Adults with ADHD face higher health risks of a wide range of physical conditions. That includes nervous system, respiratory, musculo-skeletal, and metabolic diseases. These research findings come from a large register-based study from Sweden’s Karolinska Institute. It was published July 6, 2021 in The Lancet Psychiatry.
No, this isn’t the first evidence pointing to the very real physical risks of ADHD. That’s in terms of genetics and lifestyle issues. Yet, it does underscore the importance of viewing ADHD with more respect as a public health issue— not simply a subjective matter of “focus” or “attention.”
I’ll share more about the study, which included millions of Swedes, in a minute. And, I’ll share my 2005 exchange on this topic with the ever-prescient Russell Barkley, PhD, along with his comment on this Karolinska study.
But first, a little background.
Seems Obvious, Right?
The study findings have seemed obvious to me since the late 1990s. That’s when I first learned about ADHD and started leading discussion groups—both adults with ADHD and their partners (separate groups). Many hundreds of members.
With the “partners of” group, I’d sometimes ask about their ADHD partner’s physical health, including sleep disorders and diabetes. That’s because these issues sometimes came up in conversation, but only tangentially, as sources of additional worry. Until I suggested a potential connection, most had never thought to connect their spouse’s hypertension, asthma, or sleep disorder to ADHD. And neither did their ADHD partner’s physicians. Many still do not, and that is a problem.
As for the adult ADHD groups, certain health conditions came up sometimes—but only in the context of stimulant medication. That is, their physicians maintained their health conditions meant they could not take stimulant medication. An irony, to be sure, and also not always true.
By 2003: Question for NIMH Director Thomas Insel, MD
Thomas Insel, MDThomas Insel, then-director of the U.S. National Institutes of Mental Health, spoke at a 2003 ADHD conference I attended. After his talk, I asked him: “We know about the physical health issues associated with depression. Is anyone studying this with ADHD?”
He paused, very thoughtfully, and said, “No, but that’s a very good idea.”
During his tenure, Insel increased focus on studying the genetics of mental health. Currently, he serves as co-founder and president of a non-profit called Mindstrong Health. According to the website: “We’re a collective of socially-minded creatives, entrepreneurs, musicians, inventors, engineers, doctors, researchers, business leaders, policy wonks, and every-day problem solvers dedicated to building a more supportive world.”
2004-2006: ADHD Partner Survey Results
While creating the ADHD Partner Survey, I made sure to include a question on physical health to respondents: the partners of adults with ADHD.
The survey was the first and still only large-scale examination of adult ADHD through the eyes of a spouse or intimate partner. As with all my work over 20 years, it was self-funded. No pharmaceutical industry support of any kind. You can read more about it here: ADHD Partner Survey
Though not “scientific” (for example, no control group), the results made an impression on me. And, published research has since found similar results. I included other survey findings in my chapter in Dr. Barkley’s clinical guide, Counseling ADHD Couples.
2005: “Dear Dr. Barkley”
Russell Barkley, PhDMid-way through conducting the survey, I discovered Russell Barkley, PhD, a serious scientist who has devoted his career to ADHD. Back then, he was well known among other researchers and clinicians but definitely not consumers. In other words, he was not the YouTube Rockstar he is today.
I wrote to ask him about this topic. Excerpted:
I know about the increased risk of accidents and substance use. Beyond that, it seems that ADHD genetics and “lifestyle” increase vulnerability to various health issues, including hypertension, diabetes, obesity, sleep apnea, prostate cancer (and other cancers promoted by insulin resistance) — even Alzheimer’s.
Could we make a case for ADHD meriting treatment for reasons other than (or in addition to) the psychological/behavioral ones? Perhaps connecting physical maladies to ADHD might decrease resistance to the diagnosis and treatment—and prevent or at least improve treatment outcomes for chronic conditions such as diabetes, hypertension, obesity, etc.
Russel Barkley, PhD, Responds
In part:
I wrote in my 1998 handbook (first edition of Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment) and in my newsletter that ADHD may reduce life expectancy through its effects on health-related behaviors (increased smoking, drinking, less exercise, poor eating, etc.) which we have documented in follow-up studies along with the more well documented risk for accidental injuries…
My own follow-up study just completed has performed complete physicals and health histories on our ADHD children who are now young adults and will be looking at these issues in some detail. So, that is about the extent of what we know but it’s an intriguing area of research.
That follow-up study featured prominently in Barkley’s 2008 ADHD: What the Science Says. It came as a powerful correction to the prevailing ADHD as Gift media trope that was leading many people astray (consumers and clinicians). You’ll see Dr. Barkley’s comments on the Swedish study at the end of this post.
The Lancet Study
As promised, now for the recent study. You can read the full text at this link:
Three quick definitions might be helpful:
1. Phenotypic, or phenotype:
A phenotype is an individual’s observable traits, such as height, eye color, and blood type. The genetic contribution to the phenotype is called the genotype. (from the National Genome Research Institute, part of the U.S. National Institutes of Health)
2. Aetiological
Simply: causing or contributing to the development of a disease or condition
3. Register study
For several decades, participants in Sweden’s healthcare system (virtually the entire population, now about 10 million) have been registered in a central data bank. It includes all instances of patient care.
This is a comprehensive, longitudinal database. Among its other uses, it enormously expedites research complex health issues among millions of study subjects. You can read more here: Patient Register
Sweden’s Karolinska InstituteMethods:
The study’s chief investigator, Henrik Larsson, PhD, is a professor at Orebro University. From Dr. Larsson’s profile, we learn about the approach:
[The] team uses large ADHD cohorts identified from national health registers, the Swedish twin register and clinical cohorts. These datasets contain:
- Valid diagnoses of ADHD
- Prospective measures of environmental risks
- High throughput genotyping,
- Longitudinal information on prescribed ADHD medications and assessments of serious medical (psychiatric and somatic problems) and functional (social, educational and occupational) outcomes.
For this study, more than four million individuals (full-sibling and maternal half-sibling pairs) born between 1932-1995 were identified through Swedish registers and followed between 1973-2013.
Researchers examined the risk of 35 different physical conditions in individuals with ADHD compared to those without, and in siblings of individuals with ADHD compared to siblings of those without.
Major Findings
Individuals with ADHD had a statistically significant increased risk of all studied physical conditions except arthritis.
The strongest associations were:
- Alcohol-related liver disease
- Sleep disorders
- Chronic obstructive pulmonary disease (COPD)
- Epilepsy
- Fatty liver disease
- Obesity
To a lesser degree, ADHD was also linked to a higher risk of cardiovascular disease, Parkinson’s disease, and dementia.
“These results are important because stimulant therapy requires careful monitoring in ADHD patients with co-occurring cardiac disease, hypertension and liver failure,” Dr. Larsson said.
The team attributes the elevated risks largely to underlying genetic factors that contributed both to ADHD and the physical disease. Excepted: nervous system disorders and age-related diseases.
Worth noting: Full siblings of individuals with ADHD—even if they did not fully meet the ADHD diagnostic criteria— also had significantly increased risk for most physical conditions.
Barkley: ADHD Health Risks “A Fact in the Bag”
When I asked Dr. Barkley to comment on this study, he wrote:
The health consequences of ADHD are now a fact in the bag as is increased early mortality from accidents, suicide, and even homicide in adulthood not to mention my study that found reduced life expectancy
[For a quick summary on that study, subscribers to Barkley’s The ADHD Report can turn to the July 2020 issue.]
The Lancet study, which I obtained two days ago, just corroborates all this, particularly in adults with ADHD and using a population size sample, but most of its findings had already been found in earlier studies.
It’s nice to see all these risks in one place in one large study, though. And to see that many such shared risks with medical disorders seem to be due to shared genetic risk between ADHD genes and the genes predisposing to these conditions, though a few also had non shared environmental factors contributing as well (epilepsy, dementia, etc.).
As I now teach, ADHD is a public health disorder, not just a mental health disorder.
For other stories related to ADHD research:
ADHD, Balance, and Postural Sway
ADHD & Empathy: A Study, Book Excerpt, and Empathy Defined
Genetic-Testing for ADHD Medication
I welcome your questions and comments.
—Gina Pera
Is there any updates literature on this? I just came across this article and am blown away. My ADHD spouse has diabetes, high cholesterol, cardiovascular issues, sleep apnea, restless leg syndrome and was just diagnosed with fatty liver disease. He’s only 47. He’s had health issues as long as we’ve been together (17 years), and his relationship to food as comfort and alcohol as stress relief, not even a heart attack at the age of 38 can snap him out of his this unhealthy spiral. His ADHD is untreated and he ignores it. I’d really like to see some new information on this connection, if it exists.
Thank you
Hi Banders,
I’m confused. This landmark study is from July 2021, and there are many other supporting the findings. What do you anticipate has changed since then?
These facts won’t change. The evidence is only growing for the association between RLS, sleep apnea, etc. and ADHD. I’m incorporating the latest science in Course 2 of my online training.
https://adhdsuccesstraining.com/solving-your-adult-adhd-puzzle-for-couples-and-individuals/
But it sounds like many of your husband’s issues aren’t gene-specific to ADHD. They seem like the result of poorly managed ADHD in terms of eating, self-medicating with alcohol, etc..
To be clear, you don’t need new information. If you and your husband want to turn around his physical decline, you both need to get serious about managing his ADHD. I include you because often the partner is the one to spearhead this.
This essay, based on reading Chapter 12 in my first book, explains why.
https://adhdrollercoaster.org/adhd-and-relationships/chapter-12-solving-adhds-double-whammy/
Cheers,
Gina
There is a clear link between ADHD and diabetes and a strong link between ADHD and anxiety, going beyond that of behavior and genetics, those are biochemically intertwined and can lead to neurogenerative disease such as Alzheimer’s and dementia. Note Parkinson is a neurodegenerative disease linked to the role of dopamine in motor function.
Anxiety in people with ADHD makes them more likely to have chronic higher levels of cortisol, high levels of cortisol makes one more prone to have insulin disturbances and thus to diabetes. That is irrelevant of sugar intake – stress and chronic stress!
Insulin dysfunction in the brain is known to be involved in Alzheimer’s disease, as it impacts the ability for the brain to be well nourished using glucose. (Side note: that’s why ketogenic diet is showing some promise and why MCT oil may be beneficial to prevent and to protect the brain – bypassing the glucose mechanism.)
Thanks for your article!
Thanks, Lisane. Very important information!
Couldn’t have said it better myself.
My husband’s work recently included a genomics project on Alzheimer’s. I took the opportunity to say, “All this over-focus Alzheimer’s genes, amyloid plaque (sketchy premise, shown again and again), without one bit of focus on [exactly what you write here, Lisane]…..it’s a dead end for us but a boon for pharma.”
He sort of agrees. 🙂
g
Very thorough article that shows your foresight and ability to connect the the dots.
I am sure that folks with ADHD are also more likely to be affected by hyperoxaluria / oxalosis which cam affect several systems and show up as mineral deficiencies, tooth decay, pain, digestive symptoms, fatigue, urinary problems and classic kidney stones/ crystals. Hyperoxaluria is closely linked to hypothyroidism and to Hashimoto’s disease as oxalates have affinity with iodine receptors needed for proper thyroid function. The oxalosis/ hyperoxaluria and ADHD can also be closely connected to genetic variants or SNPs for methylation.
Hi again, Lisane,
Oh! Interesting!!
That term is new to me (hyperoxaluria / oxalosis). But I’ve heard what seems like a higher-than-average stories about these sequellae to wonder….is it lifestyle or metabolic?
For example:
Tooth decay — Some folks with ADHD don’t brush their teeth regularly. They forget, it’s boring, etc.. Some also “self-medicate” with sugary and starchy foods. Not to mention caffeinated sugar drinks.
Kidney stones — Those same sodas could, I thought, be the culprit behind the so-many kidney stones stories I hear. That, or magnesium deficiency.
But you have a “unifying theory” here.
Hashimoto’s — the only people I know diagnosed with this are women with late-diagnosis ADHD — and there are quite a few of them.
I explored oxalates years ago, when I was very ill and disabled from several repetitive-use injuries (busy news room), insomnia from the pain, and fibromyalgia.
One doctor prominent on fibro at that time had the oxalate theory. I tried following his protocol. Didn’t work for me, but it seemed to work for others.
I found my own way back to health. But at one point, my doctor did test me for iodine and found deficiency. I supplement occasionally still.
thank you! I’m glad you liked the article!
g
Thank you for sharing, Gina!! ❤️
Hi Anne Marie,
Thanks for reading! 🙂
g
Hmmm… As a gal with ADHD & Hashimoto’s Thyroiditis who’s on a thyroid med, it is not suprising then why my body likes an additional daily thyroid supplement.
Hi Jewelle,
I know so many women with ADHD and Hashimoto’s.
Sure wish someone clever would come up with a protocol. Or better explain what is viewed as Hashimoto’s — maybe the etiology is off.
g
Thanks Gina, Managing Hashi’s has been the same kind of scramble as getting to know ADHD, gain a kernel of insight here and there, very piece meal. I do think the curious researcher part of me has helped me to cobble together an approach that seems to be working.
Good for you. That’s the way to do it — pro-active!
If I weren’t pro-active years ago with a health condition, I’d still be bedridden and unable to type. 🙂
g
I just read your post and intend to read the full text later. Russell Barkley mentions reduced life expectancy, are there any statistics on natural life expectancy?
Hi Sara,
ADHD is a highly variable syndrome. So estimates of “natural life expectancy” would be hard to come by.
I suspect that, for research such as Barkley’s, they measure average ADHD life expectancy versus the general population.
But there are differences among the groups studied. For example, some of Barkley’s study subjects were diagnosed with ADHD in childhood. At that time, those tended to be the more severe cases.
It’s a very tricky thing to study, as despite what we see plastered all over the Internet, there is no “ADHD brain” or “ADHD gene”. There is only variable manifestations of a highly variable syndrome — with all the rest of a person’s makeup to consider.
g
I don’t know why the word “Thyroid” does not appear in this article. Adequate Thyroid Hormone supplementation is a known remedy for most of the ailments cited. But I don’t mean in an amount that corrects your TSH number. The amount required is much much more. So what if people with ADHD were also chemically resistant to thyroid hormone? Which is a thing called “Thyroid Hormone Resistance”. Since ADHD is a brain chemical imbalance or difference, maybe it also plays a role in thyroid hormone uptake. Someone with much more scientific expertise than me should be considering that.
Hi Lynn,
Yes, it seems pretty obvious to me. If the “chemical messages” — from brain to body and back — aren’t flowing smoothly, all kinds of physiological processes can be affected. That includes the signals to manufacture and regulate hormones. Including thyroid hormones. But this kind of cross-disciplinary sophistication isn’t very common in medicine these days, where so many “specialists” apply a tunnel-vision focus to their specialty.
In fact, I mention this in a lesson of my new online training: https://adhdsuccesstraining.com/adult-adhd-solving-the-four-essential-puzzle-pieces-consumers/
But did you read the full paper? I linked to it in the post.
Excerpt:
Endocrine or metabolic
Type 1 diabetes 80 741 (1·69%)
Type 2 diabetes 154 209 (3·22%)
Thyroid disorders 149 861 (3·13%)
Obesity 113 768 (2·38%)
Gout 20 686 (0·43%)
g
Wow…such good information! I was though trying to scan the article for skeletal-muscular conditions and couldn’t find it. Besides weight gain that is the one area that I am interested in.
Hi Joellen,
Did you read the full text of the paper? Here is an excerpt:
Musculoskeletal
Rheumatoid arthritis 42 985 (0·90%)
Arthrosis 322 417 (6·73%)
Connective tissue disease 68 865 (1·44%)
Dorsalgia (back pain) 298 076 (6·22%)
g