Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that can persist from childhood into older adulthood. It affects individuals from all ethnic groups and socioeconomic backgrounds.
Current estimates suggest that one of every 21 people in Canada has the disorder. This number is likely to rise as our understanding of varied presentations and subtypes continues to improve.
While current research indicates that ADHD symptoms start at a similar age in both males and females, women are often misdiagnosed or diagnosed later in life because of differences in presentation.
A recent study suggests that women tend to be diagnosed five years later than men. This gap is significant because a delayed diagnosis leads to more severe and consequential symptoms. In other words, “women can lose on average five years of treatment, five years of a better life.”
We now know that women are more likely to present with predominantly inattentive symptoms such as getting easily distracted, having trouble staying organized and dealing with negative thoughts and feelings. Men, on the other hand, often present with more overt hyperactive and impulsive behaviors.
Geographic barriers
The growing recognition that ADHD often presents differently across genders has led to an increase in demand for diagnoses and supports for girls as well as adult women.
While the gender barriers are coming down, new research suggests that there remain significant geographical barriers to accessing diagnoses and treatment for both men and women with ADHD, particularly in regions where specialist services are limited and wait times are longer.
In Canada, these gaps are compounded by the uneven distribution of trained clinicians, differences in provincial health-care coverage and reduced access to mental-health services in rural and remote communities.
Unfortunately, this situation reflects the ongoing geographical inequities in Canadian health care more generally. While our understanding of ADHD has improved our ability to diagnose it, it has not improved our ability to offer services to everyone.
These inequities always come with hidden costs, not only for the individuals suffering the consequences of living with undiagnosed and/or misdiagnosed ADHD, but also for employers, health-care systems and communities that are underserved.
Economic impact of ADHD
One American study found that the total social and economic cost of ADHD from 2018 to 2019 was US$12.76 billion, with productivity costs accounting for 81% of that total.
In Canada, ADHD-related productivity losses are estimated to cost between $6 billion and $11 billion annually. These costs could be significantly reduced with equitable access to diagnoses and treatment. Delayed diagnosis increases reliance on health care and social services, especially when ADHD is misidentified as anxiety, depression or other mental-health conditions.
Health care spending is often framed as an economic drain. Mental health care is often the most vulnerable to this negative perception and is often understood as a privilege rather than a right.
Yet mental health disorders such as ADHD are among the top five causes of disability in Canada. These numbers indicate that without accessible mental health care, Canada’s health care will never be universal.
The care economy
Instead of understanding health care spending as an economic drain, advocates of the “care economy” are working to change this perception. Their research shows that while much care work remains unpaid, health and education alone account for 12.3% of GDP and 21% of all paid employment.
In fact, when it comes to GDP, the care economy is outpaced only by real estate and is far more of an economic driver than manufacturing, oil and gas, or finance.
As our awareness and understanding of ADHD continue to improve, many adults are now looking for diagnoses and treatments. Understanding the economic benefits of investing in equitable health care—including mental health care—across all regions of the country is an essential part of working to meet the demand while also building resilient local, provincial and national economies.
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