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The prevalence and workplace costs of adult attention deficit hyperactivity disorder in a large manufacturing firm

  • R. C. Kessler (a1), M. Lane (a1), P. E. Stang (a2) and D. L. Van Brunt (a3)
Abstract
Background

Little is known about the effects of adult attention deficit hyperactivity disorder (ADHD) on work performance or accidents-injuries.

Method

A survey was administered in 2005 and 2006 to employees of a large manufacturing firm to assess the prevalence and correlates of adult ADHD. Respondents (4140 in 2005, 4423 in 2006, including 2656 in both surveys) represented 35–38% of the workforce. ADHD was assessed with the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS), a validated screening scale for DSM-IV adult ADHD. Sickness absence, work performance and workplace accidents-injuries were assessed with the WHO Health and Work Performance Questionnaire (HPQ).

Results

The estimated current prevalence (standard error) of DSM-IV ADHD was 1.9% (0.4). ADHD was associated with a 4–5% reduction in work performance (χ12=9.1, p=0.001), a 2.1 relative-odds of sickness absence (χ12=6.2, p=0.013), and a 2.0 relative-odds of workplace accidents-injuries (χ12=5.1, p=0.024). The human capital value (standard error) of the lost work performance associated with ADHD totaled US$4336 (676) per worker with ADHD in the year before interview. No data were available to monetize other workplace costs of accidents-injuries (e.g. destruction of equipment). Only a small minority of workers with ADHD were in treatment.

Conclusions

Adult ADHD is a significantly impairing condition among workers. Given the low rate of treatment and high human capital costs, in conjunction with evidence from controlled trials that treatment can reduce ADHD-related impairments, ADHD would seem to be a good candidate for workplace trials that evaluate treatment cost-effectiveness from the employer's perspective.

Copyright
Corresponding author
*Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. (Email: kessler@hcp.med.harvard.edu)
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LA Adler , TJ Spencer , LR Levine , JL Ramsey , R Tamura , D Kelsey , SG Ball , AJ Allen , J Biederman (2007). Functional outcomes in the treatment of adults with ADHD. Journal of Attention Disorders. Published online: 19 November 2007. doi: 10.1177/1087054707308503.

RA Barkley , D Cox (2007). A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance. Journal of Safety Research 38, 113128.

RA Barkley , KR Murphy , T O'Connell , DF Connor (2005). Effects of two doses of methylphenidate on simulator driving performance in adults with attention deficit hyperactivity disorder. Journal of Safety Research 36, 121131.

J Biederman , SV Faraone , TJ Spencer , E Mick , MC Monuteaux , M Aleardi (2006). Functional impairments in adults with self-reports of diagnosed ADHD: a controlled study of 1001 adults in the community. Journal of Clinical Psychiatry 67, 524540.

MB Buntin , AM Zaslavsky (2004). Too much ado about two-part models and transformation? Comparing methods of modeling Medicare expenditures. Journal of Health Economics 23, 525542.

AJ Dobson (2001). Introduction to Generalized Linear Models, 2nd edn. Chapman and Hall: London.

BG Druss , SC Marcus , M Olfson , T Tanielian , L Elinson , HA Pincus (2001). Comparing the national economic burden of five chronic conditions. Health Affairs (Millwood) 20, 233241.

M Fischer , RA Barkley , L Smallish , K Fletcher (2007). Hyperactive children as young adults: driving abilities, safe driving behavior, and adverse driving outcomes. Accident Analysis and Prevention 39, 94105.

AS Hervey , JN Epstein , JF Curry (2004). Neuropsychology of adults with attention-deficit/hyperactivity disorder: a meta-analytic review. Neuropsychology 18, 485503.

P Jenkins , G Earle-Richardson , DT Slingerland , J May (2002). Time dependent memory decay. American Journal of Industrial Medicine 41, 98101.

PS Jensen , M Rubio-Stipec , G Canino , HR Bird , MK Dulcan , ME Schwab-Stone , BB Lahey (1999). Parent and child contributions to diagnosis of mental disorder: are both informants always necessary? Journal of the American Academy of Child and Adolescent Psychiatry 38, 15691579.

RC Kessler , L Adler , M Ames , RA Barkley , H Birnbaum , P Greenberg , JA Johnston , T Spencer , TB Ustun (2005 a). The prevalence and effects of adult attention deficit/hyperactivity disorder on work performance in a nationally representative sample of workers. Journal of Occupational and Environmental Medicine 47, 565572.

RC Kessler , L Adler , R Barkley , J Biederman , CK Conners , O Demler , SV Faraone , LL Greenhill , MJ Howes , K Secnik , T Spencer , TB Ustun , EE Walters , AM Zaslavsky (2006 a). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry 163, 716723.

RC Kessler , LA Adler , MJ Gruber , CA Sarawate , T Spencer , DL Van Brunt (2007). Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) screener in a representative sample of health plan members. International Journal of Methods in Psychiatric Research 16, 5265.

RC Kessler , HS Akiskal , M Ames , H Birnbaum , P Greenberg , RM Hirschfeld , R Jin , KR Merikangas , GE Simon , PS Wang (2006 b). Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers. American Journal of Psychiatry 163, 15611568.

RC Kessler , M Ames , PA Hymel , R Loeppke , DK McKenas , DE Richling , PE Stang , TB Ustun (2004 a). Using the World Health Organization Health and Work Performance Questionnaire (HPQ) to evaluate the indirect workplace costs of illness. Journal of Occupational and Environmental Medicine 46, S2337.

RC Kessler , C Barber , A Beck , P Berglund , PD Cleary , D McKenas , N Pronk , G Simon , P Stang , TB Ustun , P Wang (2003). The World Health Organization Health and Work Performance Questionnaire (HPQ). Journal of Occupational and Environmental Medicine 45, 156174.

RC Kessler , PE Greenberg , KD Mickelson , LM Meneades , PS Wang (2001). The effects of chronic medical conditions on work loss and work cutback. Journal of Occupational and Environmental Medicine 43, 218225.

M Knight , S Stewart-Brown , L Fletcher (2001). Estimating health needs: the impact of a checklist of conditions and quality of life measurement on health information derived from community surveys. Journal of Public Health Medicine 23, 179186.

S Mannuzza , RG Klein , A Bessler , P Malloy , M LaPadula (1998). Adult psychiatric status of hyperactive boys grown up. American Journal of Psychiatry 155, 493498.

JJ McGough , RA Barkley (2004). Diagnostic controversies in adult attention deficit hyperactivity disorder. American Journal of Psychiatry 161, 19481956.

JL Moran , PJ Solomon , AR Peisach , J Martin (2007). New models for old questions: generalized linear models for cost prediction. Journal of Evaluation in Clinical Practice 13, 381389.

B Reimer , LA D'Ambrosio , JF Coughlin , R Fried , J Biederman (2007). Task-induced fatigue and collisions in adult drivers with attention deficit hyperactivity disorder. Traffic Injury Prevention 8, 290299.

RT Reville , J Bhattacharya , LR Sager Weinstein (2001). New methods and data sources for measuring economic consequences of workplace injuries. American Journal of Industrial Medicine 40, 452463.

DB Rubin (1987). Multiple Imputation for Nonresponse in Surveys. John Wiley & Sons: New York, NY.

JL Schafer (1999). Multiple imputation: a primer. Statistical Methods in Medical Research 8, 315.

JB Schweitzer , DO Lee , RB Hanford , CF Zink , TD Ely , MA Tagamets , JM Hoffman , ST Grafton , CD Kilts (2004). Effect of methylphenidate on executive functioning in adults with attention-deficit/hyperactivity disorder: normalization of behavior but not related brain activity. Biological Psychiatry 56, 597606.

D Simpson , GL Plosker (2004). Spotlight on atomoxetine in adults with attention-deficit hyperactivity disorder. CNS Drugs 18, 397401.

A Swensen , HG Birnbaum , R Ben Hamadi , P Greenberg , PY Cremieux , K Secnik (2004). Incidence and costs of accidents among attention-deficit/hyperactivity disorder patients. Journal of Adolescent Health 35, 346347.

DC Turner , L Clark , J Dowson , TW Robbins , BJ Sahakian (2004). Modafinil improves cognition and response inhibition in adult attention-deficit/hyperactivity disorder. Biological Psychiatry 55, 10311040.

PS Wang , A Beck , P Berglund , JA Leutzinger , N Pronk , D Richling , TW Schenk , G Simon , P Stang , TB Ustun , RC Kessler (2003). Chronic medical conditions and work performance in the health and work performance questionnaire calibration surveys. Journal of Occupational and Environmental Medicine 45, 13031311.

PS Wang , AL Beck , DK McKenas , LM Meneades , NP Pronk , JS Saylor , GE Simon , EE Walters , RC Kessler (2002). Effects of efforts to increase response rates on a workplace chronic condition screening survey. Medical Care 40, 752760.

PS Wang , GE Simon , J Avorn , F Azocar , EJ Ludman , J McCulloch , MZ Petukhova , RC Kessler (2007). Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial. Journal of the American Medical Association 298, 14011411.

D Weil (2001). Valuing the economic consequences of work injury and illness: a comparison of methods and findings. American Journal of Industrial Medicine 40, 418437.

PH Wender , LE Wolf , J Wasserstein (2001). Adults with ADHD. An overview. Annals of the New York Academy of Sciences 931, 116.

E Zaloshnja , TR Miller , G Waehrer (2006). The impact of occupational injury reduction on the U.S. economy. American Journal of Industrial Medicine 49, 719727.

M Zucker , MK Morris , SM Ingram , RD Morris , R Bakeman (2002). Concordance of self- and informant ratings of adults' current and childhood attention-deficit/hyperactivity disorder symptoms. Psychological Assessment 14, 379389.

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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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