Sick leave in young adults diagnosed with childhood ADHD and references, a prospective cohort study
Abstract
Background: Most studies on sickness absence (SA) and attention-deficit hyperactivity disorder (ADHD) are based on adults, irrespective of individual age at diagnosis.
Purpose: To explore future SA (in SA spells >14 days) and disability pension (DP) in young adults who were diagnosed with ADHD in childhood.
Methods: A prospective cohort study using microdata linked from 5 Swedish nationwide registers of the 62,910 people born in 1973-2001 diagnosed with ADHD when aged 4-17 and 1:8 references (n = 503,280) matched on sex and birth year, without childhood ADHD. Group‑based trajectory modelling was used to identify patterns of SADP days/year among those 7768 in the ADHD cohort and their 62,179 matched references who could be followed over 12-years (e.g., when aged 18-29). Multinominal logistic regression was used to estimate odds ratios (OR) of associations between individual factors and trajectory memberships.
Results: Young adults with childhood ADHD, especially women, had substantially higher SA and DP levels compared with matched references. In the 12-year follow-up, 6 SADP trajectories were identified among women with childhood ADHD: (1) ‘Low, constant’ (38.4% of all), (2) ‘Low, increasing some’ (13.3%), (3) ‘Low, increasing much’ (7.6%), (4) ‘Some, decreasing much’ (7.6%), (5) ‘Some and fluctuating’ (7.6%), and (6) ‘Some, increasing much’ (25.6%). Four of these trajectories were identified among men with childhood ADHD; 1) ‘Low, constant’ (57.1%), 2)’ Low, increasing some’ (8.7%), 4) ‘Some, decreasing much’ (24.2%), and 6) ‘Some, increasing much’ (24.2%). Among women with childhood ADHD, also diagnosed with childhood autism, the OR of belonging to 6) ‘Some, increasing much’ trajectory was 5.0 (95%CI 3.4-7.6). The corresponding OR for those men was 6.1 (95%CI 5.0-7.6).
Conclusions: Childhood ADHD was associated with significantly elevated and heterogeneous long‑term SADP patterns in young adulthood, with substantial sex differences. Autism increased the ORs of high SADP levels.
Key messages: • About 50% of women and 66% of men with childhood ADHD had trajectories of low levels or no sick-leave/disability pension during the 12-year follow-up, while about 25% had much increasing levels.
• Having both childhood ADHD and autism was associated with high and heterogenous SADP levels both in women and men. Knowledge is needed on how to support their future study- and work participation.
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BibTeX
@article{alexanderson2026sick,
title = {{Sick leave in young adults diagnosed with childhood ADHD and references, a prospective cohort study}},
author = {K Alexanderson and M Unenge Hallerbäck and K Sonnby and I Alaie and K Gémes},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.482},
url = {https://doi.org/10.1093/eurpub/ckag169.482},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Sick leave in young adults diagnosed with childhood ADHD and references, a prospective cohort study
AU - K Alexanderson
AU - M Unenge Hallerbäck
AU - K Sonnby
AU - I Alaie
AU - K Gémes
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.482
UR - https://doi.org/10.1093/eurpub/ckag169.482
AB - Background: Most studies on sickness absence (SA) and attention-deficit hyperactivity disorder (ADHD) are based on adults, irrespective of individual age at diagnosis. Purpose: To explore future SA (in SA spells >14 days) and disability pension (DP) in young adults who were diagnosed with ADHD in childhood. Methods: A prospective cohort study using microdata linked from 5 Swedish nationwide registers of the 62,910 people born in 1973-2001 diagnosed with ADHD when aged 4-17 and 1:8 references (n = 503,280) matched on sex and birth year, without childhood ADHD. Group‑based trajectory modelling was used to identify patterns of SADP days/year among those 7768 in the ADHD cohort and their 62,179 matched references who could be followed over 12-years (e.g., when aged 18-29). Multinominal logistic regression was used to estimate odds ratios (OR) of associations between individual factors and trajectory memberships. Results: Young adults with childhood ADHD, especially women, had substantially higher SA and DP levels compared with matched references. In the 12-year follow-up, 6 SADP trajectories were identified among women with childhood ADHD: (1) ‘Low, constant’ (38.4% of all), (2) ‘Low, increasing some’ (13.3%), (3) ‘Low, increasing much’ (7.6%), (4) ‘Some, decreasing much’ (7.6%), (5) ‘Some and fluctuating’ (7.6%), and (6) ‘Some, increasing much’ (25.6%). Four of these trajectories were identified among men with childhood ADHD; 1) ‘Low, constant’ (57.1%), 2)’ Low, increasing some’ (8.7%), 4) ‘Some, decreasing much’ (24.2%), and 6) ‘Some, increasing much’ (24.2%). Among women with childhood ADHD, also diagnosed with childhood autism, the OR of belonging to 6) ‘Some, increasing much’ trajectory was 5.0 (95%CI 3.4-7.6). The corresponding OR for those men was 6.1 (95%CI 5.0-7.6). Conclusions: Childhood ADHD was associated with significantly elevated and heterogeneous long‑term SADP patterns in young adulthood, with substantial sex differences. Autism increased the ORs of high SADP levels. Key messages: • About 50% of women and 66% of men with childhood ADHD had trajectories of low levels or no sick-leave/disability pension during the 12-year follow-up, while about 25% had much increasing levels. • Having both childhood ADHD and autism was associated with high and heterogenous SADP levels both in women and men. Knowledge is needed on how to support their future study- and work participation.
SN - 1101-1262
SN - 1464-360X
ER -