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Child Psychiatrist /Adult Psychiatrist

ADHD and Loneliness Compounds Mental Health Difficulties in Young People

Keypoint: Young people with ADHD experience higher levels of loneliness, which in turn contribute to worse mental health outcomes.

Mental Health

Young people with attention-deficit/hyperactivity disorder (ADHD) experience higher levels of loneliness than their peers without ADHD, according to results from a systematic review and meta-analysis published in the Journal of Attention Disorders. These higher levels of loneliness are associated with additional mental health difficulties, emphasizing the need for early interventions in this population.

Although individuals with ADHD often experience social difficulties, relatively little is known about the prevalence of loneliness — the subjective experience of perceived social isolation — among young people with ADHD. Because both ADHD and loneliness are separately associated with adverse mental health outcomes, understanding the prevalence and effect of this comorbidity may help researchers and providers develop mental health interventions for individuals with ADHD.

To this aim, investigators conducted a systematic review and meta-analysis to determine the 1) prevalence of loneliness among young people (10 to 24 years of age) with and without ADHD and 2) how loneliness affects mental health in individuals with ADHD. The investigators searched publication databases for cross-sectional or longitudinal quantitative studies that evaluated at least 1 measure of loneliness among young people with ADHD. Participants’ ADHD was verified via Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses, International Classification of Disease (ICD) codes, or symptomatic presentation.

A total of 20 studies were included, 17 of which included a comparison group in addition to individuals with ADHD. Additionally, 8 studies evaluated mental health difficulties associated with loneliness among young people with ADHD. The pooled sample size was 1253 for participants with ADHD and 5028 for the non-ADHD comparator cohort. The ADHD cohort primarily comprised boys/men while the non-ADHD cohort had more girls/women.

The investigators observed that 9 out of the 17 studies found higher levels of loneliness in the ADHD group, while 4 showed no notable differences, 3 did not conduct significance tests, and 1 indicated lower loneliness levels in the ADHD group during adolescence compared to childhood. The meta-analysis results confirmed that younger people with ADHD reported significantly higher levels of loneliness (Hedges g, 0.41; 95% CI, 0.25, 0.58; P <.001) relative to individuals without ADHD. Despite concerns about potential publication bias, moderator analyses indicated no significant influence on the effect size.

In the systematic review exploring the association between loneliness and mental health difficulties in young individuals with ADHD, the investigators found significant positive associations between loneliness and externalizing behavior, internalizing behaviors, depression, anxiety, and addiction among individuals with ADHD. Loneliness fully mediated the association between depression and ADHD symptoms, and a diagnosis of ADHD diagnosis was a significant predictor for major depressive disorder onset, even after controlling for confounders. Additionally, social anxiety and internet addiction were correlated with loneliness in young individuals with ADHD.

Authors concluded, “This review highlights that loneliness may be an important problem in ADHD and clinicians should be aware of and assess the potential for elevated loneliness in this population.” The investigators noted, “A better understanding of the experience of loneliness in young people with ADHD, including what contributes to their loneliness, may aid in developing loneliness interventions targeted for this population.”

Study limitations include a small number of studies, the narrow focus on loneliness, and the use of a dichotomous categorization of ADHD (which may have excluded less severe presentations of ADHD).

Note: This article originally appeared on Psychiatry Advisor

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