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

Published online by Cambridge University Press:  21 April 2008

R. C. Kessler ,
M. Lane ,
P. E. Stang  and
D. L. Van Brunt
R. C. Kessler*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
M. Lane
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
P. E. Stang
Affiliation:
Institute for Primary Care Research, Blue Bell, PA, USA
D. L. Van Brunt
Affiliation:
Eli Lilly and Company, Indianapolis, IN, USA
*
*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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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.

Keywords

ADHDadult ADHDcosts of illnessepidemiologyproductivityHealth and Work Performance Questionnaire (HPQ)workplace costs of illness
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 1 , January 2009 , pp. 137 - 147
Copyright
Copyright © 2008 Cambridge University Press

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References

Able, SL, Johnston, JA, Adler, LA, Swindle, RW (2007). Functional and psychosocial impairment in adults with undiagnosed ADHD. Psychological Medicine 37, 97–107.CrossRefGoogle ScholarPubMed
Adler, L, Spencer, T (2004). The Adult ADHD Clinical Diagnostic Scale (ACDS) v 1.2. New York University School of Medicine: New York, NY.Google Scholar
Adler, LA, Spencer, TJ, Levine, LR, Ramsey, JL, Tamura, R, Kelsey, D, Ball, SG, Allen, AJ, Biederman, J (2007). Functional outcomes in the treatment of adults with ADHD. Journal of Attention Disorders. Published online: 19 November 2007. doi: 10.1177/1087054707308503.Google ScholarPubMed
Baker, M, Stabile, M, Deri, C (2001). What do self-reported, objective measures of health measure? NBER Working Paper 8419. National Bureau of Economic Research: Cambridge, MA.CrossRefGoogle Scholar
Barkley, RA (1995). ADHD behavior checklist for adults. ADHD Report 3, 6–7.Google Scholar
Barkley, RA, Cox, D (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, 113–128.CrossRefGoogle ScholarPubMed
Barkley, RA, Murphy, KR, O'Connell, T, Connor, DF (2005). Effects of two doses of methylphenidate on simulator driving performance in adults with attention deficit hyperactivity disorder. Journal of Safety Research 36, 121–131.CrossRefGoogle ScholarPubMed
Biederman, J, Faraone, SV, Spencer, TJ, Mick, E, Monuteaux, MC, Aleardi, M (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, 524–540.CrossRefGoogle ScholarPubMed
Buntin, MB, Zaslavsky, AM (2004). Too much ado about two-part models and transformation? Comparing methods of modeling Medicare expenditures. Journal of Health Economics 23, 525–542.CrossRefGoogle ScholarPubMed
DeQuiros, GB, Kinsbourne, M (2001). Adult ADHD: analysis of self-ratings in a behavior questionnaire. Annals of the New York Academy of Sciences 931, 140–147.CrossRefGoogle Scholar
Dobson, AJ (2001). Introduction to Generalized Linear Models, 2nd edn. Chapman and Hall: London.Google Scholar
Druss, BG, Marcus, SC, Olfson, M, Tanielian, T, Elinson, L, Pincus, HA (2001). Comparing the national economic burden of five chronic conditions. Health Affairs (Millwood) 20, 233–241.CrossRefGoogle ScholarPubMed
Edwards, WS, Winn, DM, Kurlantzick, V, Sheridan, S, Berk, ML, Retchin, S, Collins, JG (1994). Evaluation of National Health Interview Survey Diagnostic Reporting. National Center for Health Statistics. Vital and Health Statistics 2 120, 1–116.Google Scholar
Fischer, M, Barkley, RA, Smallish, L, Fletcher, K (2007). Hyperactive children as young adults: driving abilities, safe driving behavior, and adverse driving outcomes. Accident Analysis and Prevention 39, 94–105.CrossRefGoogle ScholarPubMed
Gittelman, R, Mannuzza, S (1985). Diagnosing ADD-H in adolescents. Psychopharmacology Bulletin 21, 237–242.Google ScholarPubMed
Hervey, AS, Epstein, JN, Curry, JF (2004). Neuropsychology of adults with attention-deficit/hyperactivity disorder: a meta-analytic review. Neuropsychology 18, 485–503.CrossRefGoogle ScholarPubMed
Hosmer, DW, Lemeshow, S (2001). Applied Logistic Regression, 2nd edn. Wiley & Son: New York, NY.Google Scholar
Jenkins, P, Earle-Richardson, G, Slingerland, DT, May, J (2002). Time dependent memory decay. American Journal of Industrial Medicine 41, 98–101.CrossRefGoogle ScholarPubMed
Jensen, PS, Rubio-Stipec, M, Canino, G, Bird, HR, Dulcan, MK, Schwab-Stone, ME, Lahey, BB (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, 1569–1579.CrossRefGoogle ScholarPubMed
Kessler, RC, Adler, L, Ames, M, Barkley, RA, Birnbaum, H, Greenberg, P, Johnston, JA, Spencer, T, Ustun, TB (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, 565–572.CrossRefGoogle Scholar
Kessler, RC, Adler, L, Ames, M, Demler, O, Faraone, S, Hiripi, E, Howes, MJ, Jin, R, Secnik, K, Spencer, T, Ustun, TB, Walters, EE (2005 b). The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological Medicine 35, 245–256.CrossRefGoogle Scholar
Kessler, RC, Adler, L, Barkley, R, Biederman, J, Conners, CK, Demler, O, Faraone, SV, Greenhill, LL, Howes, MJ, Secnik, K, Spencer, T, Ustun, TB, Walters, EE, Zaslavsky, AM (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, 716–723.CrossRefGoogle ScholarPubMed
Kessler, RC, Adler, LA, Gruber, MJ, Sarawate, CA, Spencer, T, Van Brunt, DL (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, 52–65.CrossRefGoogle Scholar
Kessler, RC, Akiskal, HS, Ames, M, Birnbaum, H, Greenberg, P, Hirschfeld, RM, Jin, R, Merikangas, KR, Simon, GE, Wang, PS (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, 1561–1568.CrossRefGoogle Scholar
Kessler, RC, Ames, M, Hymel, PA, Loeppke, R, McKenas, DK, Richling, DE, Stang, PE, Ustun, TB (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, S23–37.CrossRefGoogle ScholarPubMed
Kessler, RC, Barber, C, Beck, A, Berglund, P, Cleary, PD, McKenas, D, Pronk, N, Simon, G, Stang, P, Ustun, TB, Wang, P (2003). The World Health Organization Health and Work Performance Questionnaire (HPQ). Journal of Occupational and Environmental Medicine 45, 156–174.CrossRefGoogle ScholarPubMed
Kessler, RC, Greenberg, PE, Mickelson, KD, Meneades, LM, Wang, PS (2001). The effects of chronic medical conditions on work loss and work cutback. Journal of Occupational and Environmental Medicine 43, 218–225.CrossRefGoogle ScholarPubMed
Kessler, RC, Haro, JM, Heeringa, SG, Pennell, BE, Ustun, TB (2006 c). The World Health Organization World Mental Health Survey Initiative. Epidemiologia e Psichiatria Sociale 15, 161–166.CrossRefGoogle ScholarPubMed
Kessler, RC, Richling, DE, Sullivan, S (2004 b). Rationalizing employer health care spending by measuring workplace value. Health and Productivity Management 3, 4–8.Google Scholar
Knight, M, Stewart-Brown, S, Fletcher, L (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, 179–186.CrossRefGoogle ScholarPubMed
Kooij, JJ, Buitelaar, JK, van den Oord, EJ, Furer, JW, Rijnders, CA, Hodiamont, PP (2005). Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychological Medicine 35, 817–827.CrossRefGoogle Scholar
Landen, DD, Hendricks, S (1995). Effect of recall on reporting of at-work injuries. Public Health Reports 110, 350–354.Google ScholarPubMed
Mannuzza, S, Klein, RG, Bessler, A, Malloy, P, LaPadula, M (1998). Adult psychiatric status of hyperactive boys grown up. American Journal of Psychiatry 155, 493–498.CrossRefGoogle ScholarPubMed
McGough, JJ, Barkley, RA (2004). Diagnostic controversies in adult attention deficit hyperactivity disorder. American Journal of Psychiatry 161, 1948–1956.CrossRefGoogle ScholarPubMed
Moran, JL, Solomon, PJ, Peisach, AR, Martin, J (2007). New models for old questions: generalized linear models for cost prediction. Journal of Evaluation in Clinical Practice 13, 381–389.CrossRefGoogle ScholarPubMed
National Center for Health Statistics (2005). Health, United States 2004. U.S. Department of Health and Human Services: Hyattsville, MD.Google Scholar
Ratey, J, Greenberg, S, Bemporad, JR, Lindem, K (1992). Unrecognized attention-deficit hyperactivity disorder in adults presenting for outpatient psychotherapy. Journal of Child and Adolescent Psychopharmacology 4, 267–275.CrossRefGoogle Scholar
Reimer, B, D'Ambrosio, LA, Coughlin, JF, Fried, R, Biederman, J (2007). Task-induced fatigue and collisions in adult drivers with attention deficit hyperactivity disorder. Traffic Injury Prevention 8, 290–299.CrossRefGoogle ScholarPubMed
Reville, RT, Bhattacharya, J, Sager Weinstein, LR (2001). New methods and data sources for measuring economic consequences of workplace injuries. American Journal of Industrial Medicine 40, 452–463.CrossRefGoogle ScholarPubMed
Rubin, DB (1987). Multiple Imputation for Nonresponse in Surveys. John Wiley & Sons: New York, NY.CrossRefGoogle Scholar
Schafer, JL (1999). Multiple imputation: a primer. Statistical Methods in Medical Research 8, 3–15.CrossRefGoogle ScholarPubMed
Schoenborn, CA, Adams, PF, Schiller, JS (2003). Summary health statistics for the U.S. population: National Health Interview Survey, 2000. Vital and Health Statistics 10, 1–83.Google Scholar
Schweitzer, JB, Lee, DO, Hanford, RB, Zink, CF, Ely, TD, Tagamets, MA, Hoffman, JM, Grafton, ST, Kilts, CD (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, 597–606.CrossRefGoogle Scholar
Simpson, D, Plosker, GL (2004). Spotlight on atomoxetine in adults with attention-deficit hyperactivity disorder. CNS Drugs 18, 397–401.CrossRefGoogle ScholarPubMed
Swensen, A, Birnbaum, HG, Ben Hamadi, R, Greenberg, P, Cremieux, PY, Secnik, K (2004). Incidence and costs of accidents among attention-deficit/hyperactivity disorder patients. Journal of Adolescent Health 35, 346–347.CrossRefGoogle ScholarPubMed
Turner, DC, Clark, L, Dowson, J, Robbins, TW, Sahakian, BJ (2004). Modafinil improves cognition and response inhibition in adult attention-deficit/hyperactivity disorder. Biological Psychiatry 55, 1031–1040.CrossRefGoogle ScholarPubMed
Wang, PS, Beck, A, Berglund, P, Leutzinger, JA, Pronk, N, Richling, D, Schenk, TW, Simon, G, Stang, P, Ustun, TB, Kessler, RC (2003). Chronic medical conditions and work performance in the health and work performance questionnaire calibration surveys. Journal of Occupational and Environmental Medicine 45, 1303–1311.CrossRefGoogle ScholarPubMed
Wang, PS, Beck, AL, McKenas, DK, Meneades, LM, Pronk, NP, Saylor, JS, Simon, GE, Walters, EE, Kessler, RC (2002). Effects of efforts to increase response rates on a workplace chronic condition screening survey. Medical Care 40, 752–760.CrossRefGoogle ScholarPubMed
Wang, PS, Simon, GE, Avorn, J, Azocar, F, Ludman, EJ, McCulloch, J, Petukhova, MZ, Kessler, RC (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, 1401–1411.CrossRefGoogle ScholarPubMed
Weil, D (2001). Valuing the economic consequences of work injury and illness: a comparison of methods and findings. American Journal of Industrial Medicine 40, 418–437.CrossRefGoogle ScholarPubMed
Weiss, G, Hechtman, L (1993). Hyperactive Children Grown Up: ADHD in Children, Adolescents, and Adults. Guilford Press: New York, NY.Google Scholar
Wender, PH, Wolf, LE, Wasserstein, J (2001). Adults with ADHD. An overview. Annals of the New York Academy of Sciences 931, 1–16.CrossRefGoogle ScholarPubMed
Wolter, KM (1985). Introduction to Variance Estimation. Springer-Verlag: New York, NY.Google Scholar
Zaloshnja, E, Miller, TR, Waehrer, G (2006). The impact of occupational injury reduction on the U.S. economy. American Journal of Industrial Medicine 49, 719–727.CrossRefGoogle ScholarPubMed
Zucker, M, Morris, MK, Ingram, SM, Morris, RD, Bakeman, R (2002). Concordance of self- and informant ratings of adults' current and childhood attention-deficit/hyperactivity disorder symptoms. Psychological Assessment 14, 379–389.CrossRefGoogle ScholarPubMed