Childhood attention deficit hyperactivity disorder traits, societal exclusion and midlife psychological distress

Most research on attention deficit hyperactivity disorder (ADHD) focuses on childhood or early adulthood. Less is known about the impact of childhood ADHD traits across the lifespan. This study aims to test (1) whether childhood ADHD traits are associated with trajectories of psychological distress across adulthood up to midlife, and (2) the role of societal exclusion in the relationship between ADHD traits and midlife distress. Data were from the 1970 British Cohort Study (N = 17,196 at birth), a prospective longitudinal cohort. ADHD traits were measured at age 10 using a validated 14-item measure. Psychological distress was assessed at 5 time points (26-46) using the Malaise Inventory Scale. Measures of 5 domains of societal exclusion (health, relational, political, economic and services) were available at age 34. Higher childhood ADHD traits were associated with higher distress across adulthood and being in higher distress trajectories. The predicted probability of having clinically relevant distress in midlife was about 27% for people who had high childhood ADHD traits (5.05%), compared with 18% for those who did not have high ADHD traits, adjusting for sex, ethnicity and childhood social class. Societal exclusion acted as an indirect pathway in the association between ADHD traits and midlife psychological distress through health, relational, economic and services exclusion, but not political exclusion. People with higher childhood ADHD traits are more likely to experience psychological distress in adulthood, which was partly explained by societal exclusion. Exclusion experienced by people with ADHD may be a determinant of long-term adverse mental health outcomes. Addressing structural and relational barriers across the life course is an important step toward promoting well-being for people with ADHD.