Abstract
BACKGROUND: ADHD is the most common neurodevelopmental disorder. While much is known about the functional and academic impacts of ADHD, impacts on long-term health-related quality of life (HRQoL) are less well-documented. AIMS: To explore, in children aged 4 to 17 years, associations between clinical ADHD symptoms and (1) children's HRQoL; (2) whether internalizing or externalizing problems attenuate this association; and (3) factors contributing to this association. METHODS: Data were drawn from the Longitudinal Study of Australian Children at child ages 4 to 17 years (N = 4,194). Clinical ADHD symptoms (e.g., score >8) were measured using the hyperactivity scale from the Strengths and Difficulties Questionnaire (SDQ). Internalizing or externalizing problems were classified as children with scores ≥5 on the Emotional Problems and scores ≥4 on the Conduct Problems scale on the SDQ, respectively. Children's HRQoL was measured using the Pediatric Quality of Life Inventory (PedsQL). Linear mixed models were used, adjusting for child and family factors. RESULTS: Compared to those with no ADHD symptoms, children with ADHD symptoms had significantly lower HRQoL across all domains from 4 to 17 years (mean difference = 7.65, 95% CI [6.09, 9.19]). Internalizing and externalizing problems slightly attenuated the association between ADHD symptoms and children's HRQoL (mean difference = 4.91, 95% CI [3.40, 6.43]). Being a female or having autism or other medical conditions, or taking ADHD/ADD medication or caregiver having mental health problems was associated with poorer HRQoL while having two or more siblings was associated with better HRQoL. CONCLUSION: ADHD clinical symptoms are associated with poorer children's HRQoL from 4 to 17 years. Given that co-occurring medical conditions and poor caregiver mental health are associated with poorer child HRQoL, ADHD treatment needs to identify and address co-occurring conditions and parental mental health.