February 26, 2021
A Dutch and German team compared the performance of 45 adults with ADHD and 51 normally developing controls on a battery of standardized tests and questionnaires designed to assess competence in financial decision-making (FDM). These were supplemented with neuropsychological tests, as well as evaluations of each participant’s personal financial situation.
The two groups had roughly comparable demographic characteristics. There were no significant differences in age, gender balance, years of education, or work status. Students were excluded from both groups because they tend to be financially dependent and to have little or no income.
The ADHD group scored more than three times higher on self-report questionnaires for both the retrospective assessment of childhood symptoms ( Wender Utah Rating Scale—Childhood) and for evaluating current symptoms of ADHD (ADHD self-report scale). Researchers did not perform clinical evaluations of ADHD.
To determine their personal financial situation, participants were asked about their income range as well as, “Do you have debts other than mortgage or study loans?”;“Do you receive social security?”; “Do you have a savings account?”;“Do you save actively, that is, do you put money in your savings account on a regular basis?”; “Do you save for retirement?”; and “Do you own a house?” They were also asked how much they set aside in monthly savings, and, where applicable, how much they receive in social security.
On five out of nine criteria, significant differences emerged between the two groups. Whereas healthy controls had median incomes in the range of €35,000 to €45,000, for those with ADHD it was dramatically lower, between €15,000 and €25,000. Healthy controls also had twice as much disposable income. Whereas almost half of adults with ADHD reported debts other than mortgage or educational loans, only a third as many healthy adults had such debt. And whereas only slightly over half of those with ADHD reported having savings accounts, among healthy adults it was more than six out of seven. Finally, healthy controls were four times as likely to own a home.
Participants were then given standardized tests to evaluate financial competence, financial decision-making capacity, financial decision styles, the ability to make financial decisions using decision rules, the capacity to make decisions with implications for the future, impulsive buying tendencies, and a gambling task as a measure of emotional decision-making.
Adults with ADHD scored significantly lower than healthy adults on the financial competence test, and in particular, on financial abilities, financial judgment, financial management, and financial support resources. Similar outcomes emerged from the financial decision-making capacity test, especially when it came to identifying and understanding relevant information. Adults with ADHD were also significantly more likely to use avoidant and spontaneous decision styles. They also showed significantly more temporal discounting, meaning they tended to prefer immediate gratification over long-term financial security. That translated into significantly higher propensities to buy on impulse. In all cases these differences had large effect sizes.
Finally, participants were tested on nine cognitive functions: information processing speed, vigilance and selective attention, inhibition, interference, figural fluency, cognitive flexibility, task switching, verbal working memory, and numeracy.
Those with ADHD performed significantly worse, with medium effect sizes, on three cognitive measures: vigilance, interference, and numeracy. There were no significant differences on the other six measures.
The authors concluded, “The results show that the personal financial situation of adults with ADHD was less optimal than the financial situation of healthy controls. Furthermore, adults with ADHD showed significantly decreased performances compared with healthy controls in five out of seven tasks measuring FDM and on measures of vigilance, interference, and numeracy. However, mediation analyses indicated that differences in cognitive functioning cannot fully explain the differences with regard to FDM between adults with ADHD and healthy controls.”
They also pointed to limitations of the study. One is that 19 of the 45 adults with ADHD had comorbid disorders, of which three were substance dependencies. However, removing them had little effect on the outcome. Another limitation was that adults with ADHD were off medication during the testing, so it is unclear how stimulants would affect the test outcomes. The authors state, “The influence of treatment use should, therefore, be explored in future research on FDM and adults with ADHD.”
Dorien F. Bangma, et al., “Financial Decision-Making in Adults With ADHD,” Neuropsychology (2019), http://dx.doi.org/10.1037/neu0000571.
A 2021 consensus statement by an international group of scientists and clinicians (Bauer et al.) recommended that pregnant individuals “forego [acetaminophen] unless its use is medically indicated,” due to the potential risk of developmental disorders such as autism and attention-deficit/hyperactivity disorder (ADHD).
A mostly Swedish research team, collaborating with a U.S. researcher, nevertheless noted that previous studies have been limited by:
Sweden has a single-payer health insurance system that includes virtually its entire population, and national registers that enable tracking the health history of mothers and their children, including their children’s siblings.
The team used the Swedish registers to identify the roughly two-and-a-half million children born in Sweden from mid-1995 through 2019. They were also able to identify all siblings to be able to control for otherwise unmeasured familial and genetic confounding.
Almost 186,000 of these children were exposed to acetaminophen during pregnancy.
After adjusting for available known confounders, including (but not limited to) child sex and birthdate, mother’s age and medical history, use of any other painkillers, use of any psychoactive medications, country of birth, residential region, smoking status, highest household education, and disposable income, children exposed to acetaminophen during pregnancy were 7% more likely to be diagnosed with ADHD subsequently than those who were not exposed.
However, roughly the same results were found for other painkillers, including aspirin, non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and antimigraine medication. High doses of acetaminophen did not produce any stronger association with subsequent ADHD than low dosage.
Moreover, when confining results to siblings – 8,526 children who were exposed versus 87,679 who were unexposed – the association between acetaminophen use during pregnancy and subsequent offspring ADHD vanished altogether (and, again, at every dose level). The associations similarly vanished with every other painkiller medication.
The Swedish team concluded, “Acetaminophen use during pregnancy was not associated with children’s risk of autism, ADHD, or intellectual disability in sibling control analyses. This suggests that associations observed in models without sibling control may have been attributable to confounding.”
Antipsychotic medications are used to treat a variety of psychiatric disorders, including schizophrenia, bipolar disorder, sleeping problems, major depression, and severe anxiety.
Untreated maternal mental illness is associated with poor health outcomes for both mothers and their offspring. On the other hand, one must guard against any potential direct harms of medications on development – including neurological development – of the fetus.
Because prenatal use of antipsychotics is infrequent, previous observational studies have suffered from small sample sizes that have not enabled precise and reliable assessment of risk. The clinical decision about whether to continue antipsychotic treatment in patients who become pregnant has therefore remained inconclusive.
In search of more reliable guidance, an international study team conducted a systematic search of the peer-reviewed medical literature to perform the first meta-analysis on this topic.
They evaluated study quality and only included studies rated “good” or better.
Identification of ADHD was determined by clinical diagnosis.
Meta-analysis of four studies encompassing over eight million participants found a slight association. Children exposed to maternal antipsychotics during pregnancy were 11% more likely to be diagnosed with ADHD subsequently.
But even in observational studies with millions of participants, such associations – especially when slight to begin with – could be due to unmeasured confounders.
The team therefore compared children with gestational exposure to siblings from the same mother who were not exposed, to address shared genetic and social factors at the family level.
Meta-analysis of two population-based sibling-matched studies with a combined total of over 4.6 million participants in Denmark, Norway, Sweden, Finland, Iceland, and Hong Kong found no significant association between gestational exposure to antipsychotic medications and subsequent diagnosis of ADHD.
The team concluded, “Our systematic review and meta-analysis of observational studies indicates that the heightened risks of ADHD and ASD observed in children gestationally exposed to antipsychotics appear to be attributable to maternal characteristics, rather than having a causal relation to the antipsychotic itself.”
Most previous studies of suicide and self-harm risk among persons with ADHD have focused on adolescents and adults. They’ve also tended to be cross-sectional, analyzing data from a population at a specific point in time.
An Australian study team took a different approach, conducting a before-and-after study through the birth cohort of the Longitudinal Study of Australian Children (LSAC), comprising 5,107 children who have been followed up every two years since birth.
The diagnosis of ADHD was based on parents reporting that their child had received a diagnosis of ADHD at or before age ten.
Suicide and self-harm were defined as children’s self-report at age 14 of any thought or attempt of suicide and self-harm respectively over the past year.
The team adjusted for the following confounders: socioeconomic status, birth weight, ADHD medication history, maternal education level, maternal age at birth, experience in bullying victimization at age 12, and depression score based on Short Mood and Feelings Questionnaire (SMFQ).
Of the 5,107 participants, 3,696 had all the valid data required for analysis and were included in the final cohort. Of these, 3.6% were diagnosed with ADHD by age 10.
With a diagnosis of ADHD at age 10 and all other factors held constant:
Both depression and exposure to bullying were statistically significant mediators for the relationship. Nevertheless, depression and exposure to bullying each accounted for well under 10% of the overall effect.
Neither socioeconomic status nor maternal factors had any significant mediating effect on outcomes.
The authors concluded, “This study provides compelling evidence that children diagnosed with ADHD at the age of 10 years face significantly elevated risks of experiencing suicidal thoughts, planning, or attempts, as well as self-harm, by the age of 14 years, which underscores the critical importance of recognizing and addressing these heightened risks in children with ADHD.”
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