More work is also required to improve our understanding of both the differences and interrelationships between the different levels of analysis that comprise a child’s overall functioning (e.g. ADHD symptoms, associated functional impairment and QoL) as these concepts are currently not well delineated either theoretically or on a practical level within the different measurement scales. Different questionnaires contain different mixes of items which tap into all three levels. This means that there is inevitably item-overlap between symptoms rating scales and QoL measures and it then becomes difficult to tease out any independent effects that the disorder or its treatment may be having on symptoms on the one hand and QoL on the other. This in turn begs the question as to whether an apparent treatment related change as measured by current QoL instruments actually adds anything to our understanding of treatment effects. Whilst we believe that measures of QoL can add considerable colour to the measurement of treatment outcome future research needs to address the contribution of these different elements in characterizing ADHD and its relationship to QoL. A major question to be addressed here would be; does the concept of QoL add any value to our understanding of ADHD over and above the concepts of symptoms and more specific functional impairment? One study , explicitly studied aspects of this overlap and reported that the removal of potentially overlapping (symptom) items made little difference to the relationships between mental illness and QoL that they had previously established. There is the potential for similar analyses to be conducted with existing datasets and this may help to provide a more definitive answer to this question. This may suggest ways that the existing measures of QoL could be refined for use with ADHD populations or scored differently when used in this group. This may also result in a clearer delineation of the key characteristics that lay at the core of QoL that are independent of both symptoms and general functional impairment.
Relatively few child studies have compared QoL in ADHD either with QoL in other psychiatric disorders or with chronic physical disorders. Those studies that have been conducted have started to suggest that different disorders may result in different QoL profiles, however, more and larger studies will improve our understanding considerably.
Attention deficit hyperactive disorder is “a problem of not being able to focus, being overactive, not being able to control behavior, or a combination of these.” Many kids are trapped under the accusation of having attention deficit hyperactive disorder because they cannot focus in school; they are hyper and like to be active....
As confirmed by the National Survey of Children's Health (NSCH), about 56 percent of children diagnosed with ADHD as of 2003, were given stimulants (Mental Health in the United States: Prevalence of Diagnosis and Medication Treatment for Attention-Deficit/Hyperactivity Disorder --- United States,...
Children with ADHD had significantly worse QoL scores than children with no disorder across all domains. Differences remained after controlling for overlapping questions. Children with MDD were described as having more pain and discomfort and emotional problems than those with CD and ADHD. Children with CD and ADHD had greater behavioural problems than those with MDD
Most studies have used parental reports both for symptom severity and QoL. This introduces the problem of shared-rater variance and may induce at least two possible sources of bias. This could result in a spurious association between ADHD symptoms and QoL and leaves both measures open to undue influence by parent characteristics: other than the very general data from the ADORE study mentioned above , we are unaware of any studies that have investigated the effect of parental mental health on measures of their child’s QoL. Future studies should, as a matter of course, take independent ratings of QoL and symptoms. The choice of who should act as the second informant itself raises a number of issues. In the broader field of ADHD, teachers’ ratings are often used to address this problem. However, the low correlations found between ratings of QoL by the child or parent and teacher-reported symptoms may be accounted for by the fact that teachers are interested in and observe different maladaptive and adaptive behaviours in the classroom than parents do at home, or that they often only see the children when they are medicated. On the other hand, it is also possible that parents may have exaggerated both symptoms and impact on well-being.
In summary, the available data supports the validity of QoL measures as being associated with, but not completely overlapping with, ADHD symptomatology and impairment. Increased symptom levels and impairment predict poorer QoL. The presence of comorbid conditions or psychosocial stressors is also predictive of poorer QoL in samples of ADHD children. Further studies are required to extend our understanding of the predictors and correlates of reduced QoL. These data should also be examined in detail to gain a better understanding of the overlaps between the various frames of reference (symptoms, impairment and QoL) and this information fed back so into efforts to refine the structure and scoring of current measures and the development of new and improved measures of QoL.
In the ADORE study the association between 26 independent factors including comorbid problems and ADHD children’s QoL was investigated using the CHIP-CE . The presence of high emotional symptoms, conduct problems, peer relationship problems, coordination problems, asthma or two or more somatic symptoms, and having a parent with mental health or health problems, were all associated with poor parent-reported QoL on the CHIP-CE over and above the association between ADHD and QoL.
Several studies have investigated the correlations between symptom severity and QoL scores. Clearly an absence of correlation would be surprising and cast doubt on the relationship between ADHD and QoL. On the other hand a perfect or very high correlation would lead one to question whether the two concepts were in fact separable and whether measuring QoL adds anything to our understanding of the child with ADHD. A significant but moderately strong correlation supports the notion that QoL and ADHD symptoms are related but distinct constructs and that both may be required to give a full picture of a child’s difficulties.
In summary, ADHD has been shown to have a comparable overall impact on QoL when compared to physical disorders. However, a closer inspection suggests greater impact on psychosocial QoL domains, and a lesser impact on physical QoL domains than common chronic physical illnesses. Initial evidence also suggests that ADHD has a comparable overall impact on QoL when compared to other mental health conditions. The available data is starting to suggest that different mental health disorders may impact on some QoL domains (e.g. peer and school problems and impact on parents) in similar ways while on other domains the impact varies depending on the disorder (e.g. children with ADHD had more behavioural problems and interference with family activities, but fewer emotional problems than those with major depressive disorder). However, data on these issues remains sparse and more studies are required before any clear statements can be made. Such data will be important not only to clinicians but also to health service planners who are required to make decisions about resource allocation between different parts of comprehensive children’s healthcare services and within different parts of child and adolescent mental health services.
Pastor PN, Reuben CA. 2002. Attention Deficit Disorder and Learning Disability: United States, 1997–98. Vital Health Stat 10(206). Available: [accessed 15 May 2103].