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The Prevalence and Effects of Adult Attention Deficit/Hyperactivity Disorder on Work Performance in a Nationally Representative Sample of Workers

Kessler, Ronald C. PhD; Adler, Lenard MD; Ames, Minnie PhD; Barkley, Russell A. PhD; Birnbaum, Howard PhD; Greenberg, Paul MA; Johnston, Joseph A. MD, MSc; Spencer, Thomas MD; Üstün, T Bedirhan MD

Journal of Occupational and Environmental Medicine: June 2005 - Volume 47 - Issue 6 - p 565-572
doi: 10.1097/01.jom.0000166863.33541.39
Original Articles

Objective: The prevalence and workplace consequences of adult attention deficit/hyperactivity disorder (ADHD) are unknown.

Methods: An ADHD screen was included in a national household survey (n = 3198, ages 18–44). Clinical reinterviews calibrated the screen to diagnoses of Diagnostic and Statistical Manual of Mental Disorders, 4th edition ADHD. Diagnoses among workers were compared with responses to the WHO Health and Work Performance Questionnaire (HPQ).

Results: A total of 4.2% of workers had ADHD. ADHD was associated with 35.0 days of annual lost work performance, with higher associations among blue collar (55.8 days) than professional (12.2 days), technical (19.8 days), or service (32.6 days) workers. These associations represent 120 million days of annual lost work in the U.S. labor force, equivalent to $19.5 billion lost human capital.

Conclusions: ADHD is a common and costly workplace condition. Effectiveness trials are needed to estimate the region of interest of workplace ADHD screening and treatment programs.

From the Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts (Drs Kessler, Ames); the Departments of Psychiatry and Neurology, New York University School of Medicine and Psychiatry Service, New York Harbor Veterans Administration Medical Center, New York, NY (Dr Adler); the University of Massachusetts Medical School, Boston, Massachusetts (Dr Barkley); the Analysis Group–Economics (Dr Birnbaum, Mr Greenberg); Eli Lilly and Company, US Health Outcomes (Dr Johnson); the Department of Psychiatry, Massachusetts General Hospital (Dr Spencer); and Classifications, World Health Organization (Dr Üstün).

Ronald C. Kessler received support for this research from Eli Lilly and Company.

Address correspondence to: Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115; E-mail:

©2005The American College of Occupational and Environmental Medicine