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The Long-Term Impact of ADHD on Children and Adolescents' Health-Related Quality of Life: Results from a Longitudinal Population-Based Australian Study

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Title: The Long-Term Impact of ADHD on Children and Adolescents' Health-Related Quality of Life: Results from a Longitudinal Population-Based Australian Study
Language: English
Authors: Ha Nguyet Dao Le (ORCID 0000-0001-8279-8324), Courtney Keily, David Coghill, Lisa Gold
Source: Journal of Attention Disorders. 2025 29(14):1278-1289.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 12
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Foreign Countries, Attention Deficit Hyperactivity Disorder, Children, Adolescents, Symptoms (Individual Disorders), Quality of Life, Child Health, Behavior Problems, Correlation, Mental Health, Child Behavior
Geographic Terms: Australia
Assessment and Survey Identifiers: Strengths and Difficulties Questionnaire
DOI: 10.1177/10870547251353366
ISSN: 1087-0547
1557-1246
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 [greater than or equal to]5 on the Emotional Problems and scores [greater than or equal to]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.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1488304
Database: ERIC
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  Value: <anid>AN0188923023;gs001dec.25;2025Oct30.03:45;v2.2.500</anid> <title id="AN0188923023-1">The Long-Term Impact of ADHD on Children and Adolescents' Health-Related Quality of Life: Results From a Longitudinal Population-Based Australian Study </title> <p>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 (<reflink idref="bib1" id="ref1">1</reflink>) children's HRQoL; (<reflink idref="bib2" id="ref2">2</reflink>) whether internalizing or externalizing problems attenuate this association; and (<reflink idref="bib3" id="ref3">3</reflink>) 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.</p> <p>Keywords: HRQoL; ADHD; children; adolescent</p> <hd id="AN0188923023-2">Introduction</hd> <p>ADHD is the most common childhood neurodevelopmental condition, affecting approximately 2% to 7.6% of children ([<reflink idref="bib44" id="ref4">44</reflink>]; [<reflink idref="bib52" id="ref5">52</reflink>]). It is characterized by high levels of hyperactivity, inattention, and impulsivity and is often diagnosed during the primary school years, most commonly around the age of 7 years in the United States (US; [<reflink idref="bib2" id="ref6">2</reflink>]; [<reflink idref="bib67" id="ref7">67</reflink>]) or 7.5 years in Europe and Australia ([<reflink idref="bib32" id="ref8">32</reflink>]; [<reflink idref="bib48" id="ref9">48</reflink>]). ADHD can affect a child's academic, cognitive, social, and emotional performance at school as well as impact their home and social life ([<reflink idref="bib2" id="ref10">2</reflink>]). Children with ADHD report a more negative classroom experience, reduced task-related motivation, and lower academic functioning compared to their peers ([<reflink idref="bib37" id="ref11">37</reflink>]). They are more likely to have impaired social skills, anxiety, and peer relationship problems ([<reflink idref="bib4" id="ref12">4</reflink>]; [<reflink idref="bib45" id="ref13">45</reflink>]) and poorer quality of life ([<reflink idref="bib68" id="ref14">68</reflink>]).</p> <p>Health, according to the World Health Organization (WHO), is "a state of complete physical, mental and social well-being" ([<reflink idref="bib71" id="ref15">71</reflink>]). In line with this definition, an important tool to assess the overall health and well-being of children is the health-related quality of life (HRQoL). HRQoL is primarily a self-reported, multidimensional, and subjective appraisal of the impact of health conditions and their treatments on a person's physical, psychological, and social functioning ([<reflink idref="bib14" id="ref16">14</reflink>]). Yet children may find it challenging to provide accurate and valid self-rated questionnaire responses due to their underdeveloped linguistic and communicative capabilities, which may be compounded by concentration challenges in ADHD sufferers ([<reflink idref="bib13" id="ref17">13</reflink>]). Parent-proxy HRQoL reporting is often used when a child's self-reported measurement may be unreliable, particularly in younger children ([<reflink idref="bib33" id="ref18">33</reflink>]). HRQoL has become increasingly common as a measurement of therapeutic effectiveness in clinical trials ([<reflink idref="bib15" id="ref19">15</reflink>]) including ADHD treatment ([<reflink idref="bib5" id="ref20">5</reflink>]) and patient care ([<reflink idref="bib63" id="ref21">63</reflink>]) due to its utility in guiding patient treatment and designing population health interventions. Improving understanding of how health conditions such as ADHD impact a child's HRQoL can provide insights for patient-focused service planning and support to optimize outcomes for individuals ([<reflink idref="bib49" id="ref22">49</reflink>]; [<reflink idref="bib59" id="ref23">59</reflink>]).</p> <p>Several studies have assessed HRQoL in children with ADHD ([<reflink idref="bib33" id="ref24">33</reflink>]; [<reflink idref="bib68" id="ref25">68</reflink>]). A recent systematic review and meta-analysis found that ADHD has a significant negative effect on children's HRQoL ([<reflink idref="bib68" id="ref26">68</reflink>]). Yet the impact of ADHD is not uniform across all HRQoL domains. The psychosocial HRQoL domain appears to be the most affected by ADHD, with effect magnitude variability seen between self-reported and parent proxy results ([<reflink idref="bib68" id="ref27">68</reflink>]). HRQoL physical domain scores may also be lower in children with ADHD yet this association is questionable as several studies have found no difference in HRQoL physical domain scores between children with and without ADHD ([<reflink idref="bib33" id="ref28">33</reflink>]). In line with this, one study found that improving ADHD symptoms results in higher children's HRQoL only in the psychosocial domain, not the physical domain ([<reflink idref="bib35" id="ref29">35</reflink>]). The review also highlighted a limited number of longitudinal studies to explore the long-term impact of ADHD on HRQoL. Several studies used longitudinal data to explore this association but they mainly include a short period, for example, 1 year ([<reflink idref="bib7" id="ref30">7</reflink>]; [<reflink idref="bib29" id="ref31">29</reflink>]; [<reflink idref="bib40" id="ref32">40</reflink>]). No existing study has examined the long-term impact of ADHD symptoms over an extended period, such as the 13 years covered in our study. Longitudinal research is essential for understanding how children's HRQoL evolves, whether disparities persist, widen, or diminish with age. Unlike cross-sectional studies, which assume stability, a longitudinal approach provides critical insights into these dynamic patterns. Such evidence is crucial for informing policy and intervention strategies. If HRQoL disparities widen over time, it may indicate the need for sustained or adaptive interventions at different developmental stages.</p> <p>Children may present with high levels of clinical ADHD symptoms without a formal diagnosis, especially at younger ages (e.g., under 8 years; [<reflink idref="bib51" id="ref33">51</reflink>]), yet limited research has examined the association between ADHD clinical symptoms and children's HRQoL ([<reflink idref="bib10" id="ref34">10</reflink>]). In Australia, the average diagnostic delay for children with ADHD is about 3.5 years ([<reflink idref="bib32" id="ref35">32</reflink>]). This diagnosis delay of ADHD may occur despite symptomatology, in part due to inequities that exist in both the healthcare and education systems ([<reflink idref="bib73" id="ref36">73</reflink>]). There are effective treatments for ADHD. A recent review and meta-analysis found that pharmacology treatment was efficacious in improving children's HRQoL and ADHD symptoms ([<reflink idref="bib5" id="ref37">5</reflink>]). Therefore, understanding the impact of ADHD clinical symptoms on children's HRQoL is important to advocate for early diagnosis and treatment of ADHD to minimize the long-term adverse effects of ADHD on children, their families, and societies.</p> <p>Many child, family, and social factors could influence children's HRQoL and/or ADHD symptoms, yet research exploring this topic is scarce. The home environment and family adversity have been shown to affect ADHD symptoms in children and impact their HRQoL ([<reflink idref="bib39" id="ref38">39</reflink>]). A European study found that living with a parent who is suffering from either a physical or mental health condition and not living with both parents are all associated with poorer HRQoL ([<reflink idref="bib47" id="ref39">47</reflink>]). Children with ADHD commonly present with mental health comorbidities, with 50% to 70% of children with ADHD also having an externalizing problem (e.g., oppositional defiant disorder) and up to 64% with an internalizing problem (e.g., anxiety and depression; [<reflink idref="bib20" id="ref40">20</reflink>]; [<reflink idref="bib26" id="ref41">26</reflink>]; [<reflink idref="bib56" id="ref42">56</reflink>]). Research shows that children with ADHD and co-occurring internalizing and/or externalizing problems were associated with poorer peer functioning, reduced daily functioning and HRQoL ([<reflink idref="bib3" id="ref43">3</reflink>]; [<reflink idref="bib43" id="ref44">43</reflink>]; [<reflink idref="bib56" id="ref45">56</reflink>]). Understanding the interrelationships between ADHD clinical symptoms and co-occurring internalizing/externalizing problems and their impact on children's HRQoL is important for treatment planning to maximize the effectiveness of treatment strategies.</p> <p>Existing evidence is largely cross-sectional, limited by small samples and lacking the exploration of the factors influencing the relationship between ADHD and children's HRQoL.</p> <p>The current study will address some of the gaps in the literature by using the large population-based Longitudinal Study of Australian Children to explore (<reflink idref="bib1" id="ref46">1</reflink>) the 13-year association between ADHD clinical symptoms and children's HRQoL/HRQoL domains at 4 to 17 years of age, (<reflink idref="bib2" id="ref47">2</reflink>) whether internalizing or externalizing behavior attenuates this association; and (<reflink idref="bib3" id="ref48">3</reflink>) the other factors influencing children's HRQoL. We hypothesize that ADHD clinical symptoms were negatively associated with children's HRQoL from 4 to 17 years and that internalizing or externalizing problems attenuate this association.</p> <hd id="AN0188923023-3">Methods</hd> <p></p> <hd id="AN0188923023-4">Study Design and Participants</hd> <p>LSAC is a nationwide cohort study of children and their families. The initial recruitment and study design have been reported previously ([<reflink idref="bib53" id="ref49">53</reflink>]). In brief, the initial wave of LSAC commenced in 2004 and followed two separate cohorts of children, a birth (B) and a kindergarten (K) cohort, each containing around 5,000 children ([<reflink idref="bib61" id="ref50">61</reflink>]). At the time of the analysis, the study contained nine waves, with data collected biennially.</p> <p>Children were selected from the Australian Medicare database using a two-stage cluster sampling design ([<reflink idref="bib61" id="ref51">61</reflink>]). First, postcodes (excluding the most remote) were sampled after stratifying by state of residence and urban versus rural status. Within the selected postcodes, children in the Kindergarten (K) cohort were chosen if they were born between March 1999 and February 2000 and enrolled in the Australian Medicare database. Of the contactable families, 4,983 four- to five-year-old children participated in Wave 1 data collection in 2004. This paper involves K cohort children and their caregiver's reports of HRQoL from the age of 4 to 17 years (waves 1–7) where the HRQoL or SDQ measures were available (<emph>N</emph> = 4,194).</p> <hd id="AN0188923023-5">Measures</hd> <p></p> <hd id="AN0188923023-6">Health-Related Quality of Life</hd> <p>HRQoL was measured from waves 1 to 7 using the parent proxy-reported 23-item Pediatric Quality of Life (PedsQL) generic core scale 4.0 which comprises four domains including social (e.g., feeling afraid or scared; sad or blue; angry; trouble sleeping; and worrying about what will happen), emotional, physical, and school functioning ([<reflink idref="bib66" id="ref52">66</reflink>]). Different parent proxy-reported formats were used depending on the age of the child including 5 to 7 years (young child), 8 to 12 years (child), and 13 to 18 years (adolescent). A 5-point response scale (0 = never a problem; 1 = almost; 2 = sometimes; 3 = often; and 4 = always) is used for ages 8 to 18 years. An HRQoL summary score ranging between 0 and 100 was generated by combining all items with a higher score indicating a better HRQoL ([<reflink idref="bib66" id="ref53">66</reflink>]). A parent proxy-reported HRQoL difference of 4.5 points in the summary score (or 6.9, 7.8, 9.0, and 9.7 in the physical, emotional, social, and school functioning respectively) was considered the minimum for clinical significance between the two comparison groups ([<reflink idref="bib66" id="ref54">66</reflink>]). Across all age groups, the parent proxy-reported HRQoL score has high internal reliability (alpha coefficient >.9 for the summary score and ≥.8 for all four domain scores; [<reflink idref="bib66" id="ref55">66</reflink>]).</p> <hd id="AN0188923023-7">ADHD Clinical Symptoms</hd> <p>ADHD clinical symptoms were measured from 4 to 17 years (waves 1–7) using the five hyperactivity-inattention subscale questions from the parent-reported 25-item Strengths and Difficulties Questionnaire (SDQ; [<reflink idref="bib21" id="ref56">21</reflink>]). Five questions make up the hyperactivity-inattention domain, which uses a 3-point Likert scale (0 = "not true," 1 = "somewhat true," and 2 = "certainly true"). We defined ADHD clinical symptoms using the standard cut-off of ≥90th percentile (score ≥8, possible scores range from 0 to 10) as per previous literature ([<reflink idref="bib55" id="ref57">55</reflink>]). The SDQ hyperactivity-inattention subscale has high internal consistency reliability (alpha coefficient of.74; [<reflink idref="bib42" id="ref58">42</reflink>]). Children scoring at or above the 90th percentile on the hyperactivity-inattention subscale are about 18 times more likely to meet the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV; [<reflink idref="bib1" id="ref59">1</reflink>]) criteria for ADHD compared to their peers ([<reflink idref="bib23" id="ref60">23</reflink>]).</p> <hd id="AN0188923023-8">Internalizing and Externalizing Problems</hd> <p>Internalizing and externalizing problems were assessed using the 5-item Emotional Problems and Conduct Problems scales, respectively from the SDQ ([<reflink idref="bib21" id="ref61">21</reflink>]), collected from waves 1 to 7. Scores for each scale ranged from 0 to 10, with higher scores representing more problems. Children with scores greater than 90th percentile (e.g., scores of 5 or more on the Emotional Problems and scores of 4 or more on the Conduct Problems scale) were classified as internalizing or externalizing problems.</p> <hd id="AN0188923023-9">Child and Family Characteristics</hd> <p>Study child and family characteristics (e.g., child's age, gender, number of siblings, and primary caregiver having a partner) were collected across different time points (Supplemental Table S1). The presence of parental psychological distress (in the primary caregiver) was assessed using the six-item Kessler 6 depression scale and was measured at ages 4 to 17 years (waves 1–7; [<reflink idref="bib30" id="ref62">30</reflink>]). Family socioeconomic position (SEP) was measured using parent information about educational attainment, combined annual family income and parents' occupational status for each family ([<reflink idref="bib19" id="ref63">19</reflink>]). These characteristics, chosen from the literature ([<reflink idref="bib39" id="ref64">39</reflink>]; [<reflink idref="bib47" id="ref65">47</reflink>]), were used as explanatory variables in the analyses.</p> <hd id="AN0188923023-10">Ethics</hd> <p>Ethical approval for LSAC was granted by the Royal Children's Hospital Melbourne and the Australian Institute for Family Studies ([<reflink idref="bib61" id="ref66">61</reflink>]). All participating caregivers provided written and informed consent.</p> <hd id="AN0188923023-11">Statistical Analyses</hd> <p>Baseline characteristics of the whole sample and the analytic sample with complete HRQoL and SDQ data at each time point were described. Cross-sectional associations between children's HRQoL at each time point (waves 1–7) and children's ADHD symptoms (waves 1–7) were explored using multivariable linear regression. Despite the relative skewness of HRQoL data, estimation was robust given that the normality assumption is not required in a large sample ([<reflink idref="bib34" id="ref67">34</reflink>]). We conducted the analysis using general linear models (GLM) to test the robustness of our model choice. Results of the GLM model were similar to the multivariable linear model, confirming the robustness of our estimation. The analyses were adjusted for child and family characteristics identified from the literature (Supplemental Table S1).</p> <p>Predictors were chosen using the best variable sets from the <emph>vselect</emph> command. We used the Akaike Information Criteria (AIC; i.e., the smallest AIC represents the best model) to select the final regression models. In the primary analysis, we did not include internalizing and externalizing problems. We included both of these factors in the secondary analysis to assess whether the association between ADHD clinical symptoms and children's HRQoL is affected by internalizing/externalizing problems.</p> <p>Longitudinal association between children's overall HRQoL and HRQoL domains (from 4 to 17 years) and ADHD clinical symptoms (measured at each wave from 1 to 7) were explored using the mixed effects model with individual child indicator and family postcode indicator as random effects. The mixed effects model accounts for the possible correlation of repeated measures within each child over time and utilizes all available data ([<reflink idref="bib24" id="ref68">24</reflink>]). The mixed effects model estimated the mean children's HRQoL/HRQoL domains associated with having ADHD clinical symptoms over the period of 4 to 17 years, with a 95% confidence interval. Sample weights were applied in all analyses to account for cluster sampling design and sample attrition ([<reflink idref="bib60" id="ref69">60</reflink>]). Analyses were conducted using STATA 18 ([<reflink idref="bib62" id="ref70">62</reflink>]).</p> <hd id="AN0188923023-12">Results</hd> <p>ADHD clinical symptoms prevalence from 4 to 17 years (waves 1–7) is presented in Figure 1. Baseline characteristics of the analytic sample (i.e., with data on both the PedsQL and SDQ) at wave 1 are comparable between children with and without ADHD clinical symptoms, however, there were more boys with ADHD clinical symptoms than girls. In addition, a higher proportion of children with ADHD clinical symptoms were from lower SEP or caregivers with a possible mental health illness than those without ADHD clinical symptoms (Table 1). A similar pattern was found at 16 to 17 years (wave 7) however, there was a higher proportion of children with clinical ADHD symptoms who took ADHD medication compared to 4 to 5 years (wave 1).</p> <p>Graph: Figure 1. ADHD clinical symptoms prevalence from waves 1 to 7 (4–17 years).</p> <p>Table 1. Baseline Characteristics of the LSAC Sample for Both Analyses.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" rowspan="2">Factors</th><th align="center" rowspan="2">Whole sample (<italic>N</italic> = 4,966)</th><th align="center" colspan="2">Wave 1 analytic sample (<italic>N</italic> = 4,194)</th><th align="center" colspan="2">Wave 7 analytic sample (<italic>N</italic> = 2,985)</th></tr><tr><th align="center">No ADHD symptoms (<italic>N</italic> = 3,960)</th><th align="center">ADHD symptoms<xref ref-type="table-fn" rid="tfn3">b</xref> (<italic>N</italic> = 234)</th><th align="center">No ADHD symptoms (<italic>N</italic> = 2,912)</th><th align="center">ADHD symptoms<xref ref-type="table-fn" rid="tfn3">b</xref> (<italic>N</italic> = 233)</th></tr></thead><tbody><tr><td>Child sex, male</td><td>2,540 (51.1%)</td><td>2,321 (49.7%)</td><td>219 (73.1%)</td><td>1,409 (50.5%)</td><td>65 (83.5%)</td></tr><tr><td>Indigenous</td><td>194 (3.9%)</td><td>178 (3.8%)</td><td>16 (5.4%)</td><td>63 (2.2%)</td><td>1 (1.3%)</td></tr><tr><td colspan="6">No. of siblings</td></tr><tr><td> 0</td><td>570 (11.5%)</td><td>535 (11.5%)</td><td>35 (11.6%)</td><td>221 (8.1%)</td><td>7 (9.6%)</td></tr><tr><td> 1</td><td>2,364 (47.6%)</td><td>2,220 (47.6%)</td><td>144 (48.1%)</td><td>1,257 (45.9%)</td><td>30 (39.5%)</td></tr><tr><td> 2</td><td>1,329 (26.8%)</td><td>1,255 (26.9%)</td><td>74 (24.6%)</td><td>827 (30.2%)</td><td>29 (37.4%)</td></tr><tr><td> 3 and more</td><td>703 (14.2%)</td><td>657 (14.1%)</td><td>47 (15.6%)</td><td>434 (15.9%)</td><td>10 (13.5%)</td></tr><tr><td>Living with both parents</td><td>4,061 (99.4%)</td><td>3,848 (99.4%)</td><td>212 (99.2%)</td><td>2,010 (99.3%)</td><td>40 (93.3%)</td></tr><tr><td>Having autism at any time point</td><td>329 (11.3%)</td><td>273 (9.9%)</td><td>57 (34.1%)</td><td>143 (5.4%)</td><td>20 (26.1%)</td></tr><tr><td>Internalizing problems</td><td>399 (8.0%)</td><td>337 (7.2%)</td><td>62 (20.6%)</td><td>414 (14.8%)</td><td>45 (58.1%)</td></tr><tr><td>Externalizing problems</td><td>1,432 (28.8%)</td><td>1,219 (26.1%)</td><td>213 (71.1%)</td><td>145 (5.2%)</td><td>42 (53.9%)</td></tr><tr><td>Other medical conditions</td><td>557 (11.2%)</td><td>462 (9.9%)</td><td>95 (31.7%)</td><td>159 (6.0%)</td><td>26 (33.3%)</td></tr><tr><td>Had ADD or ADHD medicine</td><td>13 (0.3%)</td><td>4 (0.1%)</td><td>8 (2.8%)</td><td>48 (1.7%)</td><td>21 (27.4%)</td></tr><tr><td>Parental mental health<xref ref-type="table-fn" rid="tfn2">a</xref></td><td>159 (3.9%)</td><td>128 (3.3%)</td><td>31 (12.7%)</td><td>70 (2.6%)</td><td>5 (7.5%)</td></tr><tr><td>Socioeconomic position, mean (<italic>SD</italic>)</td><td>−0.106 (0.983)</td><td>−0.077 (0.982)</td><td>−0.554 (0.891)</td><td>0.035 (0.974)</td><td>−0.342 (0.875)</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note</emph>. Analyses are weighted and account for LSAC survey design. LSAC = Longitudinal Study of Australian Children; HRQoL = Health-related Quality of life; <emph>SD</emph> = standard deviation.</p> <ulist> <item>2 Indication of primary caregiver's mental illness: measured by the Kessler Psychological Distress Scale (K6).</item> <item>3 ADHD clinical symptoms: measured by the Strengths and Difficulties Questionnaire hyperactivity scale score where a score >8 is suggestive of ADHD.</item> </ulist> <hd id="AN0188923023-13">Age-Related Associations Between ADHD Clinical Symptoms and Children's HRQoL, From 4 to 17 Ye...</hd> <p>At all time points, children with ADHD symptoms experienced poorer HRQoL than their peers without the condition (Figure 2). From 4 to 17 years, considering child and family factors, multivariable linear regression results showed that compared to children without symptoms of ADHD, children with clinical ADHD symptoms had poorer HRQoL (Table 2). At all time points, the mean differences in children's HRQoL between those with and without ADHD symptoms were larger than the meaningful clinical difference of 4.5 points for the PedsQL.</p> <p>Graph: Figure 2. Health-related quality of life of children with and without ADHD symptoms from waves 1 to 7 (4–17 years).</p> <p>Table 2. HRQoL in Children With and Without ADHD Symptoms From 4 to 17 Years (Multivariable Regression Models).</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" rowspan="2">Time point</th><th align="center" colspan="2">Whole analytic sample</th><th align="center" colspan="2">ADHD symptoms</th><th align="center" colspan="2">No ADHD symptoms</th><th align="center" colspan="2">Unadjusted analyses</th><th align="center" colspan="2">Adjusted analysis<xref ref-type="table-fn" rid="tfn5">a</xref></th></tr><tr><th align="center"><italic>N</italic></th><th align="center">Mean (<italic>SD</italic>)</th><th align="center"><italic>N</italic></th><th align="center">Mean (<italic>SD</italic>)</th><th align="center"><italic>N</italic></th><th align="center">Mean (<italic>SD</italic>)</th><th align="center">Mean difference</th><th align="center">95% <italic>CI</italic></th><th align="center">Mean difference</th><th align="center">95% <italic>CI</italic></th></tr></thead><tbody><tr><td>4–5 years (wave 1)</td><td>4,194</td><td>79.70 (11.41)</td><td>234</td><td>70.45 (12.15)</td><td>3,960</td><td>80.28 (11.10)</td><td><bold>−9.83</bold></td><td><bold>[−11.60, −8.07]</bold></td><td><bold>−6.31</bold></td><td><bold>[−8.49, −4.12]</bold></td></tr><tr><td>6–7 years (wave 2)</td><td>3,433</td><td>79.47 (12.70)</td><td>197</td><td>71.71 (13.73)</td><td>3,236</td><td>79.96 (12.46)</td><td><bold>−8.09</bold></td><td><bold>[−10.26, −5.92]</bold></td><td><bold>−5.40</bold></td><td><bold>[−8.20, −2.59]</bold></td></tr><tr><td>8–9 years (wave 3)</td><td>3,794</td><td>79.12 (13.15)</td><td>217</td><td>68.08 (14.86)</td><td>3,577</td><td>79.83 (12.70)</td><td><bold>−11.68</bold></td><td><bold>[−14.05, −9.31]</bold></td><td><bold>−9.24</bold></td><td><bold>[−12.82, −5.65]</bold></td></tr><tr><td>10–11 years (wave 4)</td><td>4,116</td><td>77.42 (15.48)</td><td>239</td><td>64.91 (16.01)</td><td>3,877</td><td>78.23 (15.08)</td><td><bold>−13.33</bold></td><td><bold>[−15.84, −10.83]</bold></td><td><bold>−11.65</bold></td><td><bold>[−15.40, −7.89]</bold></td></tr><tr><td>12–13 years (wave 5)</td><td>3,851</td><td>80.41 (14.33)</td><td>193</td><td>67.07 (15.70)</td><td>3,658</td><td>81.17 (13.85)</td><td><bold>−13.77</bold></td><td><bold>[−16.33, −11.21]</bold></td><td><bold>−11.15</bold></td><td><bold>[−14.88, −7.42]</bold></td></tr><tr><td>14–15 years (wave 6)</td><td>3,368</td><td>78.72 (15.95)</td><td>125</td><td>63.30 (16.70)</td><td>3,243</td><td>79.36 (15.58)</td><td><bold>−16.58</bold></td><td><bold>[−20.13, −13.03]</bold></td><td><bold>−8.14</bold></td><td><bold>[−12.66, −3.62]</bold></td></tr><tr><td>16–17 years (wave 7)</td><td>2,985</td><td>79.95 (14.76)</td><td>73</td><td>61.10 (17.74)</td><td>2,912</td><td>80.47 (14.30)</td><td><bold>−19.02</bold></td><td><bold>[−23.75, −14.28]</bold></td><td><bold>−13.23</bold></td><td><bold>[−18.92, −7.54]</bold></td></tr></tbody></table> </ephtml> </p> <ulist> <item>4 <emph>Note</emph>. Analyses are weighted and account for LSAC survey design. Significant statistics at a 5% significance level are in bold. <emph>SD</emph> = standard deviation.</item> <item>5 Analyses were adjusted for ADHD symptoms (waves 1–7), SEP (waves 1–7), child gender (wave 1), Indigenous status (wave 1), autism (self-reported of ever had a diagnosis of autism), other medical conditions (waves 1–7), number of siblings (waves 1–7), living with both parents (waves 1–7), parental mental health (waves 1–7), had ADD/ADHD medication (waves 1–7).</item> </ulist> <hd id="AN0188923023-14">Longitudinal Association Between ADHD Clinical Symptoms and Children's HRQoL From 4 to 17 yea...</hd> <p>Mixed effects model showed that children with clinical ADHD symptoms experienced significantly poorer HRQoL than children without ADHD symptoms for overall HRQoL (mean difference = 7.65, 95% CI [6.09, 9.19]) and for all HRQoL domains including physical (mean difference = 5.77, 95% CI [3.83, 7.72]), social (mean difference = 9.23, 95% CI [7.29, 11.17]), emotional (mean difference = 9.73, 95% CI [7.50, 11.97]), and school (mean difference = 3.06, 95% CI [0.78, 5.35]) domains (Table 3). The mean differences in overall HRQoL, social and emotional domains were larger than the meaningful clinical differences for the PedsQL or its social and emotional domains.</p> <p>Table 3. Longitudinal Association Between ADHD Symptoms and Children's Overall HRQoL/HRQoL Domains From 4 to 17 Years (Mixed-effect Models).</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left" rowspan="2">Factors</th><th align="center" colspan="2">Overall HRQoL</th><th align="center" colspan="2">Physical domain</th><th align="center" colspan="2">Social domain</th><th align="center" colspan="2">Emotional domain</th><th align="center" colspan="2">School domain</th></tr><tr><th align="center">Coefficient</th><th align="center">95%<italic>CI</italic></th><th align="center">Coefficient</th><th align="center">95%<italic>CI</italic></th><th align="center">Coefficient</th><th align="center">95%<italic>CI</italic></th><th align="center">Coefficient</th><th align="center">95%<italic>CI</italic></th><th align="center">Coefficient</th><th align="center">95%<italic>CI</italic></th></tr></thead><tbody><tr><td>ADHD symptoms</td><td><bold>−7.65</bold></td><td><bold>[−9.19, −6.09]</bold></td><td><bold>−5.77</bold></td><td><bold>[−7.72, −3.83]</bold></td><td><bold>−9.23</bold></td><td><bold>[−11.17, −7.29]</bold></td><td><bold>−9.73</bold></td><td><bold>[−11.97, −7.50]</bold></td><td><bold>−3.06</bold></td><td><bold>[−5.35, −0.78]</bold></td></tr><tr><td>Female</td><td><bold>−0.91</bold></td><td><bold>[−1.56, −0.27]</bold></td><td><bold>−0.83</bold></td><td><bold>[−1.61, −0.04]</bold></td><td><bold>−1.25</bold></td><td><bold>[−2.04, −0.45]</bold></td><td>−0.69</td><td>[−1.52, 0.14]</td><td>−0.10</td><td>[−0.92, 0.72]</td></tr><tr><td>Indigenous</td><td>−2.24</td><td>[−5.19, 0.70]</td><td>−2.98</td><td>[−6.48, 0.52]</td><td>0.78</td><td>[−2.47, 4.03]</td><td><bold>−4.60</bold></td><td><bold>[−8.64, −0.55]</bold></td><td>0.17</td><td>[−3.43, 3.76]</td></tr><tr><td>Having autism</td><td><bold>−5.11</bold></td><td><bold>[−6.99, −3.23]</bold></td><td><bold>−3.19</bold></td><td><bold>[−5.43, −0.96]</bold></td><td><bold>−3.19</bold></td><td><bold>[−5.36, −1.01]</bold></td><td><bold>−10.27</bold></td><td><bold>[−12.70, −7.84]</bold></td><td>−1.57</td><td>[−3.61, 0.48]</td></tr><tr><td>Having other medical conditions</td><td><bold>−4.57</bold></td><td><bold>[−5.76, −3.38]</bold></td><td><bold>−4.72</bold></td><td><bold>[−6.18, −3.25]</bold></td><td><bold>−2.59</bold></td><td><bold>[−4.03, −1.15]</bold></td><td><bold>−6.11</bold></td><td><bold>[−7.74, −4.48]</bold></td><td><bold>−6.92</bold></td><td><bold>[−8.62, −5.22]</bold></td></tr><tr><td>Had ADD/ADHD medication</td><td><bold>−6.47</bold></td><td><bold>[−9.59, −3.35]</bold></td><td>−1.27</td><td>[−4.79, 2.25]</td><td><bold>−11.36</bold></td><td><bold>[−15.07, −7.64]</bold></td><td><bold>−9.58</bold></td><td><bold>[−13.74, −5.42]</bold></td><td>−0.68</td><td>[−3.75, 2.39]</td></tr><tr><td colspan="11">Number of siblings</td></tr><tr><td> 1</td><td>0.48</td><td>[−0.88, 1.85]</td><td>0.84</td><td>[−0.66, 2.35]</td><td>0.28</td><td>[−1.35, 1.91]</td><td>0.21</td><td>[−1.59, 2.02]</td><td>0.95</td><td>[−0.72, 2.62]</td></tr><tr><td> 2</td><td><bold>1.51</bold></td><td><bold>[0.08, 2.93]</bold></td><td><bold>2.13</bold></td><td>[0.57, 3.70]</td><td>1.01</td><td>[−0.72, 2.74]</td><td>1.46</td><td>[−0.41, 3.33]</td><td>1.00</td><td>[−0.75, 2.75]</td></tr><tr><td> 3 and more</td><td><bold>2.14</bold></td><td><bold>[0.61, 3.66]</bold></td><td><bold>2.58</bold></td><td>[0.81, 4.35]</td><td><bold>2.15</bold></td><td><bold>[0.27, 4.02]</bold></td><td>1.44</td><td>[−0.58, 3.46]</td><td>0.92</td><td>[−1.11, 2.96]</td></tr><tr><td>Living with both parents</td><td>6.77</td><td>[−0.45, 14.00]</td><td>8.80</td><td>[−0.16, 17.77]</td><td>1.64</td><td>[−5.85, 9.14]</td><td><bold>7.61</bold></td><td><bold>[0.77, 14.45]</bold></td><td>−2.60</td><td>[−7.41, 2.22]</td></tr><tr><td>Socioeconomic position</td><td>0.38</td><td>[−0.03, 0.79]</td><td><bold>0.56</bold></td><td><bold>[0.06, 1.06]</bold></td><td>−0.22</td><td>[−0.67, 0.24]</td><td><bold>0.71</bold></td><td><bold>[0.22, 1.20]</bold></td><td><bold>2.02</bold></td><td><bold>[1.50, 2.53]</bold></td></tr><tr><td>Caregiver's mental health</td><td><bold>−5.20</bold></td><td><bold>[−8.01, −2.39]</bold></td><td><bold>−3.75</bold></td><td><bold>[−6.87, −0.62]</bold></td><td><bold>−7.27</bold></td><td><bold>[−10.21, −4.34]</bold></td><td><bold>−6.48</bold></td><td><bold>[−10.10, −2.86]</bold></td><td>−3.53</td><td>[−7.27, 0.22]</td></tr><tr><td colspan="11">Wave</td></tr><tr><td> 2</td><td>−0.68</td><td>[−1.67, 0.32]</td><td>−0.76</td><td>[−1.90, 0.37]</td><td><bold>2.21</bold></td><td><bold>[1.15, 3.28]</bold></td><td><bold>−3.42</bold></td><td><bold>[−4.74, −2.09]</bold></td><td><bold>−3.89</bold></td><td><bold>[−5.16, −2.62]</bold></td></tr><tr><td> 3</td><td><bold>3.26</bold></td><td><bold>[1.92, 4.60]</bold></td><td><bold>4.64</bold></td><td><bold>[3.00, 6.28]</bold></td><td><bold>3.58</bold></td><td><bold>[2.03, 5.13]</bold></td><td>0.68</td><td>[−1.20, 2.56]</td><td>1.86</td><td>[−0.01, 3.73]</td></tr><tr><td> 4</td><td><bold>2.51</bold></td><td><bold>[1.08, 3.94]</bold></td><td>0.83</td><td>[−0.95, 2.62]</td><td><bold>4.93</bold></td><td><bold>[3.38, 6.49]</bold></td><td><bold>2.54</bold></td><td><bold>[0.61, 4.48]</bold></td><td><bold>2.01</bold></td><td><bold>[0.12, 3.91]</bold></td></tr><tr><td> 5</td><td><bold>1.01</bold></td><td><bold>[0.10, 1.92]</bold></td><td>0.32</td><td>[−0.74, 1.39]</td><td><bold>4.08</bold></td><td><bold>[2.96, 5.20]</bold></td><td>−0.95</td><td>[−2.13, 0.23]</td><td><bold>−5.15</bold></td><td><bold>[−6.44, −3.86]</bold></td></tr><tr><td>_cons</td><td><bold>74.40</bold></td><td><bold>[67.12, 81.67]</bold></td><td><bold>74.51</bold></td><td><bold>[65.60, 83.42]</bold></td><td><bold>71.52</bold></td><td><bold>[63.88, 79.17]</bold></td><td><bold>77.99</bold></td><td><bold>[71.06, 84.92]</bold></td><td><bold>92.98</bold></td><td><bold>[88.00, 97.95]</bold></td></tr></tbody></table> </ephtml> </p> <ulist> <item>6 <emph>Note</emph>. Number of observations = 9,715. Analyses are weighted and account for LSAC survey design. Significant statistics at a 5% significance level are in bold.</item> <item>7 Mean difference (coefficient): difference in mean HRQoL scores between children with and without ADHD symptoms, estimated as a random effect once random intercept.</item> <item>8 and random slope have been modelled to represent within child variability in repeated measures. Analyses were adjusted for ADHD symptoms (waves 1–7), SEP (waves 1–7), child gender (wave 1), Indigenous status (wave 1), autism (self-reported of ever had a diagnosis of autism), other medical conditions (waves 1–7), number of siblings (waves 1–7), living with both parents (waves 1–7), parental mental health (waves 1–7), had ADD/ADHD medication (waves 1–7). <emph>SE</emph> = standard errors; SEP = socioeconomic position; HRQoL = Health-related quality of life.</item> </ulist> <hd id="AN0188923023-15">Factors Contributing to the Association Between ADHD Clinical Symptoms and Children's HRQoL/H...</hd> <p>Child and family factors that influenced children's HRQoL are presented in Table 3. Having two or more siblings was associated with better HRQoL while parental mental health, having autism or other medical conditions or taking ADHD medication was associated with reduced children's HRQoL (Table 3). When additionally considering internalizing and externalizing problems in the analysis, the association between ADHD clinical symptoms and children's HRQoL were still significant and clinically meaningful albeit slightly reduced (mean difference = 4.91, 95% CI [3.40, 6.43]; Supplemental Table S2). Both internalizing (mean difference = 10.92, 95% CI [9.71, 12.13]) and externalizing problems (mean difference = 5.54, 95% CI [4.56, 6.51]) were associated with significantly poorer children's HRQoL with the mean difference in HRQoL well above the minimal clinically meaningful difference (Supplemental Table S2).</p> <hd id="AN0188923023-16">Discussion</hd> <p>This study is the first to explore the long-term association between ADHD clinical symptoms and children's HRQoL from 4 to 17 years and the factors that influence this association. We found that from 4 to 17 years of age, children with ADHD clinical symptoms have significantly poorer overall HRQoL across all domains than children without significant ADHD symptoms. Being from a family with two or more siblings was associated with better children's HRQoL while having other medical conditions or autism, taking ADHD medication, and having a caregiver with mental illness were associated with poorer overall HRQoL.</p> <p>Our findings about the poorer overall HRQoL in children with high ADHD symptoms compared to children without ADHD symptoms are consistent with the current meta-analyses and systematic reviews ([<reflink idref="bib33" id="ref71">33</reflink>]; [<reflink idref="bib68" id="ref72">68</reflink>]). We extended the current knowledge about the association between ADHD symptoms and children's HRQoL by presenting the longitudinal findings from 4 to 17 years. No research has explored the long-term impact of ADHD symptoms on children's HRQoL across a 13-year period.</p> <hd id="AN0188923023-17">Association Between ADHD Clinical Symptoms and Children's HRQoL</hd> <p>Consistent with previous studies ([<reflink idref="bib13" id="ref73">13</reflink>]; [<reflink idref="bib68" id="ref74">68</reflink>]), we found a reduction in HRQoL in social, emotional, and school domains (i.e., social and emotional HRQoL) in children and adolescents with ADHD clinical symptoms compared to typically developing children, with the magnitude of the reduction being twice the minimum clinically important difference of HRQoL measured by the PedsQL. Both social and communication skills may be reduced in children and adolescents with ADHD ([<reflink idref="bib31" id="ref75">31</reflink>]). This can impact their relationships and activities within the home, at school ([<reflink idref="bib36" id="ref76">36</reflink>]) and more broadly in the community ([<reflink idref="bib38" id="ref77">38</reflink>]). Additionally, children with ADHD face social difficulties including peer rejection, inappropriate behavior ([<reflink idref="bib50" id="ref78">50</reflink>]) as well as learning difficulties, putting them at greater risk for low academic achievement ([<reflink idref="bib12" id="ref79">12</reflink>]).</p> <p>We found a reduction in the physical domain of HRQoL in children with ADHD clinical symptoms, yet the magnitude of the HRQoL reduction is lower than that of the psychosocial domains. There are mixed findings about the impact of ADHD on the physical domain ([<reflink idref="bib33" id="ref80">33</reflink>]; [<reflink idref="bib68" id="ref81">68</reflink>]). Despite likely being hyperactive, children with ADHD are less likely to be physically active and participate in organized recreational activities ([<reflink idref="bib16" id="ref82">16</reflink>]). This lower participation rate may be associated with cognitive and emotional difficulties experienced by children with ADHD, or challenges related to social interactions not related to physical capabilities. Additionally, when engaged in physical activities, children with ADHD are more likely to become injured ([<reflink idref="bib64" id="ref83">64</reflink>]). On the other hand, a recent Spanish study found a positive correlation between increased levels of physical activity practices and children's HRQoL among those aged 8 to 14 years ([<reflink idref="bib17" id="ref84">17</reflink>]).</p> <hd id="AN0188923023-18">Child and Family Factors Influencing Children's HRQOL</hd> <p>Findings about the negative association between parental mental health and children's HRQoL align with current research in this area ([<reflink idref="bib18" id="ref85">18</reflink>]). Stressed mothers exhibited less responsiveness and empathy, and are more likely to show criticism, hostility, and negativity ([<reflink idref="bib69" id="ref86">69</reflink>]). Children of stressed parents have a greater risk of receiving reduced emotional and practical care ([<reflink idref="bib28" id="ref87">28</reflink>]). This may be particularly problematic in families of children with ADHD, who often face psychological and learning difficulties and require increased emotional, social, and learning support from parents. Research has also shown that strain on family functioning may lead to an increase in risk-taking behaviors by the child and worsen their resilience, resulting in reduced coping strategies and lower family involvement ([<reflink idref="bib47" id="ref88">47</reflink>]). Parental mental health may also influence how they rate their children's HRQoL. Research showed that parents with mental illness are more likely to rate their children's HRQoL lower than the children's rating and that parental mental health was the main predictor for this disagreement ([<reflink idref="bib46" id="ref89">46</reflink>]).</p> <p>The finding of poorer HRQoL in children with co-occurring medical conditions such as autism is consistent with the existing literature ([<reflink idref="bib25" id="ref90">25</reflink>]; [<reflink idref="bib65" id="ref91">65</reflink>]). Our study revealed that the additional reduction in children's HRQoL in children with autism or other medical conditions is itself considered clinically meaningful. It is, therefore, important to recognize and treat the co-occurring conditions in tandem with ADHD symptoms to improve children's overall health and well-being.</p> <p>We found that accounting for internalizing and externalizing behaviors did not attenuate the association between ADHD clinical symptoms and children's HRQoL across all HRQoL domains. This finding suggests that both ADHD symptoms and internalizing/externalizing problems contribute to reducing children's HRQoL.</p> <p>While previous studies reported on the positive effects of pharmaceutical treatment of ADHD on functional outcomes and HRQoL ([<reflink idref="bib9" id="ref92">9</reflink>]; [<reflink idref="bib11" id="ref93">11</reflink>]), with smaller effect sizes for children's HRQoL ([<reflink idref="bib5" id="ref94">5</reflink>]), in our population, having ADHD medication was associated with lower children's HRQoL. We found that those taking ADHD medication in our sample experienced more severe ADHD symptoms (analysis not shown), which may have significantly impacted children's functioning, such as social and emotional domains ([<reflink idref="bib29" id="ref95">29</reflink>]). Furthermore, the small sample size of children taking ADHD medication, especially in the early childhood phase (4–8 years) in our study, may affect the reliability of this finding. Caution must be taken when interpreting this result.</p> <hd id="AN0188923023-19">Strengths and Limitations</hd> <p>The strengths of this study include a large representative population sample, the exploration of the longitudinal association between ADHD symptoms and children's HRQoL and the inclusion of sample weights to account for sample attrition and clustering design. Limitations include the use of SDQ as a clinical measure for ADHD symptoms. While the SDQ is a valuable screening tool, it should not be used alone as an assessment tool for ADHD. However, it is the only available possible measure for ADHD clinical symptoms in LSAC. Research has found that SDQ is a valid outcome measure in randomized controlled trials and clinical setting ([<reflink idref="bib22" id="ref96">22</reflink>]) and that children with parent-reported ADHD were very similar to those with ADHD clinical symptoms on the SDQ ([<reflink idref="bib57" id="ref97">57</reflink>], [<reflink idref="bib55" id="ref98">55</reflink>]).</p> <p>Furthermore, the use of parent-proxy reports on both children's HRQoL and ADHD clinical symptoms may result in shared measure variance. Empirical research shows that among children with ADHD, parents rated their children's HRQoL and HRQoL domains lower than the children themselves ([<reflink idref="bib68" id="ref99">68</reflink>]). In the absence of the self-rated HRQoL in LSAC at ages 4 to 14 years, the parent-proxy report was the only available alternative. The parent-reported SDQ hyperactivity-inattention subscale has high internal consistency and reliability ([<reflink idref="bib42" id="ref100">42</reflink>]). While incorporating multiple informants would enhance robustness, parent reports remain highly informative, particularly in capturing behaviours across different settings, including the home environment, where ADHD symptoms are often most evident ([<reflink idref="bib27" id="ref101">27</reflink>]). Previous research has also reported moderate to good agreement between parent and teacher reports of SDQ ([<reflink idref="bib6" id="ref102">6</reflink>]; [<reflink idref="bib8" id="ref103">8</reflink>]).</p> <hd id="AN0188923023-20">Implications for Policy, Practice, and Future Research</hd> <p>Our study findings have important implications for both policy and future research. First, the findings about the poorer HRQoL across all HRQoL domains in children with ADHD clinical symptoms compared to children with no symptoms underscores the need for ADHD intervention/treatment to comprehensively address the behavioral, psychological, and educational needs of the child to improve overall health and well-being, not just manage the underlying symptoms ([<reflink idref="bib70" id="ref104">70</reflink>]). A recent meta-analysis supports the efficacy of pharmacological treatments in reducing core ADHD symptoms and improving HRQoL although the effects on HRQoL remain modest ([<reflink idref="bib5" id="ref105">5</reflink>]). It also highlights the need to explore the effects of combining pharmacological and non-pharmacological interventions for more holistic improvement in children's well-being.</p> <p>Furthermore, physical activity interventions have been shown to have a significant improvement in ADHD symptomology ([<reflink idref="bib72" id="ref106">72</reflink>]), thus encouraging children with ADHD to participate in appropriate physical activities may improve ADHD core symptoms. Further research is warranted to explore integrated treatment strategies to optimize children's overall well-being.</p> <p>Given the negative association between caregiver's mental health and children's HRQoL, supporting caregivers is essential to improve family functioning, children's social-emotional aspects, and overall well-being. Research shows that family cohesion and parental support not only improve children's HRQoL but also reduce emotional problems in adolescents with ADHD ([<reflink idref="bib54" id="ref107">54</reflink>]). Interventions targeting both caregivers' mental health and family dynamics can, thus play a pivotal role in fostering better long-term outcomes for children ([<reflink idref="bib41" id="ref108">41</reflink>]).</p> <p>Although we attempted to include many child and family factors in the analysis, we may have not included all factors that could influence children's HRQoL due to the unavailability of data in LSAC. For example, reduced psychosocial HRQoL may also be affected by external environmental factors such as lack of support and other significant contextual factors relating to school and family-based characteristics ([<reflink idref="bib58" id="ref109">58</reflink>]). Future research should explore other environmental and contextual factors to fully understand the determinants of children's HRQoL.</p> <hd id="AN0188923023-21">Conclusion</hd> <p>Children from 4 to 17 years of age with ADHD clinical symptoms have significantly poorer overall HRQoL across all HRQoL domains than children without ADHD symptoms. Children from families with two or more siblings had better children's HRQoL. Conversely, those with other medical conditions or autism, ADHD medication use, or a caregiver with mental illness were likely to experience poorer overall HRQoL. ADHD treatment needs to address psychosocial and learning needs in addition to ADHD core symptoms.</p> <hd id="AN0188923023-22">Supplemental Material</hd> <p>Graph: Supplemental material, sj-docx-1-jad-10.1177_10870547251353366 for The Long-Term Impact of ADHD on Children and Adolescents' Health-Related Quality of Life: Results From a Longitudinal Population-Based Australian Study by Ha Nguyet Dao Le, Courtney Keily, David Coghill and Lisa Gold in Journal of Attention Disorders</p> <p>Dr Ha Le is supported by Executive Dean Health postdoctoral fellowship at Deakin University.</p> <ref id="AN0188923023-23"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).</bibtext> </blist> <blist> <bibl id="bib2" idref="ref2" type="bt">2</bibl> <bibtext> American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Text revision).</bibtext> </blist> <blist> <bibl id="bib3" idref="ref3" type="bt">3</bibl> <bibtext> Armstrong D., Lycett K., Hiscock H., Care E., Sciberras E. (2015). Longitudinal associations between internalizing and externalizing comorbidities and functional outcomes for children with ADHD. Child Psychiatry & Human Development, 46, 736–748.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref12" type="bt">4</bibl> <bibtext> Becker S. P., Langberg J. M., Evans S. W., Girio-Herrera E., Vaughn A. J. (2015). Differentiating anxiety and depression in relation to the social functioning of young adolescents with ADHD. Journal of Clinical Child & Adolescent Psychology, 44(6), 1015–1029.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref20" type="bt">5</bibl> <bibtext> Bellato A., Perrott N. J., Marzulli L., Parlatini V., Coghill D., Cortese S. (2024). Systematic review and meta-analysis: Effects of pharmacological treatment for attention-deficit/hyperactivity disorder on quality of life. Journal of the American Academy of Child & Adolescent Psychiatry, 64, 346–361.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref102" type="bt">6</bibl> <bibtext> Bied A., Biederman J., Faraone S. (2017). Parent-based diagnosis of ADHD is as accurate as a teacher-based diagnosis of ADHD. Postgraduate Medicine, 129(3), 375–381.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref30" type="bt">7</bibl> <bibtext> Bussing R., Mason D. M., Bell L., Porter P., Garvan C. (2010). Adolescent outcomes of childhood attention-deficit/hyperactivity disorder in a diverse community sample. Journal of the American Academy of Child & Adolescent Psychiatry, 49(6), 595–605.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref103" type="bt">8</bibl> <bibtext> Cheng S., Keyes K. M., Bitfoi A., Carta M. G., Koç C., Goelitz D., Otten R., Lesinskiene S., Mihova Z., Pez O. (2018). Understanding parent–teacher agreement of the Strengths and Difficulties Questionnaire (SDQ): Comparison across seven European countries. International Journal of Methods in Psychiatric Research, 27(1), e1589.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref92" type="bt">9</bibl> <bibtext> Coghill D. (2010). The impact of medications on quality of life in attention-deficit hyperactivity disorder: A systematic review. CNS Drugs, 24, 843–866.</bibtext> </blist> <blist> <bibtext> Coghill D., Hodgkins P. (2016). Health-related quality of life of children with attention-deficit/hyperactivity disorder versus children with diabetes and healthy controls. European Child & Adolescent Psychiatry, 25, 261–271.</bibtext> </blist> <blist> <bibtext> Coghill D. R., Banaschewski T., Soutullo C., Cottingham M. G., Zuddas A. (2017). Systematic review of quality of life and functional outcomes in randomized placebo-controlled studies of medications for attention-deficit/hyperactivity disorder. European Child & Adolescent Psychiatry, 26, 1283–1307.</bibtext> </blist> <blist> <bibtext> Daley D., Birchwood J. (2010). ADHD and academic performance: Why does ADHD impact on academic performance and what can be done to support ADHD children in the classroom? Child: Care, Health and Development, 36(4), 455–464.</bibtext> </blist> <blist> <bibtext> Danckaerts M., Sonuga-Barke E. J., Banaschewski T., Buitelaar J., Döpfner M., Hollis C., Santosh P., Rothenberger A., Sergeant J., Steinhausen H.-C. (2010). The quality of life of children with attention deficit/hyperactivity disorder: A systematic review. European Child & Adolescent Psychiatry, 19, 83–105.</bibtext> </blist> <blist> <bibtext> Dey M., Landolt M. A., Mohler-Kuo M. (2012). Health-related quality of life among children with mental disorders: A systematic review. Quality of Life Research, 21, 1797–1814.</bibtext> </blist> <blist> <bibtext> Drummond M. F., Sculpher M. J., Claxton K., Stoddart G. L., Torrance G. W. (2015). Methods for the economic evaluation of health care programmes. Oxford University Press.</bibtext> </blist> <blist> <bibtext> Engel-Yeger B., Ziv-On D. (2011). The relationship between sensory processing difficulties and leisure activity preference of children with different types of ADHD. Research in Developmental Disabilities, 32(3), 1154–1162.</bibtext> </blist> <blist> <bibtext> Gallego-Méndez J., Perez-Gomez J., Calzada-Rodríguez J. I., Denche-Zamorano Á. M., Mendoza-Muñoz M., Carlos-Vivas J., Garcia-Gordillo M. Á., Adsuar J. C. (2020). Relationship between health-related quality of life and physical activity in children with hyperactivity. International Journal of Environmental Research and Public Health, 17(8), 2804.</bibtext> </blist> <blist> <bibtext> Galloway H., Newman E., Miller N., Yuill C. (2019). Does parent stress predict the quality of life of children with a diagnosis of ADHD? A comparison of parent and child perspectives. Journal of Attention Disorders, 23(5), 435–450.</bibtext> </blist> <blist> <bibtext> Gibbings J., Blakemore T., Strazdins L. (2009). Measuring family socioeconomic position. Australian Social Policy, 8, 121–168.</bibtext> </blist> <blist> <bibtext> Gillberg C., Gillberg I. C., Rasmussen P., Kadesjö B., Söderström H., Råstam M., Johnson M., Rothenberger A., Niklasson L. (2004). Co–existing disorders in ADHD–implications for diagnosis and intervention. European Child & Adolescent Psychiatry, 13, i80–i92.</bibtext> </blist> <blist> <bibtext> Goodman R. (2001). Psychometric properties of the strengths and difficulties questionnaire. Journal of the American Academy of Child & Adolescent Psychiatry, 40(11), 1337–1345.</bibtext> </blist> <blist> <bibtext> Hall C. L., Guo B., Valentine A. Z., Groom M. J., Daley D., Sayal K., Hollis C. (2019). The validity of the Strengths and Difficulties Questionnaire (SDQ) for children with ADHD symptoms. PLoS ONE, 14(6), e0218518.</bibtext> </blist> <blist> <bibtext> Hawes D. J., Dadds M. R. (2004). Australian data and psychometric properties of the Strengths and Difficulties Questionnaire. Australian & New Zealand Journal of Psychiatry, 38(8), 644–651.</bibtext> </blist> <blist> <bibtext> Howard S. (2008). Experimental design and analysis. Chapter 15: Mixed models (2nd ed.). Carnegie Mellon University. <ulink href="http://www.stat.cmu.edu/~hseltman/309/Book/chapter15.pdf">http://www.stat.cmu.edu/~hseltman/309/Book/chapter15.pdf</ulink></bibtext> </blist> <blist> <bibtext> Ikeda E., Hinckson E., Krägeloh C. (2014). Assessment of quality of life in children and youth with autism spectrum disorder: A critical review. Quality of Life Research, 23, 1069–1085.</bibtext> </blist> <blist> <bibtext> Jarrett M. A., Ollendick T. H. (2008). A conceptual review of the comorbidity of attention-deficit/hyperactivity disorder and anxiety: Implications for future research and practice. Clinical Psychology Review, 28(7), 1266–1280.</bibtext> </blist> <blist> <bibtext> Jungersen C. M., Lonigan C. J. (2021). Do parent and teacher ratings of ADHD reflect the same constructs? A measurement invariance analysis. Journal of Psychopathology and Behavioral Assessment, 43(4), 778–792.</bibtext> </blist> <blist> <bibtext> Kavanaugh M., Halterman J. S., Montes G., Epstein M., Hightower A. D., Weitzman M. (2006). Maternal depressive symptoms are adversely associated with prevention practices and parenting behaviors for preschool children. Ambulatory Pediatrics, 6(1), 32–37.</bibtext> </blist> <blist> <bibtext> Kazda L., McGeechan K., Bell K., Thomas R., Barratt A. (2022). Association of attention-deficit/hyperactivity disorder diagnosis with adolescent quality of life. JAMA Network Open, 5(10), e2236364.</bibtext> </blist> <blist> <bibtext> Kessler R. C., Barker P. R., Colpe L. J., Epstein J. F., Gfroerer J. C., Hiripi E., Howes M. J., Normand S.-L. T., Manderscheid R. W., Walters E. E. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184–189.</bibtext> </blist> <blist> <bibtext> Klimkeit E., Graham C., Lee P., Morling M., Russo D., Tonge B. (2006). Children should be seen and heard: Self-report of feelings and behaviors in primary-school-age children with ADHD. Journal of Attention Disorders, 10(2), 181–191.</bibtext> </blist> <blist> <bibtext> Knott R., Mellahn O. J., Tiego J., Kallady K., Brown L. E., Coghill D., Williams K., Bellgrove M. A., Johnson B. P. (2024). Age at diagnosis and diagnostic delay across attention-deficit hyperactivity and autism spectrums. Australian & New Zealand Journal of Psychiatry, 58(2), 142–151.</bibtext> </blist> <blist> <bibtext> Lee Y.-c., Yang H.-J., Chen V. C.-h., Lee W.-T., Teng M.-J., Lin C.-H., Gossop M. (2016). Meta-analysis of quality of life in children and adolescents with ADHD: By both parent proxy-report and child self-report using PedsQL™. Research in Developmental Disabilities, 51, 160–172.</bibtext> </blist> <blist> <bibtext> Lumley T., Diehr P., Emerson S., Chen L. (2002). The importance of the normality assumption in large public health data sets. Annual Review of Public Health, 23(1), 151–169.</bibtext> </blist> <blist> <bibtext> Matza L. S., Rentz A. M., Secnik K., Swensen A. R., Revicki D. A., Michelson D., Spencer T., Newcorn J. H., Kratochvil C. J. (2004). The link between health-related quality of life and clinical symptoms among children with attention-deficit hyperactivity disorder. Journal of Developmental & Behavioral Pediatrics, 25(3), 166–174.</bibtext> </blist> <blist> <bibtext> McQuade J. D., Hoza B. (2008). Peer problems in attention deficit hyperactivity disorder: Current status and future directions. Developmental Disabilities Research Reviews, 14(4), 320–324.</bibtext> </blist> <blist> <bibtext> Morsink S., Sonuga-Barke E., Van der Oord S., Van Dessel J., Lemiere J., Danckaerts M. (2021). Task-related motivation and academic achievement in children and adolescents with ADHD. European Child & Adolescent Psychiatry, 30, 131–141.</bibtext> </blist> <blist> <bibtext> Moyá J., Stringaris A. K., Asherson P., Sandberg S., Taylor E. (2014). The impact of persisting hyperactivity on social relationships: A community-based, controlled 20-year follow-up study. Journal of Attention Disorders, 18(1), 52–60.</bibtext> </blist> <blist> <bibtext> Mulligan A., Anney R., Butler L., O'Regan M., Richardson T., Tulewicz E. M., Fitzgerald M., Gill M. (2013). Home environment: Association with hyperactivity/impulsivity in children with ADHD and their non-ADHD siblings. Child: Care, Health and Development, 39(2), 202–212.</bibtext> </blist> <blist> <bibtext> Mulraney M., Giallo R., Sciberras E., Lycett K., Mensah F., Coghill D. (2019). ADHD symptoms and quality of life across a 12-month period in children with ADHD: A longitudinal study. Journal of Attention Disorders, 23(13), 1675–1685.</bibtext> </blist> <blist> <bibtext> Otto C., Haller A.-C., Klasen F., Hölling H., Bullinger M., Ravens-Sieberer U., Group B. S. (2017). Risk and protective factors of health-related quality of life in children and adolescents: Results of the longitudinal BELLA study. PLoS ONE, 12(12), e0190363.</bibtext> </blist> <blist> <bibtext> Palmieri P. A., Smith G. C. (2007). Examining the structural validity of the Strengths and Difficulties Questionnaire (SDQ) in a US sample of custodial grandmothers. Psychological Assessment, 19(2), 189.</bibtext> </blist> <blist> <bibtext> Pan P.-Y., Yeh C.-B. (2017). Impact of depressive/anxiety symptoms on the quality of life of adolescents with ADHD: A community-based 1-year prospective follow-up study. European Child & Adolescent Psychiatry, 26(6), 659–667.</bibtext> </blist> <blist> <bibtext> Polanczyk G. V., Willcutt E. G., Salum G. A., Kieling C., Rohde L. A. (2014). ADHD prevalence estimates across three decades: An updated systematic review and meta-regression analysis. International Journal of Epidemiology, 43(2), 434–442.</bibtext> </blist> <blist> <bibtext> Pollack B., Hojnoski R., DuPaul G. J., Kern L. (2016). Play behavior differences among preschoolers with ADHD: Impact of comorbid ODD and anxiety. Journal of Psychopathology and Behavioral Assessment, 38, 66–75.</bibtext> </blist> <blist> <bibtext> Radicke A., Barkmann C., Adema B., Daubmann A., Wegscheider K., Wiegand-Grefe S. (2021). Children of parents with a mental illness: Predictors of health-related quality of life and determinants of child–parent agreement. International Journal of Environmental Research and Public Health, 18(2), 379.</bibtext> </blist> <blist> <bibtext> Riley A. W., Spiel G., Coghill D., Döpfner M., Falissard B., Lorenzo M. J., Preuss U., Ralston** S. J., Group* A. S. (2006). Factors related to health-related quality of life (HRQoL) among children with ADHD in Europe at entry into treatment. European Child & Adolescent Psychiatry, 15, i38–i45.</bibtext> </blist> <blist> <bibtext> Rocco I., Corso B., Bonati M., Minicuci N. (2021). Time of onset and/or diagnosis of ADHD in European children: A systematic review. BMC Psychiatry, 21, 1–24.</bibtext> </blist> <blist> <bibtext> Romero M., Vivas-Consuelo D., Alvis-Guzman N. (2013). Is Health Related Quality of Life (HRQoL) a valid indicator for health systems evaluation? Springerplus, 2, 1–7.</bibtext> </blist> <blist> <bibtext> Ros R., Graziano P. A. (2018). Social functioning in children with or at risk for attention deficit/hyperactivity disorder: A meta-analytic review. Journal of Clinical Child & Adolescent Psychology, 47(2), 213–235.</bibtext> </blist> <blist> <bibtext> Sainsbury W. J., Carrasco K., Whitehouse A. J., McNeil L., Waddington H. (2023). Age of diagnosis for co-occurring autism and attention deficit hyperactivity disorder during childhood and adolescence: A systematic review. Review Journal of Autism and Developmental Disorders, 10(3), 563–575.</bibtext> </blist> <blist> <bibtext> Salari N., Ghasemi H., Abdoli N., Rahmani A., Shiri M. H., Hashemian A. H., Akbari H., Mohammadi M. (2023). The global prevalence of ADHD in children and adolescents: A systematic review and meta-analysis. Italian of Pediatrics, 49(1), 48.</bibtext> </blist> <blist> <bibtext> Sanson A., Nicholson J., Ungerer J., Zubrick S., Wilson K., Ainley J., Berthelsen D., Bittman M., Broom D., Harrison L. (2002). Introducing the longitudinal study of Australian children (LSAC discussion paper No. 1). Australian Institute of Family Studies.</bibtext> </blist> <blist> <bibtext> Schei J., Jozefiak T., Nøvik T. S., Lydersen S., Indredavik M. S. (2016). The impact of coexisting emotional and conduct problems on family functioning and quality of life among adolescents with ADHD. Journal of Attention Disorders, 20(5), 424–433.</bibtext> </blist> <blist> <bibtext> Sciberras E., Lucas N., Efron D., Gold L., Hiscock H., Nicholson J. M. (2017). Health care costs associated with parent-reported ADHD: A longitudinal Australian population–based study. Journal of Attention Disorders, 21(13), 1063–1072.</bibtext> </blist> <blist> <bibtext> Sciberras E., Lycett K., Efron D., Mensah F., Gerner B., Hiscock H. (2014). Anxiety in children with attention-deficit/hyperactivity disorder. Pediatrics, 133(5), 801–808.</bibtext> </blist> <blist> <bibtext> Sciberras E., Ukoumunne O. C., Efron D. (2011). Predictors of parent-reported attention-deficit/hyperactivity disorder in children aged 6–7 years: A national longitudinal study. Journal of Abnormal Child Psychology, 39, 1025–1034.</bibtext> </blist> <blist> <bibtext> Shabat T., Fogel-Grinvald H., Anaby D., Golos A. (2021). Participation profile of children and youth, aged 6–14, with and without ADHD, and the impact of environmental factors. International Journal of Environmental Research and Public Health, 18(2), 537.</bibtext> </blist> <blist> <bibtext> Sharpe H., Patalay P., Fink E., Vostanis P., Deighton J., Wolpert M. (2016). Exploring the relationship between quality of life and mental health problems in children: Implications for measurement and practice. European Child & Adolescent Psychiatry, 25, 659–667.</bibtext> </blist> <blist> <bibtext> Sipthorp M., Misson S. (2007). Wave 2 weighting and non-response. Australian Institute of Family Studies.</bibtext> </blist> <blist> <bibtext> Soloff S., Lawrence D., Johnstone R. (2005). LSAC technical paper no. 1. https://growingupinaustralia.gov.au/data-and-documentation/technical-papers</bibtext> </blist> <blist> <bibtext> StataCorp LLC, C. S., Texas 77845 USA. (2024).</bibtext> </blist> <blist> <bibtext> Sung L., Petrou S., Ungar W. J. (2010). Measurement of health utilities in children. In: Ungar W. J. (Ed.), Economic evaluation in child health (pp. 77–90). Oxford University Press.</bibtext> </blist> <blist> <bibtext> Tai Y.-M., Gau S. S.-F., Gau C.-S. (2013). Injury-proneness of youth with attention-deficit hyperactivity disorder: A national clinical data analysis in Taiwan. Research in Developmental Disabilities, 34(3), 1100–1108.</bibtext> </blist> <blist> <bibtext> Van Heijst B. F., Geurts H. M. (2015). Quality of life in autism across the lifespan: A meta-analysis. Autism, 19(2), 158–167.</bibtext> </blist> <blist> <bibtext> Varni J. W., Burwinkle T. M., Seid M., Skarr D. (2003). The PedsQL™* 4.0 as a pediatric population health measure: Feasibility, reliability, and validity. Ambulatory Pediatrics, 3(6), 329–341.</bibtext> </blist> <blist> <bibtext> Visser S. N., Danielson M. L., Bitsko R. H., Holbrook J. R., Kogan M. D., Ghandour R. M., Perou R., Blumberg S. J. (2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. Journal of the American Academy of Child & Adolescent Psychiatry, 53(1), 34–46.e32.</bibtext> </blist> <blist> <bibtext> Wanni Arachchige Dona S., Badloe N., Sciberras E., Gold L., Coghill D., Le H. N. (2023). The Impact of Childhood Attention-Deficit/Hyperactivity Disorder (ADHD) on children's health-related quality of life: A systematic review and meta-analysis. Journal of Attention Disorders, 27(6), 598–611.</bibtext> </blist> <blist> <bibtext> Whaley S. E., Pinto A., Sigman M. (1999). Characterizing interactions between anxious mothers and their children. Journal of Consulting and Clinical Psychology, 67(6), 826.</bibtext> </blist> <blist> <bibtext> Wilens T. E., Spencer T. J. (2010). Understanding attention-deficit/hyperactivity disorder from childhood to adulthood. Postgraduate Medicine, 122(5), 97–109.</bibtext> </blist> <blist> <bibtext> World Health Organization. (2023). Health and well-being. https://<ulink href="http://www.who.int/data/gho/data/major-themes/health-and-well-being">www.who.int/data/gho/data/major-themes/health-and-well-being</ulink></bibtext> </blist> <blist> <bibtext> Xie Y., Gao X., Song Y., Zhu X., Chen M., Yang L., Ren Y. (2021). Effectiveness of physical activity intervention on ADHD symptoms: A systematic review and meta-analysis. Frontiers in Psychiatry, 12, Article 706625.</bibtext> </blist> <blist> <bibtext> Zhao X., Hayes T., Timmons A. C., Wu W., Frazier S. L. (2023). Unpacking inequities in ADHD diagnosis: Examining individual-level race/ethnicity and state-level online information-seeking patterns. Administration and Policy in Mental Health and Mental Health Services Research, 50(4), 576–590.</bibtext> </blist> </ref> <ref id="AN0188923023-24"> <title> Footnotes </title> <blist> <bibtext> The Australian Institute for Family Studies approved the data used in this paper. The authors do not have permission to share the data. Data requests should be made following the LSAC public available form and appropriate approval would be needed.</bibtext> </blist> <blist> <bibtext> The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr. Ha Le is supported by the Executive Dean Health postdoctoral fellowship at Deakin University. The funder has no role in conceptualizing and decision to publish this manuscript.</bibtext> </blist> <blist> <bibtext> Ethical approval for LSAC was obtained from The Royal Children's Hospital (Melbourne) and the Australian Institute for Family Studies.</bibtext> </blist> <blist> <bibtext> All attending caregivers provided written consent for themselves and the study child.</bibtext> </blist> <blist> <bibtext> Not applicable.</bibtext> </blist> <blist> <bibtext> Ha Nguyet Dao Le</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0001-8279-8324</bibtext> </blist> <blist> <bibtext> Supplemental material for this article is available online.</bibtext> </blist> </ref> <aug> <p>By Ha Nguyet Dao Le; Courtney Keily; David Coghill and Lisa Gold</p> <p>Reported by Author; Author; Author; Author</p> <p></p> <p>Ha Nguyet Dao Le, BScEcon, MHEcon, PhD, is a senior research fellow at Deakin Health Economics, School of Health and Social Development, Deakin University.</p> <p>Courtney Keily, BSc, MPH, is an optometrist and was a research assistant at Deakin health economics, Deakin University.</p> <p>David Coghill, BSc, MBChB, MD, is the Chair of Developmental Mental Health at the University of Melbourne and a professor of child and adolescent psychiatry at the Royal Children's Hospital.</p> <p>Lisa Gold, PhD, is a professor in the economics of maternal and child health at Deakin Health Economics, Deakin University.</p> </aug> <nolink nlid="nl1" bibid="bib44" firstref="ref4"></nolink> <nolink nlid="nl2" bibid="bib52" firstref="ref5"></nolink> <nolink nlid="nl3" bibid="bib67" firstref="ref7"></nolink> <nolink nlid="nl4" bibid="bib32" firstref="ref8"></nolink> <nolink nlid="nl5" bibid="bib48" firstref="ref9"></nolink> <nolink nlid="nl6" bibid="bib37" firstref="ref11"></nolink> <nolink nlid="nl7" bibid="bib45" firstref="ref13"></nolink> <nolink nlid="nl8" bibid="bib68" firstref="ref14"></nolink> <nolink nlid="nl9" bibid="bib71" firstref="ref15"></nolink> <nolink nlid="nl10" bibid="bib14" firstref="ref16"></nolink> <nolink nlid="nl11" bibid="bib13" firstref="ref17"></nolink> <nolink nlid="nl12" bibid="bib33" firstref="ref18"></nolink> <nolink nlid="nl13" bibid="bib15" firstref="ref19"></nolink> <nolink nlid="nl14" bibid="bib63" firstref="ref21"></nolink> <nolink nlid="nl15" bibid="bib49" firstref="ref22"></nolink> <nolink nlid="nl16" bibid="bib59" firstref="ref23"></nolink> <nolink nlid="nl17" bibid="bib35" firstref="ref29"></nolink> <nolink nlid="nl18" bibid="bib29" firstref="ref31"></nolink> <nolink nlid="nl19" bibid="bib40" firstref="ref32"></nolink> <nolink nlid="nl20" bibid="bib51" firstref="ref33"></nolink> <nolink nlid="nl21" bibid="bib10" firstref="ref34"></nolink> <nolink nlid="nl22" bibid="bib73" firstref="ref36"></nolink> <nolink nlid="nl23" bibid="bib39" firstref="ref38"></nolink> <nolink nlid="nl24" bibid="bib47" firstref="ref39"></nolink> <nolink nlid="nl25" bibid="bib20" firstref="ref40"></nolink> <nolink nlid="nl26" bibid="bib26" firstref="ref41"></nolink> <nolink nlid="nl27" bibid="bib56" firstref="ref42"></nolink> <nolink nlid="nl28" bibid="bib43" firstref="ref44"></nolink> <nolink nlid="nl29" bibid="bib53" firstref="ref49"></nolink> <nolink nlid="nl30" bibid="bib61" firstref="ref50"></nolink> <nolink nlid="nl31" bibid="bib66" firstref="ref52"></nolink> <nolink nlid="nl32" bibid="bib21" firstref="ref56"></nolink> <nolink nlid="nl33" bibid="bib55" firstref="ref57"></nolink> <nolink nlid="nl34" bibid="bib42" firstref="ref58"></nolink> <nolink nlid="nl35" bibid="bib23" firstref="ref60"></nolink> <nolink nlid="nl36" bibid="bib30" firstref="ref62"></nolink> <nolink nlid="nl37" bibid="bib19" firstref="ref63"></nolink> <nolink nlid="nl38" bibid="bib34" firstref="ref67"></nolink> <nolink nlid="nl39" bibid="bib24" firstref="ref68"></nolink> <nolink nlid="nl40" bibid="bib60" firstref="ref69"></nolink> <nolink nlid="nl41" bibid="bib62" firstref="ref70"></nolink> <nolink nlid="nl42" bibid="bib31" firstref="ref75"></nolink> <nolink nlid="nl43" bibid="bib36" firstref="ref76"></nolink> <nolink nlid="nl44" bibid="bib38" firstref="ref77"></nolink> <nolink nlid="nl45" bibid="bib50" firstref="ref78"></nolink> <nolink nlid="nl46" bibid="bib12" firstref="ref79"></nolink> <nolink nlid="nl47" bibid="bib16" firstref="ref82"></nolink> <nolink nlid="nl48" bibid="bib64" firstref="ref83"></nolink> <nolink nlid="nl49" bibid="bib17" firstref="ref84"></nolink> <nolink nlid="nl50" bibid="bib18" firstref="ref85"></nolink> <nolink nlid="nl51" bibid="bib69" firstref="ref86"></nolink> <nolink nlid="nl52" bibid="bib28" firstref="ref87"></nolink> <nolink nlid="nl53" bibid="bib46" firstref="ref89"></nolink> <nolink nlid="nl54" bibid="bib25" firstref="ref90"></nolink> <nolink nlid="nl55" bibid="bib65" firstref="ref91"></nolink> <nolink nlid="nl56" bibid="bib11" firstref="ref93"></nolink> <nolink nlid="nl57" bibid="bib22" firstref="ref96"></nolink> <nolink nlid="nl58" bibid="bib57" firstref="ref97"></nolink> <nolink nlid="nl59" bibid="bib27" firstref="ref101"></nolink> <nolink nlid="nl60" bibid="bib70" firstref="ref104"></nolink> <nolink nlid="nl61" bibid="bib72" firstref="ref106"></nolink> <nolink nlid="nl62" bibid="bib54" firstref="ref107"></nolink> <nolink nlid="nl63" bibid="bib41" firstref="ref108"></nolink> <nolink nlid="nl64" bibid="bib58" firstref="ref109"></nolink>
Header DbId: eric
DbLabel: ERIC
An: EJ1488304
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: The Long-Term Impact of ADHD on Children and Adolescents' Health-Related Quality of Life: Results from a Longitudinal Population-Based Australian Study
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Ha+Nguyet+Dao+Le%22">Ha Nguyet Dao Le</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-8279-8324">0000-0001-8279-8324</externalLink>)<br /><searchLink fieldCode="AR" term="%22Courtney+Keily%22">Courtney Keily</searchLink><br /><searchLink fieldCode="AR" term="%22David+Coghill%22">David Coghill</searchLink><br /><searchLink fieldCode="AR" term="%22Lisa+Gold%22">Lisa Gold</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Attention+Disorders%22"><i>Journal of Attention Disorders</i></searchLink>. 2025 29(14):1278-1289.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 12
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Attention+Deficit+Hyperactivity+Disorder%22">Attention Deficit Hyperactivity Disorder</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink><br /><searchLink fieldCode="DE" term="%22Quality+of+Life%22">Quality of Life</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Health%22">Child Health</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Correlation%22">Correlation</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Behavior%22">Child Behavior</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Australia%22">Australia</searchLink>
– Name: SubjectThesaurus
  Label: Assessment and Survey Identifiers
  Group: Su
  Data: <searchLink fieldCode="SU" term="%22Strengths+and+Difficulties+Questionnaire%22">Strengths and Difficulties Questionnaire</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/10870547251353366
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1087-0547<br />1557-1246
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: 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 [greater than or equal to]5 on the Emotional Problems and scores [greater than or equal to]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.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1488304
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1488304
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/10870547251353366
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 12
        StartPage: 1278
    Subjects:
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Attention Deficit Hyperactivity Disorder
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Adolescents
        Type: general
      – SubjectFull: Symptoms (Individual Disorders)
        Type: general
      – SubjectFull: Quality of Life
        Type: general
      – SubjectFull: Child Health
        Type: general
      – SubjectFull: Behavior Problems
        Type: general
      – SubjectFull: Correlation
        Type: general
      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Child Behavior
        Type: general
      – SubjectFull: Australia
        Type: general
      – SubjectFull: Strengths and Difficulties Questionnaire
        Type: general
    Titles:
      – TitleFull: The Long-Term Impact of ADHD on Children and Adolescents' Health-Related Quality of Life: Results from a Longitudinal Population-Based Australian Study
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Ha Nguyet Dao Le
      – PersonEntity:
          Name:
            NameFull: Courtney Keily
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            NameFull: David Coghill
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          Name:
            NameFull: Lisa Gold
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          Dates:
            – D: 01
              M: 12
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 1087-0547
            – Type: issn-electronic
              Value: 1557-1246
          Numbering:
            – Type: volume
              Value: 29
            – Type: issue
              Value: 14
          Titles:
            – TitleFull: Journal of Attention Disorders
              Type: main
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