Abstract / Summary
Abstract Background Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder associated with adverse outcomes across multiple domains of life, including education, socioeconomic status, healthcare utilization, and broader societal outcomes. This study aimed to describe and quantify these outcomes among individuals with newly identified ADHD in Finland compared with matched controls without recorded ADHD. Methods A nationwide retrospective matched cohort study based on Finnish administrative register data. Individuals of all ages with newly identified ADHD during 2015–2020 were matched with up to four controls without recorded ADHD by age, sex and region. All participants were followed from the index date until death, emigration, or 31 December 2021, with a mean follow-up of 3.5 years. Outcomes included academic performance, educational attainment, employment status, social benefits, marital status, criminal convictions, healthcare resource utilization, and associated direct and indirect costs. The study was observational and was not designed to assess the causal effects of ADHD diagnosis or treatment on subsequent outcomes. Results The study population comprised 64,752 individuals with newly identified ADHD and 256,270 matched controls. Individuals with ADHD had poorer academic performance and lower educational attainment than controls. Long-term unemployment was more common among individuals with ADHD than controls (females: 15.3% vs. 8.2%; males: 20.5% vs. 10.7%). Imprisonment was recorded more frequently among individuals with ADHD, particularly males (5.1% vs. 1.1% in controls). Healthcare resource utilization among individuals with ADHD was consistently greater across all age groups, with the largest differences observed in psychiatric secondary care. Among adults, annual direct healthcare costs were €4,290 vs. €1,795 for females with ADHD and controls, respectively, and €3,641 vs. €1,082 for males. Annual earned income was €7,031 lower among females and €10,745 lower among males with ADHD, while annual social transfer payments were €2,806 and €2,695 higher, respectively. Conclusions Individuals with newly identified ADHD had poorer educational and socioeconomic outcomes, greater healthcare resource utilization, and higher societal costs than matched controls without recorded ADHD. These findings demonstrate that the burden associated with ADHD extends beyond healthcare to multiple sectors of society.