My first blog post is about a condition I treat every day: Attention-deficit/hyperactivity disorder (ADHD). I don’t love the name. Many patients and parents tell me that there often is a surplus of attention for themselves or the kids that have ADHD who can hyperfocus on things they are interested, like video games, or movies, or sports.
The other aspect is that most of my adult patients aren’t hyperactive and that’s not required for the diagnosis. Most people have experienced attention deficit and hyperactivity at times so it’s also a spectrum and sometimes not even a “disorder” per se.
The name Attention Regulation Differences is probably better but still doesn’t capture the entire entity as it’s missing the other two pieces of self-regulation difficulties, which are motor (read: muscle/movement) regulation issues and emotion regulation issues. This regulatory control happens in the prefrontal cortex which we know is underdeveloped in those with ADHD compared to their age-matched peers without it.
A new study came out this year out of the United Kingdom using their large database of primary care data. They looked at about 9.5 million people over the first 20 years of the 21st century and compared the death rate of those with ADHD versus those without. They did some nice statistical analyses and modeling that we won’t get into today to answer the question of how much does ADHD contribute to mortality rate. What they found was striking.
We don’t typically think of ADHD being a risk factor for death but in actuality, people are much more likely to due of accidents, particularly motor vehicle accidents, but also suicide. If you are depressed, chances are your likelihood of killing yourself goes way up if you also have an issue with impulsivity, meaning that you aren’t thinking through the consequences of what happens if you take that action.
This study didn’t look at how the individual died, but rather used all-cause mortality rates to estimate the life expectancy. This is the shocking part:
• The average life expectancy of men with ADHD is 73 years versus 80 years in those without
• The average life expectancy of women with ADHD is 75 years versus 84 years in those without
This means that men with ADHD are expected to live 7 years less than those without ADHD and women 9 years less! That’s HUGE! This is a serious condition that should be taken seriously!
When you look at each age, it seems that younger men and older women with ADHD are the ones who have higher mortality rates compared to their same-age-group peers without ADHD.
They didn’t look at how the individual died. We know that ADHD is highly genetically linked to obesity which is a big risk factor for mortality rate. We also know that it’s linked to depression, anxiety, substance use especially smoking, and other physical health problems. It’s much more likely that those are the factors driving mortality rate rather than the ADHD itself being the cause of death. They also didn’t look at other factors that contribute to mortality rate such as socioeconomic status, comorbid health conditions like heart disease or cancer, diet, or exercise.
They also didn’t look at whether the patients were medicated or not but because this sample was looking at a primary care sample. Although it may be capturing the severe cases that were medicated or had a medication on their list through their primary care doctor, it’s much more likely that these cases were unmedicated though or untreated given the dearth of specialist services for ADHD in the UK. Those who were diagnosed may have had co-morbid mental health conditions that brought them in contact with those specialists who diagnosed ADHD as well so this sample may be overrepresented and not capturing everyone with ADHD. We won’t talk about misclassification bias here today.
We do know that there’s data that ADHD medications aren’t associated with increased mortality but rather, can decrease mortality rate by prevent unintentional injuries and accidents, decrease impulsivity and therefore decrease suicide deaths, and decrease all sorts of associated risk factors that can lead to mortality.
What this is telling me is that we need to treat ADHD in order to decrease the number of years of life lost. Diagnosis and treatment of ADHD is life-saving.
If you or a loved one are looking for a diagnosis and treatment, you’re welcome to reach out to me to schedule a brief phone consultation.