Can ADHD be a Deadly Disorder?
By: Stephen V. Faraone, Ph.D.
In the world of research, it is unusual for a single study to be definitive. A possible exception is a recent report in the highly esteemed Lancet, which concluded that people diagnosed with ADHD were about two times more likely to die early than people without ADHD. The data came from the medical registers of Denmark that include 1.92 million people of which 32,061 have ADHD. The registers included the times and causes of deaths spanning 32 years. It is a remarkable resource.
We know that people with very severe ADHD are at high risk for substance use disorders and antisocial behaviors. In the Danish study, these disorders also increased the risk for premature death but the risk was even higher if people with those disorders also had ADHD. ADHD also increased the risk for early death among people without these extra problems. This latter finding points to an ADHD specific pathway to premature death. What is it? Well, we know that ADHD people are at risk for injuries, traffic accidents and traumatic brain injury. We don’t know for certain why, but two symptom clusters of ADHD, inattention and impulsivity, would be expected in increase the risk for accidents and injuries. For example, adults who are distracted while driving are clearly at risk for accidents. In fact, accidents accounted for most of the early deaths in the Danish study. But the study also found an increase in natural causes of death due to having ADHD. This may be due to the well replicated association between ADHD and obesity or the possibility that ADHD symptoms lead to poor health habits.
In the Danish study, the mean age at diagnosis was 12.3, which means that many of the ADHD people in the study were not treated for many years subsequent to the onset of symptoms. The risk for early death increased with the age at diagnosis. This suggests that failing to diagnoses and treat ADHD early makes the disorder worse and increases the risk for the types of behaviors that lead to premature death.
Will these data change public policy or clinician behavior? I hope so. Perhaps the media will stop trivializing ADHD and accept it as a bona fide disorder in need of early identification and treatment. Policy makers should allocate to ADHD people their fair share of healthcare and research resources. For clinicians, early identification and treatment should become the rule rather than the exception.
Talk of premature death will worry parents and patients. That is understandable, but such worries can be alleviated by focusing on two facts: the absolute risk for premature death is low and this risk can be greatly reduced by seeking and adhering to evidenced-based treatments for the disorder.
REFERENCES
Dalsgaard, S., Ostergaard, S. D., Leckman, J. F., Mortensen, P. B. & Pedersen, M. G. (2015). Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. Lancet.
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Adeyemo BO, Biederman J, Zafonte R, Kagan E, Spencer TJ, Uchida M, et al. Mild Traumatic Brain Injury and ADHD: A Systematic Review of the Literature and Meta-Analysis. J Atten Disord. 2014; 18(7): 576-84.
Cortese S, Faraone SV, Bernardi S, Wang S, Blanco C. Adult attention-deficit hyperactivity disorder and obesity: epidemiological study. Br J Psychiatry. 2013; 203: 24-34.
Spencer TS, Faraone SV, Tarko L, McDermott K, Biederman J. ADHD and Adverse Health Outcomes in Adults: Results from a Large Controlled Study. 2013.
Faraone SV. The scientific foundation for understanding attention-deficit/hyperactivity disorder as a valid psychiatric disorder. Eur Child Adolesc Psychiatry. 2005; 14: 1-10.