TODAY, THERE ARE nearly 100,000 – 150,000 adults in Ireland with ADHD. Research undertaken very recently by UCD, the HSE and ADHD Ireland has shown that 20% of these have attempted to take their own lives in the past.
Why is that so?
This research, funded by the NOSP (National Office of Suicide Prevention), has also shown that 50% had self-harmed and 10% considered suicide an option going forward.
While these are shocking figures, they unfortunately are in line with international comparisons. Part of this is driven by having ADHD itself, which can include impulsivity and the likelihood of co-existing mental health conditions and substance misuse, as shown by the work of Furczyk and Thome, 2014.
Social pressures
But the biggest challenge with ADHD is not the condition itself but rather societal attitudes to the condition and the stigma and low self-esteem this can create.
Research shows that children up to the age of 12 receive 20,000 negative pieces of stimulus, like ‘Put that down’, ‘Stay still’, ‘Why can you do anything I tell you?’. Imagine if this was happening to your child all the time. Imagine how this stayed with them throughout their lives.
In looking at other research regarding adolescents and young adults, a paper published in the highly regarded and authoritative British Journal of Psychiatry concluded: “The results of this longitudinal cohort study revealed that ADHD was an independent and direct risk factor for any suicide attempt and an even stronger risk factor for repeated suicide attempts.”
It also clearly demonstrated “that people who attempted suicide exhibited less premeditation (a diminished ability to think through the consequences of actions) than did other people with suicidal ideation”, and that “the independent effect of ADHD in suicide attempts may be explained by impulsivity, a primary symptom of ADHD.”
Quite simply, what all of this means is that people with ADHD because of their condition may not think about suicide, but through their impulsivity may be the ones that unfortunately go on to complete it.
Adults with ADHD are also known to have an increased risk of unemployment, marital breakdown, car crashes, unplanned pregnancies, hospital visits (for accidents and the like) and lower life expectancy, according to studies.
ADHD assessments
Added to this, in Ireland today, it is nearly impossible to get an ADHD assessment and the full range of treatment required, either through the public or private system. Minister for Mental Health Mary Butler recently announced that three new clinics for adults are planned to open by the end of this year, subject to the recruitment of medical teams. This will bring coverage in Ireland to 50% of the population, with plans to increase this in the coming years.
But it can cost you to have ADHD. In looking at the socio-economic costs of adult ADHD, a UK study by the DEMOS think tank found that compared with their non-ADHD siblings, individuals diagnosed with ADHD as adults experienced private healthcare costs of approximately €8,600 per person, per year, of which over €7,900 resulted from the adults with ADHD having lower disposable income.
Public costs amounted to around €9,000, most of which is accounted for by the loss of income tax revenue and provision of income replacement benefits.
Thus, the total yearly costs to the individual and State combined were found to be €17,769 per person, per year. Using a prevalence rate of 3% for adults having ADHD in Ireland, this then equates to 105,000 people at €17,769 per person which then works out at €1,865,745,000 per annum!
Apart from improving people’s lives, should the health service at all levels work to identify and provide treatment to all those with Adult ADHD, then significant cost expenditure could be achieved by the exchequer every year.
Further evidence of the cost to the HSE and the State in general is that studies show that 20% of all adults going through mental health services would have undiagnosed ADHD (eg Dublin 23.9%, Syed et al, 2010; Sligo 20.7%, Adamis et al, 2018).
Neurodiversity in the workplace
In the workplace, EDI (Equality, Diversity & Inclusion) is now moving up the corporate agenda, as is ADHD, as part of the neurodiversity umbrella.
This is for two reasons, organisations aiming to be truly inclusive cannot exclude such a significant demographic as the neurodivergent. To continue doing so risks missing out on talent and compromising on productivity and customer trust.
More pertinently, the business case for diversity has highlighted the importance of ‘diversity of thought’ – getting people with different perspectives, backgrounds and experiences in a room, and research shows teams will be more innovative and creative.
JPMorgan Chase completed a side-by-side comparison of a neurodiverse team with a neurotypical team, which indicated the neurodiverse team achieved 48% higher productivity.
But neurodiversity and ADHD may be one of the most challenging areas within diversity and inclusion – it is complex, nuanced, and often invisible, yet it offers a business upside in this context: given that neurodivergent people literally think differently.
Adults with ADHD can make a significant contribution to the economic life of Ireland if we work with the strengths that the condition brings (such as creativity/imagination, the willingness to take a risk and bundles of energy to name but a few) as opposed to perpetuating a negative stereotyped view of the condition.
As a society, we need to move away from a place where 20% of adults with ADHD attempt to take their own lives. We need to move from Awareness to Acceptance. Acceptance is about acknowledging and valuing differences in our society rather than about tolerance.
It is about shifting the onus of change from the ADHD individual to society as a whole. Acceptance requires an active effort to challenge perceptions, overcome prejudice and change. It is a constant process. The challenge is in acceptance.
Ken Kilbride is CEO of ADHDIreland.
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