Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental conditions in children, yet little research has explored its impact on overall health and wellbeing over a long-term period.
This Deakin study is the first in Australia to investigate the associations between ADHD and Health-Related Quality of Life (HRQoL) — as well as the factors that may influence this relationship — across multiple stages of a child’s development. Using data from the Longitudinal Study of Australian Children, researchers analysed seven waves of data collected between 2004 and 2016, covering the ages of 4 to 17.
Large-scale, long-term study
Led by Senior Research Fellow Ha Le, from Deakin Health Economics in the Institute for Health Transformation, the population-based study drew on data from more than 4000 children, who were assessed for ADHD clinical symptoms using the hyperactivity-inattention subscale from the Strengths and Difficulties Questionnaire (SDQ).
The children’s HRQoL was measured using the Paediatric Quality of Life Inventory, and any relevant internalised problems (such as anxiety and depression) and externalised problems (such as aggression) were assessed through emotional and conduct subscales of the SDQ respectively. Child and family characteristics (such as socioeconomic status and the presence of psychological distress in the caregiver) were also included as explanatory variables.
According to Le, the team examined both the cross-sectional associations of these measures at each wave of data collection and the average effects across the full 13-year period, using mixed-effects modelling. “This approach allowed us to account for repeated measures from the same children at different stages over the 13 years, and show how ADHD symptoms linked to their wellbeing as they grew,” Le says.
Associations between ADHD and children’s health-related quality of life
The analysis revealed that, across every age studied, children with ADHD clinical symptoms consistently reported a poorer HRQoL than those without symptoms. It also showed that having two or more siblings was linked to better HRQoL, while factors like living with a caregiver experiencing mental illness, having other medical conditions such as autism, and taking ADHD medication were associated with poorer HRQoL.
“The medication finding was unexpected, as previous studies have found that ADHD medication improves outcomes such as school performance and ADHD symptoms,” Le says. “Our results are likely explained by the small sample size of children taking ADHD medication at some time points and the fact that children taking medication often experience more severe symptoms and impairment, which are themselves linked to poorer HRQoL. We recommend caution in interpreting this finding.”
Implications for ADHD care
The findings point to the need for a holistic approach to ADHD management, consistent with the Australian Evidence-Based Clinical Practice ADHD Guideline for multimodal treatment. This highlights the importance of combining medication with non-medication strategies, such as psychosocial and learning support, while addressing any co-occurring conditions as well as the caregiver’s mental health and wellbeing.
Read the full research paper: The Long-Term Impact of ADHD on Children and Adolescents’ Health-Related Quality of Life: Results From a Longitudinal Population-Based Australian Study
Read more about Senior Research Fellow Ha Le’s research.
