Internalizing difficulties in childhood was found to negatively affect functioning and quality of life (QOL) during the transition to adulthood in patients with attention-deficit/hyperactivity disorder (ADHD), according to results of study published in the Journal of Attention Disorders.

“Our findings indicate that treatments aimed at reducing ADHD symptoms may be important, but that internalizing difficulties should be targeted as well,” reported the study authors. For internalizing difficulties, “cognitive-behavioral interventions may be effective, although comorbid ADHD is associated with poorer treatment outcomes in cognitive-behavioral interventions for children and adolescents with anxiety.”

Investigators from Innlandet Hospital Trust in Norway recruited patients with ADHD (n=85) who were referred to their clinic and non-ADHD controls (n=50) from local schools. Study participants underwent neuropsychology and executive function testing at baseline and 2- and 10-year follow-ups.

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The ADHD and control cohorts had mean ages of 11.6 (SD, 2.1) and 11.6 (SD, 2.0) years at baseline, 54% and 64% were boys, respectively, and they had an average full-scale intellectual quotient (FSIQ) score of 94.4 (SD, 13.8) and 103.8 (SD, 13.0) points (P <.001), respectively.

At the 2- and 10-year follow-ups, 95.3% and 71.8% of the ADHD group and 100.0% and 80.0% of the control group participated. The group that did not participate in the follow-ups had significantly lower FSIQ scores (P =.040) and scored lower on the Letter-Number Sequencing Test (P =.013) than retained participants.

At 10 years, the group with ADHD had poorer perceived QOL scores (t range, 2.639-4.088; all P ≤.010) and had more functional impairments according to the Weiss Functional Impairment Rating Scale (t range, 2.194-4.195; all P ≤.031) compared with controls.

Baseline ADHD symptoms, executive functioning, and internalizing difficulties explained a significant amount of the variance in total QOL at 10 years (F[5,91], 4.59; P <.001). Overall, greater ADHD symptoms (β, -0.29; P =.008) and internalizing symptoms (β, -0.23; P =.039) predicted poorer QOL.

Similarly, baseline ADHD symptoms, executive functioning, and internalizing symptoms explained a significant amount of the variance in functional impairment (F[5,90], 5.86; P <.001). There was a positive relationship between ADHD symptoms (β, 0.26; P =.014) and internalizing symptoms (β, 0.27; P =.014) with functional impairment.

Using data from the 2-year follow-up was also predictive of the variance in QOL (F[5,86], 4.85; P <.001) and functional impairments (F[5,86], 3.75; P =.004) at 10 years.

In exploratory analyses, greater ADHD symptoms specifically predicted lower social, physical, and cognitive QOL (all P ≤.043) and more impairments to work, risky activities, social activities, and life skills (all P ≤.040); more internalizing difficulties predicted lower cognitive QOL (P =.030) and more impairments to work, self-concept, school, and life skills (all P ≤.033); and poorer executive functioning predicted greater functional impairments to risky activities and family (both P ≤.049) outcomes.

These findings may not be generalizable for the overall ADHD population, as these patients were recruited after clinical referral for a mental health evaluation.

“The evidence base for psychosocial treatments of ADHD and co-occurring symptoms is still very limited, but our findings indicate that this is an important area of future research,” the authors concluded.


Orm S, Øie MG, Fossum IN, Fjermestad K, Andersen PN, Skogli EW. Predictors of quality of life and functional impairments in emerging adults with and without ADHD: a 10-year longitudinal study. J Atten Disord. 2023;10870547231153962. doi:10.1177/10870547231153962

This article originally appeared on Psychiatry Advisor