• ADHD is really bad for future earnings and employment

    Feeling somewhat overwhelmed by the pile of papers and other things I want to get to, I admit I will not read all of the recent paper by Jason Fletcher on labor market outcomes for people diagnosed with ADHD as kids. But it does look interesting. So, if you read it, let me know what you think. Here’s the abstract:

    Although several types of mental illness, including substance abuse disorders, have been linked with poor labor market outcomes, no current research has been able to examine the effects of childhood attention deficit/hyperactivity disorder (ADHD). Because ADHD has become one of the most prevalent childhood mental conditions, it is useful to understand the full set of consequences of the illness. This article uses a longitudinal national sample, including sibling pairs, to show the important labor market outcome consequences of ADHD. The employment reduction is between 10 and 14 percentage points, the earnings reduction is approximately 33%, and the increase in social assistance is 15 points, figures that are larger than many estimates of the Black people/White people earnings gap and the gender earnings gap. A small share of the link is explained by educational attainments and co-morbid health conditions and behaviors. The results also show important differences in labor market consequences by family background and age of onset. These findings, along with similar research showing that ADHD is linked with poor education outcomes and adult crime, suggest the importance of treating childhood ADHD to foster human capital.

    Needless to say, these are huge effects. It makes me wonder whether, to the extent it is over-diagnosed, ADHD is serving as a proxy for characteristics predictive of poor labor market outcomes. That is, Johnny is looking like he’s not succeeding in school (itself suggesting reduced earnings and employment potential), but maybe an ADHD diagnosis and the associated meds will help him. But maybe they actually don’t help much. Alternatively, maybe there is a self-fulfilling stigma to the diagnosis. Of course the straight-forward interpretation that ADHD is legitimately bad for your future is perfectly fine. It could also be all these things!

    Again, I haven’t read much of the paper. Maybe some of this speculation is addressed therein. Maybe the author will write me and set me straight. Maybe I should go to bed. That’s the best idea of them all. Good night!


    • It’s an excellent study as far as controls go. Besides the sibling cohort stuff, there are also controls for school district, maternal education, parental earnings, race, co-morbid conditions etc etc and even “unobserved effects”.

      The author’s conclusion is actually that since the study didn’t ask about interventions, it’s reasonable to believe that if there are effective interventions that ‘solve’ the issues of ADD, this could be reducing the differentials in outcomes and they could actually be on the low end. Also, since he finds much worse outcomes for kids with an early diagnosis (before age 12), he suggests that early interventions could be particularly effective.

      He doesn’t include any non-statistical speculation about whether any of the existing interventions are effective, as far as I can tell.

    • Most non-psychiatric disease also has objective clinical signs (fever, swelling, tumor visible on x-ray).

      Mental illness is diagnosed with a subjectively based on what the patient says or what others say about the patient and his behavior. Having filled out questionnaires to diagnose my kids with ADD or Autism, I was struck by the questions. Does my kid become distracted never, rarely, occasionally, frequently or very frequently? Appear fidgety when asked to sit still, never, rarely, occasionally, frequently or very frequently?

      My kid might be diagnosed with a disease and given medication based on whether I know the difference between occasionally and rarely? I was certainly aware of this fact when filling it out — and what outcome I thought was right. I suspect the teacher thought if he gets a diagnosis, he gets a pill and her problem (no ability to control her class) goes away.

      Apparently, you need symptoms in two settings for a diagnosis, home and school and he didn’t have symptoms at home (as reported by me) and did at school (as reported by the teacher).

      The next year, he had a teacher with excellent classroom management skills and was considered a typical boy, which is how every other teacher since has seen him.

      I’m sure the problem is behaviors that lead to low future income also lead to disease diagnosis and a self-fulfilling diagnosis. A friend who with a son much like mine went the different route. His fidgety boy was diagnosed with Autism and marooned in special ed classes, with an IQ substantially above 100.

    • As an adult with ADD, and no childhood diagnosis (though the symptoms were obvious in retrospect), I can vouch that it makes employability more difficult.

      There are a few careers where it’s an asset, like tech support. (Trouble focusing? Just wait 3 minutes and a new crisis will appear.)

      Comorbid depression probably did more damage to my career; I solved that problem by changing jobs, where nobody knows what I was like before discovering Effexor XR(R).

      In conclusion, SQUIRREL!

    • Unfortunately I don’t have time to read the whole study right now, but does it control for medicated vs. unmedicated individuals, or individuals who only began seeking treatment as adults vs. children and teens?

    • There’s nothing about treatment, only diagnosis.

    • Interesting that everyone’s too busy to actually read the study. Too busy or too distracted? Hmm…. That doesn’t bode well for your future income…

    • If @subdee is correct and there is no discussion of treatment, then I’m a bit suspicious of these results. Treatment for ADD/ADHD for children — until the past 5-7 years — has been primarily stimulant medication, e.g. Adderall, Ritalin, various mixtures of amphetamine salts. The NYT has been producing more stories about the untold consequences of these drugs — addiction, amphetamine psychosis, depression, even suicide, cardiac events. Measuring ADHD diagnosis as a predictive factor for future employment/employability seems insufficient, particularly when many of these subjects have been given prescription speed, which in many cases compounds the underlying problems instead of fixes them.