)
  • All anti-infective drugs were prescribed significantly more often to children with ADHD
  • The number of doctor visits was significantly higher among children with ADHD.

Bacterial or viral infections can also be a contributing factor to ADHD.

1.5.4.5. Periodontitis (+129%)¶

Adolescents with ADHD were 2.29 times more likely to develop periodontitis later in life than the control group.¹⁷⁸

1.5.4.6. Fatigue (+118%)¶

Children with neurodivergent traits aged 7 and 9 were 2.18 times more likely to suffer from chronic, disabling fatigue by the age of 18. Children with ASD had a 1.78-fold increased risk.¹⁷⁹

1.5.4.7. Tooth decay (+116%)¶

Children with ADHD symptoms in Spain are at higher risk for:¹⁸⁰

• Tooth decay (OR: 2.16)
• Extraction (OR: 1.42)
• Restoration (OR: 1.47)
• Bleeding gums (OR: 1.64)
  The increased risk of tooth decay persisted even when the analysis was limited to families in the middle/upper socioeconomic class and children with low sugar intake, good oral hygiene habits, and regular dental visits.

ADHD symptoms in early childhood increased the risk of tooth decay during adolescence by 10%.¹⁴⁸

1.5.4.8. Unhealthy lifestyle (+103%)¶

2.03-fold increased risk of an unhealthy lifestyle among adolescents (OR = 2.03; +103%)¹⁶⁸

1.5.4.9. Premature puberty (+101%)¶

ADHD was associated with a 101% increased risk of early puberty, particularly among girls.¹⁸¹ For ASD, the risk was 80% higher, again particularly among girls.¹⁸²

1.5.4.10. Childbirth complications in mothers with ADHD (up to 80%)¶

Mothers with ADHD are 1.2 to 1.8 times more likely to experience almost any type of birth complication.¹⁸³

1.5.4.11. Risk of stroke (up to +69%)¶

People with ADHD have an increased risk of stroke.

• Increased risk of ischemic stroke
  • by 15%¹⁸⁴
• Increased risk of atherosclerotic stroke involving large arteries
  • by 40%¹⁸⁴
• Increased risk of acute ischemic stroke or transient ischemic attack
  • by 69%¹⁸⁵
  • by 134% among those aged > 45
  • by 86% in cases of obesity
  • by 118% for hypertension
  • by 189% for dyslipidemia

1.5.4.12. Gliomas (+15% to +33%)¶

ADHD is associated with a 1.15-fold increased risk of gliomas and a 1.33-fold increased risk of benign gliomas.¹⁸⁶ A glioma is a tumor that originates in glial cells.

1.5.4.13. Type 2 diabetes mellitus (+10%)¶

ADHD appears to increase the risk of type 2 diabetes mellitus by about 10%.¹⁸⁷

1.5.4.14. Slightly Elevated Blood Pressure in Older Adults¶

ADHD in childhood was associated with an average increase of 3.5 mmHg in systolic blood pressure and 2.2 mmHg in diastolic blood pressure at age 45.¹⁷¹

1.5.4.15. Higher risk of COVID-19, more severe course of the disease¶

ADHD and Tourette syndrome are associated with an increased risk of COVID-19 and a more severe course of the disease.¹⁸⁸

1.6. Increase in Teenage Pregnancies (+130 to +530%)¶

• Untreated adolescents with ADHD are 2.3 times more likely to experience an early pregnancy. Teenage pregnancies are 27% more common among adolescents with untreated ADHD. When ADHD is treated, the risk decreases significantly.¹⁸⁹
• 6.3 times the risk of teenage pregnancy¹⁹⁰ Risk
• 42 times as many pregnancies by age 20 as among those not affected (dubious—this figure has not yet been verified).⁷⁷

1.7. Educational Disadvantages¶

• Poorer educational opportunities¹³⁶
  • 94% of children with ADHD have problems at school (according to parents’ reports)¹⁹¹
  • 32% of people with ADHD do not graduate from high school (12th grade)¹⁵⁷; 3.7 times the risk of not completing high school (secondary school, 12th grade) (meta-analysis, k = 98)⁹⁸
  • College degrees are 27% less common⁹⁹
  • School-leaving certificates are 11% less common⁹⁹
  • lower educational attainment⁴⁹
  • a less common bachelor’s degree¹⁹²
  • Increased school absenteeism (diagnosed ADHD, including ADHD treated with medication)¹⁹³
    • up to 10 years: 7%
    • Ages 11 to 14: 24%
    • Ages 15 and older: 23%
  • More school expulsions (diagnosed ADHD, including ADHD treated with medication)¹⁹³
    • 4.97 times higher in the quintile with the highest level of deprivation
    • 14.75 times higher in the quintile with the lowest level of deprivation
    • 5.4 times higher among boys
    • 9.42 times higher for girls
  • Increased special education needs (diagnosed ADHD, including ADHD treated with medication)¹⁹³
    • mental health: 52.85 times
    • social, emotional, and behavioral disorders: 19.97 times
    • Autism spectrum disorder: 13.72 times
    • Learning disability: 8.10 times
    • physical health: 6.97 times
    • physical or motor impairment: 6.28 times
    • Learning difficulties: 5.44 times higher
    • Communication problems: 4.78 times
    • sensory impairment: 3.62 times
  • ADHD leads to reduced emotional engagement in school over the long term, a phenomenon that is further moderated by student-teacher conflicts.¹⁹⁴
  • A high polygenic risk score¹⁹⁵
    • ADHD was associated with lower grades in language and math
    • for anorexia nervosa or bipolar disorder was associated with better grades in language and math
    • Schizophrenia and major depression were found to have a variable effect on school grades
    • for autism spectrum disorders, had no effect on school grades

A Norwegian cohort study found that among the parents of the n = 8,051 participants with ADHD, 32.3% had attended only elementary school, compared with 7.9% in the general population (an increase of 308%).¹⁹⁶

1.8. Career Disadvantages and Loss of Income¶

Significant career setbacks are a common consequence of ADHD.¹⁹²

• Job changes increased by 59%⁹⁹

• Fewer full-time jobs, more part-time jobs

  • Women (in Japan) with ADHD appear to be even more likely to have only a part-time job than men with ADHD.¹⁹⁷

• Employment rate decreased by 28%⁹⁹

• Twice the risk of unemployment (meta-analysis, k = 98)⁹⁸

• Three times the risk of losing a job⁷⁷

• Higher layoff rate: 1.1 vs. 0.3 jobs/period¹⁹⁸

• Frequent job changes: 2.7 vs. 1.3 jobs per 2–8 years of work experience¹⁹⁸, especially as people get older¹⁹⁹

• Poorer performance evaluations at work¹⁹⁸

• Not in employment, education, or training 6 months after leaving school¹⁹³

  • total: 1.39 times
  • Boys: 1.40 times
  • Girls: 1.59 times

• Work capacity is impaired one and a half times as often (approximately 30% compared to approximately 20% among those not affected)²⁰⁰

• Lack of full participation in the labor market, particularly among: (using Sweden as an example)²⁰¹

  • Elementary school as the highest level of education attained (OR: 4.03)
  • comorbid mental disorders (OR: 2.77)
  • living in villages or small towns (OR: 1.77)
  • Men less often than women (OR: 0.55)

A Norwegian cohort study found that the parents of the n = 8,051 participants with ADHD had an average income of approximately 41,637 USD, compared to 48,019 USD in the catchment area (a decrease of 13.3%).¹⁹⁶

1.9. Reduced quality of life¶

• Reduced quality of life¹⁵²²⁰²
  • Health-related quality of life significantly reduced²⁰³²⁰⁴
• A fourfold increased risk of reduced height growth and lower weight gain at ages 8 and 10. Treatment with stimulants exacerbated this risk.²⁰⁵
• ADHD in childhood predicts emotional problems later in life. These are genetically determined.²⁰⁶
• Dissatisfaction with life is a common consequence of ADHD.

According to a study with n = 1,000 participants, ADHD in adulthood leads to a significant reduction in life satisfaction (quality of life).²⁰⁷ In the areas of

• Family Life
• Partnership
• Social Life
• Integration into society
• Health and Fitness
• Professional Life
• Achieving life goals

On average, people with ADHD scored about 20% lower than people without ADHD.

Among adults in the top 10% of ADHD symptom severity according to the ADHD-E scale, distress due to general life dissatisfaction was 4.10 times more common, and distress due to a lack of social support was 3.3 times more common than among those without ADHD.²⁰⁸²⁰⁹
ADHD-C was associated with a greater impairment of quality of life than ADHD-I or ADHD-HI.²⁰⁴

Children with ADHD were 6 to 4 times more likely to have fewer close friendships and to experience greater rejection from their peers.²¹⁰

1.10. Divorces / Separations More Frequent (+87% to +400%)¶

• Divorces
  • increased by 87%⁹⁹
  • Women (in Japan) with ADHD appear to have an even higher divorce rate than men with ADHD.¹⁹⁷
• A 3- to 5-fold increased risk of separation and divorce⁴⁴

A Norwegian cohort study found that among the mothers of the n = 8,051 participants with ADHD, the marriage rate was 47%, compared to 60.4% in the catchment area (a difference of 22.2%).¹⁹⁶

1.11. More frequent moves (+135%)¶

Adults with ADHD move 2.35 times as often as those without the condition.¹⁹⁹

1.12. Depression Among Parents of Children with ADHD Has Increased (+330%)¶

Parents of children with ADHD were 4.3 times more likely to suffer from depression than parents of children without ADHD.²¹¹

2. Protective Effects of ADHD Treatment¶

ADHD medications reduce the risks associated with ADHD symptoms and their consequences. According to a meta-analysis, treatment with stimulants reduces these risks by 9 to 59 percent.²¹²

ADHD medications showed a robust protective effect with regard to (meta-analysis, k = 40):²¹³

• Mood disorders
• Suicidal tendencies
• (Car) Accidents
• Injuries
• traumatic brain injuries
• Education and academic achievement. Indifferent to this, however:²¹⁴
• Substance Abuse
• Crime

Treatment for ADHD improved long-term outcomes compared with untreated ADHD in 55 of the 76 studies analyzed (72%), although generally not to normal levels (meta-analysis, k = 351).⁵ When broken down by area, the improvement rates were as follows:

• Driving: 100%
• Obesity: 100%
• Self-esteem: 90%
• Social functioning: 82%
• Academic performance: 71%
• Drugs/Addiction: 66%
• Antisocial behavior: 50%
• Need for support: 50%
• Work: 33%

In Europe, improvements were seen in 85% of the areas, whereas in North America, improvements were seen in only 50%.⁵

2.1. Reduced premature mortality, fewer suicides (-20%)¶

MPH reduced the overall mortality rate by 20% in children with ADHD. Delayed initiation of MPH was associated with a 5% increase in mortality. Long-term use reduced the overall mortality rate by 16%.²¹⁵
Among individuals taking ADHD medications (stimulants or atomoxetine), a 22.2% reduction in mortality from unnatural causes was observed²¹⁶, and no increase in mortality was found²¹⁷.

In several large studies, stimulants reduced the risk of suicide attempts in people with ADHD by:²¹⁸

• 11.6% (across all age groups)²¹⁹
• 17%²²⁰
• 19%²²¹
• 42%²²²
• 59% for those who have been taking it for 3 months and half a year²²³
• 72% for those who have been taking it for more than half a year²²³
• Methylphenidate treatment for ADHD was associated with a reduction in the previously significantly elevated risk of suicide after 90 days.²²⁴
• Other ADHD medications (non-stimulants) showed no reduction or only a very slight reduction in suicidal tendencies, e.g., 4%²²¹

A Swedish registry study examined all n = 22,714 adolescents and adults who had been diagnosed with ADHD between 2006 and 2021.
ADHD medications reduced the risk of suicidal behavior and deaths while being taken, compared to periods when they were not being taken:²²⁵
Reduced risk of subsequent suicidal behavior:

• Dextroamphetamine: reduced by 31% (aHR 0.69)
• Lisdexamfetamine: reduced by 24% (aHR 0.76)
• Combination therapy: reduced by 15% (aHR 0.85)
• Methylphenidate: reduced by 8% (aHR 0.92)
  Increased risk of subsequent suicidal behavior:
• Atomoxetine increased the risk by 20% (aHR 1.20)
• Guanfacine: increased the risk by 65% (aHR 1.65)
• Clonidine: increased the risk by 92% (aHR 1.92)

2.2. Fewer Accidents and Injuries¶

2.2.1. Fewer accidents (-43% to -66%)¶

ADHD medication reduces the incidence of accidents among persons with ADHD, both as children and as adolescents.²²⁶²²⁷

• by 43%²²⁸
• Traumatic brain injuries decreased
  • by 49%²²⁹
  • up to 66%.²³⁰

A study found a 3% reduction in the risk of accidents (not statistically significant).²³¹
A study found a 28% increase in the risk of accidents (not statistically significant).²³¹

2.2.2. Fewer traffic accidents (-38% to -50%)¶

• fewer traffic accidents²³²

  • 12%²²⁰

  • 38% to 40% among men²³³²³⁴

  • 42% among women²³⁴

• 50% fewer serious traffic accidents (among men)²³³

• 50% fewer car accidents in a driving simulator due to a short-acting amphetamine medication²³⁵

  • Cost savings over the product’s lifetime at a cost of 80 USD / 30 days:
    • $332,660 over the course of a lifetime compared to people with ADHD who have not been treated
    • $194,278 compared to standard treatment (which was not specified)

• Improved driving performance²³⁶ in the simulator²³⁷

2.2.3. Fewer injuries (-53%)¶

Methylphenidate reduced the risk of injuries in adults with ADHD

• by 53% when taken for more than 3 months⁵⁴
• by 35.5% for a duration of less than 3 months⁵⁴

Atomoxetine reduced the risk of injuries in adults with ADHD

• by 26% when taken for more than 3 months⁵⁴

2.2.4. Fewer fractures (-32% to -74%)¶

Every medication used to treat ADHD reduced the risk

• of fractures overall²³⁸
  • by 39% to 74%, according to 6 cohort studies, for both stimulants and non-stimulants²³⁹
  • by 32% to 41%, according to a self-report survey²³⁹
  • by 60.4 to 86.2%⁵⁷

Treatment of ADHD with methylphenidate reduced the risk

• a total decrease of 60.4% in fractures⁵⁷

• stress fractures (fatigue fractures)

  • by 22.4%, although this figure was even lower than among those not affected²⁴⁰
  • 16% less than among those not affected⁵⁹

• traumatic fractures (accidental fractures)

  • by 23% when taking MPH for at least 180 days²⁴¹
  • to the same level as for those not affected⁵⁹
  • about half the value of those not affected²⁴²
  • Among people with ADHD treated with non-stimulant medications, the increased risk of bone fractures doubled to 37% compared to the risk among people with ADHD, whereas the increased risk among all people with ADHD was 17% higher than among people without ADHD.⁵⁹

• a 15% reduction in unintentional injuries²⁴³, or an effect size of 0.88²⁴⁴

• by 73% due to traumatic brain injuries²⁴³

• from poisoning²⁴⁵

• a 9% decrease in emergency room visits due to injuries²⁴⁶

• Burns in adolescents with ADHD²⁴⁷

  • by 57% among those who have been taking MPH for 90 days or longer
  • by 30% if MPH has been taken for less than 90 days

Treatment of ADHD with atomoxetine reduced the risk

• a total decrease of 86.2% in fractures⁵⁷

2.2.5. Typical Recovery Time for a Concussion¶

The longer recovery time from concussions experienced by people with ADHD was normalized by stimulants⁶²

2.2.6. Fewer emergency room visits (-45%)¶

The use of emergency rooms decreased

• by 45%²²⁸

2.2.7. Reduced Antibiotic Use¶

In the second year of stimulant use, Finnish people with ADHD took 37% less broad-spectrum penicillin than in the 12 months before they began taking stimulants (7% vs. 11.1%) and 27.9% fewer other antibiotics (4.4% vs. 6.1%), as well as 19.6% fewer beta-lactamase-sensitive penicillins (4.5% vs. 5.6%).²⁴⁸

2.2.8. Improved BBW Scores in Bladder-Bowl Dysfunction¶

Bladder-Bowl Dysfunction (BBW) is a urological disorder. Children with ADHD and BBW have more severe BBW than children with BBW who do not have ADHD. Children with ADHD who received ADHD medication had better BBW scores than children with ADHD who did not receive medication.²⁴⁹

2.3. Fewer sexually transmitted diseases and teenage pregnancies (up to a 40% reduction)¶

• fewer sexually transmitted diseases¹⁵⁶
  • by 30 to 40% in men²⁵⁰
• fewer teenage pregnancies¹⁸⁹

2.4. Fewer comorbidities¶

Many studies show that ADHD medications reduce the frequency and severity of the following comorbidities.²⁵¹
Only one Norwegian cohort study, involving n = 8,051 participants with ADHD, found that ADHD medication (87.5% MPH; 11.5% ATX, 1.4% AMP) found an unchanged comorbidity rate after 4 years and a slightly increased comorbidity rate after 9 years.¹⁹⁶ However, the study design could not distinguish between the medicated and non-medicated groups based on the severity of ADHD. Medication correlates with higher severity. Furthermore, people who have already experienced that medication can help them are likely to be more willing to undergo an additional diagnosis in the event of further problems. It is also regrettable that amphetamine-based medications are severely underrepresented.

A long-term analysis of 8,051 cases of ADHD—which, although diagnosed, but were not severe enough to require medication, showed that medication almost completely eliminated the occurrence of reactive disorders in women during the first two years of follow-up and significantly reduced the frequency of tic disorders in men during the first three years.²⁵² No other benefits or drawbacks were observed.²⁵³

2.4.1. Decrease in Psychiatric Hospitalizations (-7% to -26%)¶

A Swedish registry study examined all n = 22,714 adolescents and adults who had been diagnosed with ADHD between 2006 and 2021.
ADHD medications reduced the risk of psychiatric hospitalization while being taken, compared to periods when they were not being taken:²²⁵

• Amphetamine-based medications: by 26% (aHR 0.74)
• Lisdexamfetamine: by 20% (aHR 0.80)
• Combination therapy: by 15% (aHR 0.85)
• Dextroamphetamine: by 12% (aHR 0.88)
• Methylphenidate: by 7% (aHR 0.93)
• Atomoxetine: unchanged
• Guanfacine: unchanged
• Modafinil: unchanged
• Clonidine: unchanged.

2.4.2. Less depression (-20% to -60%)¶

ADHD medications reduce the risk of depression:²⁵⁴

• 40% three years after ingestion²⁵⁵
• by 20% while taking it²⁵⁵
• by 20% (meta-analysis)¹⁴¹
• MPH reduces ADHD symptoms by about 30% when taken long-term by children and adolescents with ADHD²⁵⁶
• Stimulants have increased by more than 60% over the past 10 years²⁵⁷

In the second year of stimulant use, Finnish people with ADHD took 12.3% fewer SSRIs than in the 12 months before they began taking stimulants (10% vs. 11.4%).²⁴⁸

2.4.3. Fewer anxiety disorders (-85%)¶

ADHD stimulants taken over a 10-year period reduced the risk of anxiety disorders by more than 85%²⁵⁷

2.4.4. Fewer Cases of Parkinson’s Disease in Women (-75%)¶

People with ADHD aged 50 and older who were treated with amphetamine medications showed a reduced risk of developing Parkinson’s disease, and this risk decreased with the number of years they were prescribed amphetamine medications. The risk of Parkinson’s disease decreased by about 75% in women in particular.²⁵⁸

2.4.5. Fewer behavioral problems and ODD (-50% to -70%)¶

ADHD stimulants taken for more than 10 years reduced the risk of²⁵⁷

• Conduct disorder: by nearly 70%
• ODD (Oppositional Defiant Disorder) by about 55%

Long-term use of MPH reduced the risk of CD and ODD by about 50% in children and adolescents with ADHD²⁵⁶ Short-term use reduced the risk to a lesser extent.

2.4.6. Fewer cases of bipolar disorder (-50%)¶

Over a 10-year period, ADHD stimulants reduced the risk of bipolar disorder by more than 50%.²⁵⁷

2.4.7. Fewer cases of psychosis (-17%)¶

Long-term use of MPH reduced the risk of psychotic disorders¹⁹⁶ by about 17% in children and adolescents with ADHD.²⁵⁶ Short-term use reduced the risk to a lesser extent.

2.5. Reduced substance use (-30% to -90%)¶

ADHD medications reduce:

• Tobacco use²⁵⁹

  • the number of smokers by 50%²⁶⁰
  • the number of people who start smoking¹⁶⁶

• Substance Abuse²⁶¹

  • by 15%²²⁰

  • by 31%²⁶²

  • to the extent that it does not affect others²⁶³

• Alcohol consumption²⁵⁹²⁶¹

• Cannabis use²⁵⁹

• Use of illegal drugs²⁵⁹²⁶⁴

  • MPH halved amphetamine use among former chronic intravenous amphetamine users²⁶⁵

ADHD medications do not increase the risk for people with ADHD:²⁶⁶

• for alcohol abuse or dependence (11 studies, over 1,300 participants)
• for nicotine abuse or dependence (6 studies, 884 participants)
• for cocaine abuse or dependence (7 studies, 950 participants)
  • but rather a significant reduction²⁶⁷
• do not increase the risk of cannabis abuse or dependence (9 studies, over 1,100 participants) (Humphreys et al., 2013).

A meta-analysis of 6 studies involving n = 1,014 participants found a significantly reduced risk of later addiction among participants treated with stimulants (in this case, MPH).²⁶⁸ According to the findings, the risk of later addiction—whether to alcohol or other substances—is 1.9 times lower (i.e., nearly halved).²⁶⁹
Another meta-analysis found that ADHD medications (both stimulants and atomoxetine) reduced cravings and increased abstinence among people with ADHD who also have substance use disorders.²⁷⁰

In opioid-dependent pregnant women with ADHD, stimulant medication resulted in²⁷¹

• 81% more frequent use of buprenorphine (a medication used for opioid withdrawal)
• 61% less frequent methadone use
• 23% lower rate of discontinuation of buprenorphine treatment once started
• 50% fewer admissions due to substance use disorders

2.6. Less periodontitis (-58%)¶

Atomoxetine was associated with a 58% reduction in the risk of developing periodontitis later on.¹⁷⁸

2.7. Fewer thermoregulation-related illnesses (-55%)¶

Stimulants reduced the risk of thermoregulation-related diseases by 44%, as shown in a cohort study (n = 1,082,112, ages 6 to 24)²⁷²

• Dehydrogenation
• Hyperthermia
• Heatstroke
• Heat syncope
• Heat cramps
• Heat exhaustion
• Heat-induced fatigue
• Heat edema
• Rhabdomyolysis
• Sunstroke

2.8. Reduced nearsightedness (-39%)¶

People with ADHD who take ADHD medications have a 39% lower risk of myopia (nearsightedness). Taking multiple ADHD medications reduced the risk more than taking a single ADHD medication.²⁷³
The risk of nearsightedness is 29% higher in people with ADHD.

2.9. Decrease in overall hospitalizations (-16% to -38%)¶

A Swedish registry study examined all n = 22,714 adolescents and adults who had been diagnosed with ADHD between 2006 and 2021.
ADHD medications reduced the risk of nonpsychiatric hospital admission while being taken, compared to periods when they were not being taken:²²⁵

• Amphetamine-based medications: by 38% (aHR 0.62)
• Lisdexamfetamine: by 36% (aHR 0.64)
• Combination therapy: by 33% (aHR 0.67)
• Dextroamphetamine: by 28% (aHR 0.72)
• Methylphenidate: by 20% (aHR 0.80)
• Modafinil: by 19% (aHR 0.81)
• Atomoxetine: by 16% (aHR 0.84)
• Guanfacine: unchanged
• Clonidine: unchanged

2.10. Less frequent cases of precocious puberty (-37%)¶

MPH reduced the increased risk of early puberty associated with ADHD by 37%.¹⁸¹

2.11. Lower rates of obesity (-26%)¶

People with ADHD who take stimulant medication are 26% less likely to be obese (BMI over 30) than people with ADHD who do not take medication (30.5% vs. 41.2%).²⁰⁰
People with ADHD who take stimulant medication are 42% more likely to be of normal weight (BMI 18.5 to 25) than people with ADHD who do not take medication (38.7% versus 27.2%).²⁰⁰

2.12. Less reduction in brain volume¶

Children with ADHD have smaller brain volumes in various brain regions. This reduction in brain volume is less pronounced in children taking medication than in those not taking medication (cerebellum: minus 3.5% instead of minus 6.2%, PFC: 3.2% decrease instead of 5.8% decrease, white matter: 8.9% decrease instead of 10.7% decrease).²⁷⁴

2.13. Rarely a victim of violence, bullying, and abuse¶

People with ADHD who were treated with MPH were less likely to be victims of bullying or cyberbullying (physical victimization, isolation, destruction of property by others, and sexual victimization), were less likely to destroy others’ property, and were less likely to engage in bullying behavior (as perpetrators).²⁷⁵

People with ADHD who were treated with MPH or ATX were significantly less likely to experience abuse than people with ADHD who were not treated.²⁷⁶

Treatment for ADHD reduced violence in the relationship.²⁷⁷

2.14. Lower crime rate (-31% to -41%)¶

ADHD medications reduce

• the crime rate

  • by 41% among women ¹¹⁸²⁷⁸
  • by 31% among men¹¹⁸²⁷⁸
    *s reduced by 25% among male adolescents: Boys aged 10 to 17 with ADHD who were treated with stimulants had a 1.5-fold risk of a first offense, compared to a 2.02-fold risk for those not treated with stimulants{{[Nielsen TC, Nanan R, Butler T, Nassar N, Poulton A (2025): Stimulant treatment for attention-deficit/hyperactivity disorder and risk of first and repeat juvenile criminal offending: a population-based cohort study
  • by 13%, regardless of gender²²⁰

• particularly in cases of crimes committed on impulse²⁷⁹

• lower recidivism rate among former offenders²⁶¹²⁶⁵ at least plausible²⁸⁰

2.15. Improved academic performance and educational attainment¶

ADHD medications improve academic performance:

• A three-month course of ADHD medication resulted in²⁸¹
  • an improvement in grades of more than nine points (scale: 0 to 320)
  • a 20% reduction in the risk of not receiving a recommendation for upper secondary school
• The test scores of people with ADHD were 4.8 points higher (on a scale of 1 to 200) during the period when they were taking medication than during the period when they were not taking medication.²⁸²
• Discontinuing ADHD medication was associated with a small but significant decline in the grade point average²⁸³
• ADHD medication had a slightly positive effect on test scores in English (SMD 0.037), math (0.063), and reading (0.071)²⁸⁴

People with ADHD who were treated with stimulants were nearly one and a half times as likely to earn a high school diploma (approximately: Gymnasium) (about 58%) as people with ADHD who did not receive medication (41.3%).²⁰⁰

ADHD stimulants reduced the risk of failing a grade by nearly 60% in the U.S.²⁵⁷

People with ADHD have reduced motivation to exert themselves cognitively or physically. Amphetamine medications consistently increased motivation in both areas, bringing it close to the level seen in healthy control subjects.²⁸⁵

2.16. Improved Ability to Work and Income¶

People with ADHD who take a combination of sustained-release and immediate-release medication are more than one and a half times as likely to be employed full-time (52.9%) as people with ADHD who do not take medication (33.3%).²⁰⁰
People with ADHD who take stimulant medication are 30% less likely to be unemployed than people with ADHD who do not take medication (37.6% vs. 53.5%).²⁰⁰
Higher Employment Rates After Incarceration.²⁶¹

People with ADHD who take stimulant medication earned²⁰⁰

• 25% more likely to earn between $25,000 and $150,000 per year than people with ADHD who are not taking medication (63.7% vs. 50.9%)
• nearly 30% less likely to earn less than $25,000 per year compared to people with ADHD who do not take medication (24.5% vs. 34.2%)

2.17. More common with standard health insurance (+26.2% to +77.6%)¶

Had commercial health insurance, as opposed to government-provided health insurance:²⁰⁰

• 44.7% of the people with ADHD who are not taking medication
• 56.4% of people with ADHD treated with immediate release stimulants (+26.2%)
• 65.2% of people with ADHD treated with sustained-release stimulants (+45.9%)
• 79.4% of people with ADHD who were treated with a combination of sustained-release and immediate release stimulants (+77.6%)

2.18. Reduced need for treatment, lower healthcare costs (–63% to –82%)¶

A combined stimulant treatment reduces the number of inpatient treatments by up to 82%:²⁰⁰

• People with ADHD who are not taking medication: 0.629 per year
• treated with a combination of sustained release and immediate release stimulants: 0.111 per year
• treated with sustained release or immediate release stimulants: 0.27 per year

A combined stimulant treatment can reduce the number of outpatient treatments by up to half:²⁰⁰

• People with ADHD who are not taking medication: 4.59 per year
• treated with a combination of sustained release and immediate release stimulants: 2.3 per year
• treated with sustained-release or immediate release stimulants: 3.5 per year

A combined stimulant treatment reduces the number of emergency room visits by up to 63%:²⁰⁰

• People with ADHD who are not taking medication: 0.862 per year
• treated with a combination of sustained release and immediate release stimulants: 0.380 per year

Annual healthcare costs are reduced by up to 70% (12,740 USD per year) through a combination of stimulant treatments:²⁰⁰

• People with ADHD who are not taking medication: $18,200 per year
• Treated with a combination of sustained-release and immediate-release stimulants: 5,460 USD per year
• treated with sustained release stimulants: $8,970 per year
• treated with immediate release stimulants: 9,190 USD per year

We interpret the difference between the combination of immediate release and sustained release stimulants compared to taking sustained release or immediate release stimulants alone as an indication of extended daily coverage and a more precise/detailed medication adjustment,

2.19. Improved Quality of Life¶

Medication significantly alleviates the decline in health-related quality of life caused by ADHD in children.²⁰³

A meta-analysis found a decline in quality of life of SMD = 0.2 when medication was discontinued in children and adolescents, but not in adults.²⁸⁶ Discontinuation of ADHD medication is likely to occur disproportionately often among people with ADHD who experience side effects. If discontinuation nevertheless impairs quality of life overall, the improvement in quality of life resulting from stimulant medications for ADHD is likely to be greater than 0.2 under normal circumstances.

2.20. No lasting protective effect from a treatment that took place a long time ago¶

Among adults who received individualized ADHD treatment between the ages of 6 and 10, the results 18 years later were mixed.²⁸⁷

• an improvement in ADHD symptoms consistent with the 8-year follow-up
  • 18% were no longer diagnosed with ADHD
  • 55% experienced partial remission; of these:
    • ADHD-I 33%
    • ADHD-HI 13%
    • ADHD-C 54%
  • An additional 27% had been diagnosed with ADHD; of these:
    • ADHD-I 67%
    • ADHD-HI 17%
    • ADHD-C 17%
  • functional impairment with regard to
    • Finance 28%
    • Daily responsibilities 28%
    • Community activities 23%
    • Learning/Acquiring New Knowledge 21%
• Poorer academic or career outcomes than expected
  • Educational and vocational credentials
    • as frequently as in the general population
    • significantly lower grades
    • High school diplomas and university entrance qualifications are much less common than in the general population
  • increased unemployment
    • currently unemployed: 17%
      • about 30% more common than in the general population (the study compares the figures to 2011, when unemployment was 30% higher than in 2019)
    • 25% had been unemployed for over a year
    • 52% had been unemployed at least once in recent years
• more frequent contact with the justice system than expected
  • Criminal convictions: 33%
• health impairments, comorbidities
  • three times the rate of externalizing or internalizing Disorders
    • three and a half times the rate of medication for mental health issues
  • 27% had a personality disorder according to the DSM-IV
    • antisocial personality disorder 12%, RR 6.8 (approximately 6 times as common; general population: 2%)
    • Avoidant Personality Disorder RR 2.0 (twice as common)
    • schizoid personality disorder: RR 2.0 (twice as common)
    • paranoid personality disorder, RR 1.3 (30% more common)
  • Addiction issues
    • Drug use: 15%; much more common
    • Smoking a little more often
    • Alcohol a little more often
  • Weight issues
    • Obesity is one and a half times as common as in the general population
    • Obesity is 30% more common than in the general population
  • Chronic pain
    • Children with ADHD had a prevalence of chronic pain of up to 66% (pain occurring at least once a week for more than 3 months). Treatment with stimulants reduced the rate of chronic pain. Another study found reduced pain perception in adolescents with ADHD, which disappeared with stimulant treatment.²⁸⁸
• Several social outcomes were favorable
  • Long-term relationship/marriage: 63%
• low life satisfaction, particularly in the areas of
  • Health
  • Job/Career
  • Leisure and recreational activities
  • My own children
  • Myself
  • Sexuality
  • Relationships with others
  • Overall life satisfaction

2.21. Number of patients needed to treat¶

How many people with ADHD must be treated with MPH over the long term to prevent one of the following long-term consequences of untreated ADHD?²⁸⁹ The results were independent of gender:

• 3 people with ADHD who received treatment = 1 case of repeating a grade avoided
• 3 people with ADHD treated = 1 case of ODD (Oppositional Defiant Disorder) prevented
• 3 people with ADHD treated = 1 case of conduct disorder prevented
• 3 people with ADHD treated = 1 anxiety disorder prevented (with 2 types of impact)
• 4 people with ADHD treated = 1 case of severe depression prevented
• 4 people with ADHD treated = 1 serious car accident prevented (in a simulation)
• 5 people with ADHD treated = 1 case of bipolar disorder prevented
• 6 people with ADHD treated = 1 person who did not start smoking
• 10 people with ADHD treated = 1 case of addiction prevented

3. Financial Consequences of ADHD¶

An initial diagnosis at an older age results in significantly higher costs for the healthcare system and society than an early diagnosis.²⁹⁰

3.1. Treatment Costs for ADHD¶

Treatment costs are the direct costs of therapy, medication, and doctor’s visits for the purpose of ADHD diagnosis and treatment.

The following figures were cited as the annual costs of drug treatment, including the costs of doctor visits and laboratory tests:

• 1998 for adults: $1,262²⁹¹
• 2001 for adults: $1,673²⁹¹
• 2004: $1,710 to $2,567²⁹²
• 2024: 1,505 EUR for children and adolescents in the first year after diagnosis. The ADHD group incurred 2.86 times the costs compared to peers without ADHD. Age and comorbidities had a significant impact on costs.²⁹³

In Germany, treatment costs for people with ADHD were $1,505 higher in the first year than for those without the condition.²⁹⁴

3.2. Health Care Costs Associated with ADHD¶

In addition to the direct costs of treating ADHD itself, healthcare costs also include the additional medical expenses associated with comorbidities resulting from ADHD (e.g., substance use disorders) and the increased risk of accidents.

A 2016 Danish cohort study found that annual healthcare costs for people with ADHD were 2,636 EUR higher (4,868 EUR instead of 1,912 EUR = 2.55 times as much).²⁹⁵
In addition, there were 477 EUR in higher annual healthcare costs for the partners of people with ADHD.

ADHD leads to more than double the healthcare costs.²⁹⁶

A meta-analysis covering Europe from 1990 to 2013 estimated annual healthcare costs for ADHD ranging from 2,022 to 2,390 EUR per person with ADHD.²⁹⁷ In addition, health care costs for family members attributable to caring for a child or adolescent with ADHD ranged from 1,339 to 1,826 EUR per person with ADHD.

From 1999 to 2001, annual health care costs were higher for people with ADHD in the United States:²⁹⁸

• Total medical costs doubled (5,651 USD vs. 2,771 USD), including
  • outpatient costs (3,009 USD vs. 1,492 USD)
  • Inpatient costs (1,259 USD vs. 514 USD)
  • Costs for prescription medications (1,673 USD vs. 1,008 USD)

Healthcare costs associated with ADHD in the United States amount to 20.6 billion USD annually.²⁹⁹
Children with ADHD account for 5.4% of the Medicaid population in New York State, but account for more than 18% of total costs—a 3.2-fold increase.³⁰⁰
The higher costs are due to behavioral health services and medications.³⁰¹

For 2018, the total annual societal cost of health care services for adults with ADHD was reported to be $1,635.³⁰²

In 2002, children with ADHD in Flanders (Belgium) required more intensive health care than their unaffected siblings. The use of medical services was as follows:³⁰³

• General practitioner (60.3% vs. 37.4%)
• Specialist (50.9% vs. 12.9%)
• Emergency room (26% compared to 12.1%)
• Hospital admissions (14% compared to 8.4%)
  The annual healthcare costs for a child with ADHD were six times those of an unaffected sibling (588 EUR versus 92 EUR). Public costs more than doubled (779 EUR versus 371 EUR).

Elementary school children with hyperactivity incurred 17.6 times higher average annual costs (£562 instead of £30) across all areas (except for non-mental health costs). The costs were consistently attributable to male gender and, for some cost codes, to behavioral disorders.³⁰⁴ It can be assumed that externalizing disorders such as ODD and CD made a separate contribution.

The annual healthcare costs for people with ADHD were reduced by up to 70% (12,740 USD per year) through combined stimulant treatment:²⁰⁰
People with ADHD who are not taking medication: $18,200 per year
Treated with a combination of sustained-release and immediate release stimulants: 5,460 USD per year
Treated with sustained-release stimulants: 8,970 USD per year
Treated with immediate release stimulants: 9,190 USD per year

People with ADHD in Germany incurred 2.86 times the usual healthcare costs.²⁹⁴

3.3. Costs for Family Members of Individuals with ADHD¶

Family-related costs are the expenses incurred by parents or legal guardians due to the additional burden resulting from the person with ADHD.

A 2016 Danish cohort study found that the annual additional direct and indirect costs per partner of a person with ADHD amounted to 7,997 EUR.²⁹⁵

A study found that for people with ADHD aged 14 to 17, the direct annual family costs (“related to the burden on caregivers”) were five times higher, excluding treatment costs and indirect costs.³⁰⁵

A meta-analysis covering Europe from 1990 to 2013 estimated the total annual costs of ADHD at 9,860 euros per child and 14,483 euros per adolescent with ADHD.²⁹⁷ Of this amount, 22% to 14% was attributable to productivity losses among family members.

For people with ADHD, the total annual societal costs for 2018 were reported to be $14,092 per person with ADHD.³⁰²
Caregivers of adults with ADHD spend an additional 0.8 hours per week on ADHD-related care compared to caregivers of adults in the general U.S. population.³⁰⁶³⁰⁷ This results in additional annual costs of 6.6 billion USD.

A meta-analysis of 19 studies estimated the total annual costs of ADHD in the United States (in 2010 USD) to be between 176 and 309 billion USD (1.17% to 2.05% of U.S. GDP).³⁰⁸ Of this amount, spillover costs borne by family members of individuals with ADHD accounted for between 33 billion USD and 43 billion USD (0.22% to 0.29% of U.S. GDP).

3.4. Educational Costs Associated with ADHD¶

A meta-analysis covering Europe between 1990 and 2013 estimated the total annual costs of ADHD at 9,860 EUR per child and 14,483 EUR per adolescent with ADHD.²⁹⁷ Of these costs, 62% and 42%, respectively, were attributable to educational expenses.

A meta-analysis of 19 studies estimated the total annual costs of ADHD in the United States (in 2010 USD) to be between 176 and 309 billion USD (1.17% to 2.05% of U.S. GDP):³⁰⁸

• for adults: 105 to 194 billion USD (0.7% to 1.29% of U.S. GDP)
  • in particular, losses in productivity and income (USD 87 billion to USD 138 billion) (0.58% to 0.92% of U.S. GDP)
• for children and adolescents: 38 to 72 billion USD (0.25% to 0.48% of U.S. GDP)
  • particularly health care: $21 billion - $44 billion (0.14% - 0.29% of U.S. GDP)
  • of which education accounted for: 15 billion USD – 25 billion USD (0.1% to 0.17% of U.S. GDP)
• Spillover costs borne by family members of individuals with ADHD: $33 billion to $43 billion (0.22% to 0.29% of U.S. GDP)

3.5. Increased Social Benefits¶

A 2016 Danish cohort study found that people with ADHD and their partners were more likely to receive social benefits (sick pay or disability benefits).²⁹⁵

3.6. Indirect Consequences of ADHD¶

3.6.1. Increased absenteeism, unemployment, and disability¶

For people with ADHD, the total annual societal costs for 2018 were reported to be $14,092 per person with ADHD.³⁰²
Of this amount,

• Additional costs due to unemployment: 54.4% (7,666 USD per person with ADHD)
  • Adult men with ADHD are 2.1 times more likely to be unemployed than those without the condition. Their unemployment rate is thus 22.1 percentage points higher.
  • Adult women with ADHD are 1.3 times more likely to be unemployed than those without the condition. Their unemployment rate is thus 9.7 percentage points higher.
  • The annual additional costs in the United States amount to 66.8 billion USD (55.8 billion USD for men and 11 billion USD for women with ADHD). This represents 0.325% of GDP.
• Productivity losses: 23.4% (3,298 USD per person with ADHD)³⁰⁹
  • 13.6 workdays of ADHD-related absences
  • 21.6 workdays lost due to ADHD while at work
  • The 35-day average productivity loss was distributed across
    • Workers: 55.8 days
    • Service sector workers: 32.6 days
    • Technicians: 19.8 days
    • Skilled workers: 12.2 days
  • Productivity costs due to ADHD amount to $28.8 billion ($19.9 billion for men and $8.9 billion for women with ADHD). This represents 0.14% of GDP.
  • Employees with ADHD were absent 3.5 times as often due to “unofficial” absences (4.33 vs. 1.13 days)²⁹⁸
  • 22.1 days of annual productivity loss³¹⁰

A Swedish registry study covering the years 1998 through 2008 found that among people with ADHD:³¹¹

• 12.2 additional days of unemployment (over 252 workdays, this would amount to 4.84%)
• 19 times more likely to receive a disability pension
  • In most cases, the inability to work is due to comorbid intellectual disabilities and developmental disorders; therefore, these conditions are only partially amenable to improvement through more consistent treatment.

A relatively small German study found that unemployment was 24.8% higher.³¹²

3.6.2. Premature mortality¶

For people with ADHD, the total annual societal costs for 2018 were reported to be $14,092 per person with ADHD.³⁰²
Adults with ADHD have an annual mortality rate that is twice as high (primarily due to higher rates of traffic and other accidents).³¹³
As a result, there was a total loss of social productivity of approximately 3.2 billion USD in 2018 (0.016% of 2018 GDP).

People with ADHD are 1.7 times more likely to have at least one accident:³¹⁴

• Children (28% vs. 18%)
• Adolescents (32% vs. 23%)
• Adults (38% vs. 18%)
  Follow-up costs for people with ADHD were higher only among adults (483 USD vs. 146 USD = 3.3 times higher).

3.6.3. Income Disparities Among People with ADHD¶

3.6.3.1. Decreased income (-16.1% to -24.4%), lower net worth (-75%)¶

A 20-year longitudinal study of 604 participants showed that, by age 30, people with ADHD have a lower net income and are more financially dependent on their parents than people without ADHD. This remains true even when they no longer meet the DSM criteria. This deficit persists throughout life and results in a lifetime expected income that is $1.27 million lower for men and a net worth at retirement that is up to 75% lower than that of non-affected individuals.³¹⁸ In addition, people with ADHD who were not diagnosed and treated during childhood earn significantly less than their unaffected twins and incur 20,000 EUR higher costs per person per year.³¹⁹

A Swedish registry study covering the years 1998 through 2008 found that people with ADHD had an annual income that was 17% lower.³¹¹

In 2003, people with ADHD achieved fewer academic milestones beyond high school. At 34%, people with ADHD were 42.3% less likely to be employed full-time than people without ADHD, who stood at 59%. Except among 18- to 24-year-olds, average household income was significantly lower, regardless of academic achievement or personal characteristics. The national loss of labor productivity associated with ADHD was estimated at $67 to 116 billion (0.58% to 1.01% of U.S. GDP), based on an assumed prevalence of 2.3%.³²⁰
In 2003, the income of people with ADHD was:

• Men: $45,645 compared to $54,399 (16.1% less)
• Women: $37,607 compared to $49,738 (24.4% less)

Given the current prevalence rate of 5% among adults, the figure would likely be more than double that. The Consumer Price Index in the U.S. rose by 40% between 2003 and 2020. Assuming that income and GDP had risen at the same rate, this would amount to 183 to 322 milliaden USD in 2020 (0.87% to 1.54% of GDP).

A 2016 Danish cohort study found that people with ADHD had lower earned income in the five years prior to their initial diagnosis.²⁹⁵

People with ADHD who were not diagnosed or treated as children earned significantly less than their unaffected twins and paid less in taxes.³¹⁹

3.6.3.2. Taxes and social security contributions resulting from reduced income¶

To date, we are aware of only one study that calculated the resulting loss of tax and social security revenue for Germany.
The net tax and social security revenue generated by a person born in 2010 who did not have ADHD was estimated to be 80,000 EUR higher than that generated by a person with ADHD who was not treated. ADHD interventions that led to an improvement in educational attainment resulted in fiscal benefits through higher tax revenues over the individual’s lifetime.
For every euro spent on a new ADHD intervention, the study estimated 1.39 EUR in discounted net tax revenue and 3.02 EUR in discounted gross tax revenue.³²¹
Based on the number of untreated adults in Germany and 2020 figures, we have calculated annual losses in net tax and social security revenue of 5.916 billion EUR. This amounts to 1.63% of the federal budget.
Not included are savings resulting from

• reduced crime
  • 111 million EUR in annual savings on prison costs
  • A reduction of 500 million EUR in annual losses due to crime
• reduced premature mortality: 580 million EUR annually
• Costs for family members: 2 billion EUR annually
• Productivity losses in the workplace: 11 billion EUR annually

3.7. Total Economic Costs¶

A study estimates that each case of ADHD that persists into adulthood in the United States results in $182,000 (as of 2015) in additional costs related to health care, education, and the consequences of crime.³²²
An Australian study estimates the total social and economic costs of ADHD to be between 8.40 and 17.44 billion USD, with an annual cost per person with ADHD of 15,664 USD (2018/2019).³²³ Of the total costs,

• Productivity costs: 81%
• Spillover losses: 11%
• Health care costs: 4%
  The loss in well-being was significant and was estimated at 5.31 billion USD.

A 2016 Danish cohort study estimated annual additional direct and indirect costs of 22,721 EUR per person with ADHD (as of 2016).²⁹⁵
People with ADHD accounted for 23,072 EUR per year.

Another Danish study of same-sex twins showed that for adults with ADHD who were not diagnosed and treated during childhood:³²⁴

• total annual costs of 20,134 EUR, which are higher than those for his siblings (as of 2010)
• a significantly lower disposable income
• lower taxes paid
• increased access to government benefits
• higher health and social welfare costs
• higher crime rates

Two American studies estimate the total annual societal costs associated with ADHD at $6,799 per child ($19.4 billion) and $8,349 per adolescent ($13.8 billion) (as of 2017/2018).³²⁵ The costs were broken down as follows:

• Education costs (59.9% for children, 48.8% for adolescents)
• direct health care costs (25.9% for children, 29.0% for adolescents)
• Childcare costs (14.1% for children, 11.5% for adolescents).

A study estimated the cost per person with ADHD at $14,576 (as of 2005), with an estimated range of between $12,005 and $17,458.³²⁶