Does Adult ADHD Lead to Early Death? Spoiler Alert: Yes.
Are we missing something when it comes to morbidity and mortality in ADHD?
The Frontier Psychiatrists is a daily enough health-themed newsletter. Some of our most popular articles are about ADHD. This disorder has a storied history and has had several monikers over the years. In the earlier 20th century, we referred to it as minimal brain dysfunction. Subsequently, we had attention deficit disorder. Then, most recently, attention deficit hyperactivity disorder was added. This, in turn, has three identified subtypes: inattentive, hyperactive, and combined, where you have both hyperactivity and inattentive symptoms.
It's even gotten so popular that we have “made-up” diagnoses—essentially, individuals advocating for new diagnostic entities that are not yet in the pantheon of the International Classification of Disease (ICD) or the Diagnostic and Statistical Manual for Mental Disorders (DSM-5-TR); it's kind of like the farm leagues for diagnosis? But we have conceptualizations like “rejection sensitivity dysphoria” or RSD, as a maybe an ADHD subtype. We've got endless TikTok videos. We've got ads where people misspell things on purpose to lure in those with ADHD for some kind of scam.
A pedantic point: RESPONCE is not how you spell the word RESPONSE. My hunch is this is part of a scam sales funnel that selects for individuals who are paying no attention to the details. To be clear, is the claim that “hypersexuality is not infidelity [but instead part of ADHD]” factual? This is not a thing—except, perhaps, as clickbait.
Moving on, we've covered here how ADHD—specifically stimulant medications—is associated with morbidity in ADHD. Allow me to summarize my now-classic (according to me alone) treatise, “Is My ADHD Medication Killing Me?”:
Yes, your ADHD medication might kill you. But, it’s more likely your ADHD will kill you on it’s own if left untreated. The deaths happen early, and the risks happen late.
While that is true about the medicines themselves, today’s publication in the British Medical Journal is an epidemiological study, following millions of people over about 20 years, evaluating the rate of early death in individuals diagnosed with ADHD.
With any study, my first question is “Who is in the sample.” As I frequently joke, this newsletter could be renamed. “The Table One Star-Ledger.” The first table in an academic research paper in biomedical science, Table One, reviews the question of who is in the sample. Here, we find the following:
A matched cohort study using prospectively collected primary care data (792 general practices, 9 561 450 people contributing eligible person-time from 2000–2019). We identified 30 039 people aged 18+ with diagnosed ADHD, plus a comparison group of 300 390 participants matched (1:10) by age, sex, and primary care practice. We used Poisson regression to estimate age-specific mortality rates, and life tables to estimate life expectancy for people aged 18+ with diagnosed ADHD.1
If we dig in further, readers may ask, is there more we could understand? So glad you asked.