Is ADHD real?
Although the medical community has pretty clearly made up its mind on this question, it’s still common to run into people in the general population who are quite convinced that ADHD is a “made-up disorder.”
And in all fairness, it’s easy to see how to someone who doesn’t understand the chronic, impairing nature of ADHD, symptoms like “inattention” and “lack of focus” could sound like nothing more than the moments of imperfection we all experience from time to time. Which is why “ADHD? Oh, doesn’t everyone have that?” is a common variant of “ADHD isn’t real” that most ADHDers have heard.
There is a wealth of hard evidence out there showing how the brains of people with ADHD really are different from those without ADHD, but that’s not what I want to talk about today. Because, let’s be honest, most people who think ADHD isn’t “real” probably aren’t going to be convinced of anything by a couple hundred published, peer-reviewed studies by world-class neuroscientists.
Instead, I want to focus on some very real effects of ADHD that are hard to dispute. The facts that show just how life-altering this disorder can be. These are far from the only ways ADHD impacts people’s lives — ADHDers can attest that the effects of ADHD are diverse and often subtle — but they’re some of the most tangible. If there’s anything that shows how silly and outdated the “debate” over whether ADHD is “real” is, I think it’s these facts, so you might want to think about having some of these on hand if at some point in the future you find yourself in the unenviable position of trying to explain why yes, ADHD actually is real.
People With ADHD Are Much More Likely to Go to Prison
The exact prevalence of ADHD in prison populations is difficult to estimate, but one thing is clear: ADHDers are vastly overrepresented among inmates. A 2010 survey of 315 male Swedish prisoners estimated the prevalence of ADHD as an astonishing 40% among longer-term prison inmates. A 2004 study of 129 young male German inmates similarly estimated the prevalence of ADHD at 45%.
ADHDers in the United States also seem to end up incarcerated at rates much higher than non-ADHDers. A 1994 survey of 102 male inmates found 25.5% met the criteria for ADHD while a 2010 survey of 319 newly committed male and female inmates found 21.3% had ADHD. Finally, a 2012 study of 3,962 found an overall prevalence of 10.5% — which is on the conservative side of all these studies but still several times higher than the population average of 2-5%. Interestingly, this study also found a higher rate of ADHD among female inmates (15.1%) than male inmates (9.8%).
No matter how you slice it, though, ADHDers appear to be dramatically overrepresented in the prison system, illustrating just how real the consequences of untreated ADHD (the vast majority of ADHD prisoners identified in the above studies had not been previously diagnosed) are both for society at large and ADHDers themselves.
People With ADHD Have More Car Accidents
Inattention, impulsivity, underarousal and the host of other executive function deficits that come with ADHD can be a recipe for disaster when ADHDers get behind the wheel.
To investigate different factors contributing to risky driving, a 2008 study asked ADHD and non-ADHD adults to participate in a simulated driving task, both under the influence of alcohol and sober. Worryingly, sober ADHD drivers not only drove worse than sober non-ADHD drivers but actually resembled intoxicated non-ADHD drivers who were over the United States’ legal blood alcohol concentration limit.
Moreover, alcohol had a stronger effect for the ADHD drivers, who became more impaired more quickly than the intoxicated non-ADHD drivers as the dosage increased. The study’s authors point to a couple takeaways from the experiment: (1) that having ADHD and being intoxicated lead to similar impairments on the road and (2) that even legal doses of alcohol could have serious consequences for ADHD drivers by exacerbating ADHD-related deficits.
Given the serious picture painted by this study, then, it’s perhaps not surprising that ADHDers are much more likely to wind up in basically any kind of driving-related trouble you can think of. For example, a 2005 study found that ADHDers were more likely to be involved in collisions and to receive both speeding tickets and other kinds of driving citations than neurotypicals.
The good news, though, is that stimulant medications have a profound effect on ADHDers’ ability to drive safely. A study done in 2000 found that ADHD drivers differed from non ADHDers not only in that they reported a history of more lifetime accidents and performed worse on a driving simulator task but also in that they drove significantly better after a dose of Ritalin. Other studies have had similar results, and a 2006 meta-analysis recommended the use of stimulant medication among young ADHD drivers as a step towards fighting the “burgeoning epidemic of road traffic death and injury which is the number one cause of death in young adults in North America.”
Of course, the driving impairments associated with ADHD pose a serious risk not only to ADHDers themselves but to everyone who has to share the road with them. Every ADHDer who doesn’t seek diagnosis or treatment because they don’t think ADHD is “real” poses a danger to themselves and the people around them as soon as they step into a vehicle. Given the hard evidence not only that ADHD and driving is a potentially catastrophic combination but also that ADHD-related driving impairments can be effectively treated with stimulants, we don’t have time to keep debating whether ADHD is real when we could be talking about how to raise awareness and save lives instead.
People With ADHD Commit Suicide More Often
Many studies have looked at the link between ADHD and suicide, and the consensus is that having ADHD significantly increases suicide risk. For instance, a 2013 study followed up on 5,718 adults from the same birth cohort found that those who’d been diagnosed with ADHD in childhood were almost 5 times as likely to be dead from suicide.
Along the same lines, a 2012 survey of 9,432 Finnish adolescents, again from a shared birth cohort, found that those with ADHD were 6 times as likely to experience suicidal ideation. The study also found that self-harm was more common among the ADHDers.
People With ADHD Are More Injury-Prone
ADHDers may be more prone to car accidents, but even when they aren’t behind the wheel they’re more likely to injure themselves in a variety of other ways. Previous research has shown that people with ADHD are more likely to hurt themselves in pretty much any situation you can think of, including walking across the street, riding bicycles or playing outdoors as children.
A survey of German children and teenagers who’d been prescribed stimulant medication for ADHD found that these ADHDers were more likely to be admitted to hospitals for accidental poisonings, head injuries and injuries of all kinds. And if these are the ones being treated with stimulants, it makes you wonder what’s going on with the ADHDers who aren’t being treated!
Of course, all these injuries cost money to take care of (you can’t even hurt yourself for free these days!), and a couple of studies have looked at the economic burden of being an accident-prone ADHDer. According to one review of the literature, ADHD children tend to have annual medical costs several hundred US dollars above those of non-ADHD children while adults with ADHD on average have medical costs several thousand dollars greater than those of their non-ADHD counterparts. Which brings us to…
People With ADHD Pay More, Earn Less
Having ADHD is expensive. ADHD is a luxury good. If you could sell your ADHD, you could probably use the extra money to get yourself a nice house, but you’re unlikely to find a willing buyer.
I’ve already mentioned that ADHDers spend more on medical care, but it turns out they also have to deal with all sorts of other added expenses like extra educational costs and higher rates of legal problems. A 2007 review looking at studies done on these different costs estimated that the average annual cost of illness for ADHD in children and teenagers is $15,000.
To add insult to injury (literally, in the case of higher medical costs), ADHDers tend to earn less than neurotypicals. A 2006 survey found that only 34% of ADHDers were employed full time, compared with 59% of non-ADHDers. Even when they had similar educational backgrounds and personal qualities, people with ADHD earned less than those without it. Overall, the study estimated that ADHD accounts for between $67 billion and $116 billion in lost wages in the United States workforce.
Of course, there’s a third aspect to all this that as far as I know hasn’t been thoroughly researched: if you have ADHD, you’re probably worse at managing money anyway. So I guess the silver lining is that you’ll have less money to mismanage?
Now, if you’ve read all the way to here, I just want to pause to say: (1) I hope you learned something and (2) I’m sorry for ruining your day. These facts don’t paint a pleasant picture of ADHD, but they represent a side of ADHD that needs to be acknowledged. To put it bluntly, if you meet diagnostic criteria for ADHD you are more likely to go to prison, get in a traffic collision, commit suicide, seriously injure yourself and experience economic hardship.
If that’s not real, I don’t know what is.