Grown-Ups With ADHD – New Epidemic or Age-Old Problem?
Attention deficit/hyperactivity disorder (ADHD) is a common mental health disorder in childhood. It involves inattention, hyperactivity and impulsivity that is severe enough to interfere with functioning or development.
The number of children diagnosed with ADHD has risen by 41% percent in the U.S.1 This has led to a debate because other countries haven’t experienced such a sharp increase. While 6.3% of U.S. parents reported a diagnosis for children aged five to nine, only 1.5% of parents in the UK did so.2
It was long believed children with ADHD just grew out of it, but it is now recognised that the condition frequently persists into later life. The prevalence in adults is between 2% and 5%. By their mid-20s, 15% of sufferers still receive a full diagnosis and just half of them will have achieved a partial remission.3
The rise in ADHD diagnoses has led many to ask whether the current trend represents overdiagnosis or even an epidemic.
This could be due to widened clinical definitions – what were once “normal” behaviours are now mental health disorders, loosening the criteria for adult ADHD. A child’s failure to meet behavioural expectations can now be attributed to illness, not parenting. Perhaps aggressive marketing of new and effective pharmacological treatments has stimulated recognition? There are also fears exposure to increased levels of toxins in environmental pollution could affect the sensitive developing brain.
An alternative conclusion is that neither overdiagnosis nor an epidemic explains the phenomenon; ADHD has always been there and it is now being properly recognised.4
But whatever your conclusion, one thing is clear: More and more people with ADHD now disclose the disorder in applications for life insurance.
People diagnosed with ADHD as adults represent a higher risk than those diagnosed in childhood or adolescence, with excess mortality mainly from unnatural causes and accidents.5 Comorbidity with depression, anxiety and substance abuse is also common.6
Fears over cardiovascular or addictive side effects of the stimulant medications used to treat ADHD have largely been allayed, but evidence remains of increased mortality rate ratios.7
When vetting applicants, underwriters should consider not only the diagnosis but its impact on work and family life. For the majority of ADHD sufferers, the outlook is rather positive and others may be accommodated with added modest premiums.
If you want to read more on the rise of childhood mental disorders, see our article The Rise and Rise of Childhood Mental Disorders: Overdiagnosis or Epidemic?
Follow our blog series on mental health for more on the complex risk challenges presented by specific disorders and behavioural issues.
- Faraone, SV et al. (2006), The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies, Psychological Medicine. 36. 159-65.
- Ball, C and Baillie, L (2014), The rise and rise of childhood mental disorders: overdiagnosis or epidemic? Underwriting Focus, Gen Re.
- Dalsgaard, S et al. (2015) Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study, The Lancet, Volume 385, No 9983, 2190–2196.
- Klein, RG and Mannuzza, S (2010) Comorbidity in Adult Attention-Deficit Hyperactivity Disorder. In Retz W, Klein RG (eds): Attention-Deficit Hyperactivity Disorder (ADHD) in Adults. Key Issues in Mental Health. Basel, Karger, 76, 126–143.
- Craig, SG et al. (2015) Long-term effects of stimulant treatment for ADHD: What can we tell our patients. Current Developmental Disorders Reports 2:1–9.