Skip to main content

Real-life instability in ADHD from young to middle adulthood: a nationwide register-based study of social and occupational problems



Studies using self-reports indicate that individuals with ADHD are at increased risk for functional impairments in social and occupational settings, but evidence around real-life instability remains limited. It is furthermore unclear if these functional impairments in ADHD differ across sex and across the adult lifespan.


A longitudinal observational cohort design of 3,448,440 individuals was used to study the associations between ADHD and residential moves, relational instability and job shifting using data from Swedish national registers. Data were stratified on sex and age (18–29 years, 30–39 years, and 40–52 years at start of follow up).


31,081 individuals (17,088 males; 13,993 females) in the total cohort had an ADHD-diagnosis. Individuals with ADHD had an increased incidence rate ratio (IRR) of residential moves (IRR 2.35 [95% CI, 2.32–2.37]), relational instability (IRR = 1.07 [95% CI, 1.06–1.08]) and job shifting (IRR = 1.03 [95% CI, 1.02–1.04]). These associations tended to increase with increasing age. The strongest associations were found in the oldest group (40–52 years at start of follow). Women with ADHD in all three age groups had a higher rate of relational instability compared to men with ADHD.


Both men and women with a diagnosis of ADHD present with an increased risk of real-life instability in different domains and this behavioral pattern was not limited to young adulthood but also existed well into older adulthood. It is therefore important to have a lifespan perspective on ADHD for individuals, relatives, and the health care sector.

Peer Review reports


Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that persists into adulthood for many individuals [1, 2]. The core symptoms of ADHD are a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning in life. Impulsivity refers to hasty actions that occur in the moment and that can manifest as making important decisions without considerations of long-term consequences (APA, 2013). Inattention problems in adults often leads to difficulties with time management, organizing activities and tasks and following instructions. Emotional dysregulation reflected in emotional impulsivity, negative affect and emotional self-regulation problems has also been considered as a core feature of ADHD [3, 4]. Although instability and impulsivity are characteristics of some other psychiatric disorders, like substance use disorder, borderline personality disorder and antisocial personality disorder there are indications that instability and impulsivity are more prominent features in ADHD [5,6,7,8]. These core characteristics of ADHD may manifest in real-life instability in occupational (e.g., job shifting), relational (e.g., divorce), and residential (residential moves) settings. However, a detailed understanding of real-life instability in adult ADHD is currently missing. This is an important limitation because instability in life are important predictors of negative life outcomes [9,10,11].

The few available observational studies suggest that adults with ADHD present with difficulties in different domains of real-life instability. In a recent narrative review of prospective studies on adult outcomes of children with ADHD followed into adulthood, it was concluded that individuals with ADHD have higher rates of quitting jobs and being fired [12]. Furthermore, a nationwide study in Denmark of welfare consequences for individuals with ADHD found that individuals with ADHD who were in employment had lower income levels than employed individuals without ADHD [13]. Recent narrative reviews of adult ADHD and romantic relationships suggested higher rates of romantic relationship problems for young adults with ADHD compared to those without ADHD [14, 15]. For example, one small study of adults found that inattentive symptoms were associated with greater interest in relational alternatives and less constructive responses to partner’s rude behaviors, whereas hyperactive-impulsive symptoms were associated with negative responses to rude behavior [16]. People with psychiatric conditions, including ADHD, move more often than the general population [17,18,19]. The increased rates of residential instability in individuals with ADHD could be due to elevated levels of impulsivity and restlessness – an urge to move around between different apartments and different places. ADHD could also be linked to higher rates of residential moves indirectly through higher rates of financial problems [20, 21]. Residential moves in adults are an important outcome because it has a close connection with various health outcomes in children [11, 22]. More research on the association between ADHD and residential instability is needed.

Previous research on ADHD and real-life instability largely consists of studies focused on young adults/individuals < 30 years [12], thus, very little information is available after young adulthood. This is a critical limitation given that the real-life impairments associated with ADHD may change across life. In order to build a more comprehensive lifespan model of real-life instability in ADHD, research on adults beyond young adulthood is needed. Another limitation of the available research on ADHD is that the focus is largely on males, while female presentations having been largely overlooked in both clinical and research settings [15]. The majority of studies on occupational and social instability in ADHD have used small samples, often without sex-specific analyses, and the outcomes are often self-reported through rating scales or by interviews. Self-reported problems in individuals with ADHD, although an important source of information, have been found to be limited in terms of validity [23,24,25].

Using large national registers from Sweden, the current study examined associations between ADHD and real-life instability over a 14-year period, with a focus on job shifting, relationship instability, and residential moves. The aim was to examine these associations in young and middle adulthood, and also across both males and females. Analyses were adjusted for parent education as previous research has established strong associations between ADHD and parental educational level [26], and because it is an important potential confounder that was fixed at the start of follow up of the individuals in this cohort. In contrast, the individuals own education level is time-varying and may change across follow up. We also included individuals own diagnoses of substance use disorder (SUD), borderline personality disorder (BPD), and criminal convictions until the end of follow up as covariates because previous research has demonstrated that these variables are associated with both ADHD [1, 27, 28] and real-life instability [29, 30].


Data sources and study population

Using the Swedish Total Population Register [31], we identified 3,448,440 individuals born between 1948 and 1982 who were alive and living in Sweden in 2013. All individuals were followed up during 14 years from January 2000 until December 2013. We linked these individuals to several registers by using a unique personal identifier [32]. The Multi Generation Register (MGR) contains information about parents of all individuals born in Sweden from 1932 or registered in the country since 1961 [33]. Using this information, it is possible to identify relatives to the linked individuals. The Integrated Database for Labor Market Research (LISA) contains information about unemployment benefits, disposable income, social welfare payments, civil status, migration, and highest attained education. For occupational data, LISA depends on the Occupation Register and are updated once a year [34]. The National Patient Register (NPR) includes information about somatic and psychiatric diagnoses based on the Swedish version of the International Classification of Diseases (ICD). The National Patient Register (NPR) covers inpatient psychiatric data from 1973 and outpatient psychiatric data from 2001 [35]. The Prescribed Drug Register (PDR) records all prescribed drugs in Sweden from 2005 and onwards [36]. The National crime register contains all convictions in Sweden from 1973 to 2013.


Individuals with ADHD were identified by at least one diagnosis of ADHD in the NPR by using ICD-diagnoses (ICD-9: code 314; ICD-10: code F90) or by at least four dispensations of ADHD medications (The Anatomical Therapeutical Chemical Codes (Amphetamine [N06BA01], Dexamphetamine [N06BA02], Methylphenidate [N06BA04], Lisdexamfetamine [N06BA12]) and non-stimulant medications (Atomoxetine [N06BA09]) in the PDR. Previous research has indicated high specificity for this register-based ADHD definition in Sweden [37, 38]. Furthermore, only physicians specialized in psychiatry/neurology and responsible for ADHD treatment are authorized to prescribe ADHD medication in Sweden, which suggests that prescription of ADHD medication is a valid indicator of ADHD diagnoses.


Job shifting

The LISA-register provides information about the extent to which an individual has changed jobs between two consecutive years. Using this information, we calculated a sum score for each individual, reflecting the total number of job changes during the follow-up across 14 years (between January 2000 and December 2013).

Relationship instability was approximated by using the MGR to measure how many children individuals have with different partners during the follow up between January 2000 and December 2013.

Residential moves

The LISA-register provides information about residential moves, for each individual, on an annual basis. Using this information, we calculated, for each individual, a sum score reflecting the total number of residential moves during the follow-up across 14 years.


The NPR were used to identify psychiatric diagnoses for BPD (F60.3) and SUD using ICD-diagnoses (ICD-8 codes 303 and 304; ICD-9 codes 303–305; ICD-10 codes F10-F19). The validity of the diagnoses of BPD in the NPR has been found to be good in an earlier Swedish register-based study [28]. In line with previous research, the National crime register was used to obtain information about criminal convictions [39]. The LISA register was used to obtain parents highest educational level.

Statistical analyses

To account for overdispersion, a negative binomial regression using the log link function was used to ascertain the relationship between ADHD and (1) job shifting, (2) relational instability, and (3) residential moves throughout follow-up. The analyses were stratified by age groups (18–29, 30–39, and 40–52 years at the start of follow-up) and sex (males, females). We first examined crude associations controlling for birth year and parent educational level. We then adjusted for SUD, BPD and criminal convictions. Effects of age and sex were tested in separate models. First, an interaction between ADHD and age group was included to determine whether the associations between ADHD and our outcomes were different among different age groups. Second, a separate test of interactions between ADHD and sex were included to assess if there were differences between males and females within each outcome. Finally, we tested a 3-way interaction between age x sex x ADHD to assess whether the sex-ADHD interaction varied in different age groups. Estimates are presented as incidence rate ratio (IRR) with 95% confidence intervals (CI).

To address the issue that some individuals are potentially not able to work and move around as much as other people, we did a sensitivity analysis where we excluded individuals with (1) severe intellectual disability, (2) an incarceration in prison longer than 2 years, (3) an annual/and or work-related income at baseline < 41,800 SEK/4,461 EUR, (4) disability pension at baseline, and (5) long term sick leave at baseline (> 183 days). Data management and statistical analyses were performed using SAS software version 9.4 (SAS Institute, Cary, NC, USA) and Stata 15 [40].


The demographic characteristics of the study population are presented in Table 1. Of the 3,448,400 individuals in this Swedish nationwide population 17,088 men (0.91%) and 13,993 women (0.84%) had an ADHD-diagnosis at some point during the follow up time. The prevalence of SUD (40%) and BPD (9.8%) were higher among individuals with ADHD compared to individuals without ADHD (SUD = 4.6%; BPD = 0.5%). Parental income was lower among individuals with ADHD. Table S1 presents the average number of job shifting, relational instability, and residential moves in the study population.

Table 1 Demographic characteristics of the study population

Associations between ADHD and real-life instability from young to middle adulthood

Adults with ADHD had an increased rate of residential moves (IRR = 2.35 [95% CI, 2.32–2.37], p < 0.001), relational instability (IRR = 1.07 [95% CI, 1.06–1.08], p < 0.001) and job shifting (IRR = 1.03 [95% CI, 1.02–1.04], p < 0.001) compared to individuals without ADHD. As can be seen from the age-stratified results in Table 2, these associations tended to increase with increasing age. All associations were significantly stronger in the older age groups (30–39 years and 40–52 years at start of follow up) compared to the youngest group (18–29 years at start of follow up), see Table 3. The older group also differed significantly from the middle age group on all of our outcomes (Residential moves IRR = 1.50 [1.47–1.54], p < 0.001, Relational instability IRR = 1.11[1.08–1.14], p < 0.001, Job shifting IRR = 1.09 [1.06–1.12], p < 0.001).

Table 2 Associations between ADHD and job shifting, children with different partners and residential moves

Males and females with ADHD in the youngest group did not differ significantly from controls without ADHD on job shifting and relational instability (Table 2). They did however have a higher rate of residential moves (IRR Males = 1.48 [95% CI, 1.45–1.49], p < 0.001; IRR Females = 1.41 [95% CI, 1.39–1.43], p < 0.001) see Table 2. The strongest associations between ADHD and real-life instability were found in the oldest group. Males and females (41–52 years) with ADHD had a significantly higher rate of job shifting (IRR Males = 1.13 [95% CI, 1.07–1.21], p < 0.001; IRR Females = 1.23 [95% CI, 1.13–1.34], p < 0.001), relational instability (IRR Males = 1.09 [95% CI, 1.05–1.16], p < 0.000; IRR Females = 1.18 [95% CI, 1.14–1.22], p < 0.001), and residential moves (IRR Males = 2.60 [95% CI, 2.46–2.75], p < 0.001; IRR Females = 2.28 [95% CI, 2.14–2.42], p < 0.001) compared to individuals in the same age without ADHD (Table 2). These crude associations were adjusted for birth year and maternal- and paternal educational level. The effect size attenuated for many of the observed associations after adjustment for BPD, SUD and criminal convictions, but all associations remained statistically significant. see Table 2.

Table 3 Interactions between age and job shifting, children with different partners and residential moves

Sex differences on the association between ADHD and real-life instability

As can be seen in Table 4, there was no significant difference between males and females with ADHD in the youngest age group (18–29 years) on job shifting (p = 0.936). However, compared with men, women with ADHD in the youngest age group had a significantly higher rate of relational instability (IRR = 1.18 [95% CI, 1.14–1.21], p < 0.001) and residential moves (IRR = 1.04 [95% CI, 1.02–1.07], p < 0.001) compared to men with ADHD. Women with ADHD in the two older age groups (30–39 years and 40–52 years) also had a significantly increased rate of relational instability (IRR 30–39 years = 1.15 [95% CI, 1.11–1.18], p < 0.001; IRR 41–52 years = 1.11 [95% CI, 1.06–1.17], p < 0.001) compared to men with ADHD, see Table 4. When examining how the moderating effect of sex on the relationship between ADHD and our outcomes could vary among different ages (i.e., sex × ADHD × age interaction), we found that this interaction did not vary at different age groups for job shifting (30–40, p = 0.743; >40 p = 0.084). For total moves, we found a significant 3-way interaction for the oldest age group (30–40 p = 0.726; >40 p < 0.001), and lastly, for relational instability, we saw a significant 3-way interaction for the age group 30–40 (p = 0.022), but not for the > 40 group (p = 0.173).

Table 4 Sex influences on the association between ADHD and job shifting, children with different partners and residential moves

Sensitivity analyses

All associations remained similar after excluding individuals; with severe intellectual disability, who were convicted for any crime more than two years, and/or were not in paid work, had disability pension, had long-term sick-leave at baseline, see Table S2.


To our knowledge, this is the first study examining associations between ADHD and register-based indicators of real-life instability, including job shifting, relational instability, and residential moves. Our primary finding was that both men and women with a diagnosis of ADHD presents with an increased risk of real-life instability in different domains, in particular beyond young adulthood. These findings shed important light on the real-life functioning of individuals with ADHD across the lifespan. Such information is critical given that recent research indicate that a large number of adults show elevated levels of ADHD symptoms, [41], but a detailed understanding of real-life functioning has until now been lacking in this age group. An increased awareness of real-life instability in ADHD across the lifespan may help reduce problems related to under-diagnosis and failures to provide adequate support for relevant real-life functional impairments in ADHD beyond young adulthood. Increased awareness of these risks are important for individuals with a diagnosis ADHD, their families and health care professionals because these factors are in themselves associated with negative outcomes in life, such as lower income, worse living conditions, and potentially harmful effects on children [11, 42].

Our findings of an increased risk of job shifting, relationship instability, and residential moves in adults with ADHD are broadly consistent with previous studies on social and occupational outcomes in adults with ADHD [12, 13, 16], but we were able to extend the available knowledge-base in three important ways.

First, the large sample size and long timescale allowed us to study associations between ADHD and real-life instability over 14 years in people aged 18 to 52 years at the start of follow-up. This allowed us to study real-life instability across a large part of the adult lifespan covering younger to middle aged adults. Our findings indicate that associations with real-life instability were more pronounced in middle aged adults with ADHD compared to younger adults with ADHD. The young adults with ADHD (18–29 years at start of follow up) had an 0–25% increased risk of real-life instability compared to individuals without ADHD. In contrast, the older groups with ADHD (30–39 and 40–52 years at start of follow up) had an 4–62% and 5–69% increased risk of real-life instability respectively compared to individuals without ADHD. One potential explanation for this pattern is that real-life instability is more normative in young adults, even in those without a diagnosis of ADHD. However, individuals with ADHD in the youngest age group (18–29 years) tended to make more residential moves compared to individuals without ADHD in the same age.

Second, our large sample size allowed us to present results separately for males and females. Overall, a similar pattern emerged across sex, suggesting that both males and females with ADHD show an increased risk of real-life instability. Our findings may, however, suggest that women with ADHD have a more pronounced risk for relationship instability compared to men with ADHD. Higher rates of relationship instability in females with ADHD is in line with findings from a recent review of females with a diagnosis of ADHD [15].

Third, we found that psychiatric comorbidity and severe behavioral problems (e.g., criminality) influence the risk of real-life instability in ADHD. These findings are consistent with a large body of research indicating that co-occurring psychiatric and behavioral problems have an important role for functional outcomes in ADHD, such as mortality, suicidal behavior, and educational level [43,44,45,46]. Even though our results demonstrated that associations attenuated after adjustment for these covariates, the associations between ADHD and different outcomes remained statistically significant but were quite small (IRR´s ranged from 1.05 to 1.69). Small effects were expected considering that our indicators of real-life instability are crude and multifactorial in nature. However, our findings are consistent with the hypothesis that core characteristics of ADHD, such as inattention, hyperactivity, and impulsivity manifest in real-world instability. Our findings point to the need of raising the awareness of real-life instability in adults with ADHD, from young to older adulthood.


Register-based studies capture only treatment seeking individuals. The ADHD-prevalence of 0.91% in our population-based sample is in line with other register-based studies on adult ADHD, but lower when compared with the 2.5% found in studies were all people with ADHD are identified - both treatment seeking individuals with earlier diagnoses and also not previously diagnosed individuals [47, 48]. We have a possible higher under-identification of ADHD in the older ages in our study. It should also be noted that the registers capture the more severe cases with ADHD, which limit the generalizability of our findings. Given the nature of the available register-data we were unable to explore potential differences between DSM ADHD subtypes (i.e., combined presentation, predominantly inattentive presentation and predominantly hyperactive/impulsive presentation). Thus, we cannot rule out potential differences between the ADHD presentations.

Using the number of children with different partners as a measure of relational instability is a crude measure. Also, there is a possibility that outcome misclassification is more pronounced in fathers than in mothers for our indicator of relational instability. This could potentially explain why we only see an association in females but not in males. However, the frequency of misattributed paternity in Sweden is low [49]. Using job shifting as a measure of real-life instability in young adulthood (18–29 years at start of follow up in our cohort) is not ideal since a lot of people in those ages are studying and a relatively high degree of job shifting is also normative. This can be a possible explanation to why we did not see an increased risk of job shifting in individuals with ADHD in younger adulthood. We used a broad definition of young adulthood (i.e., 18–29 years). While our selected age range for this group increased the possibility for variation in our indicators of instability we might also have introduced heterogeneity, which might limit the generalizability of our results to more narrow definitions of young adulthood (i.e., 18–25 years).

Overall, our indicators of instability have the advantage of being concrete reflections of real-life functioning, which could be useful in clinical settings to guide discussions around the treatment plan. On the other hand, our crude real-life indicators may miss important nuances of instability.

Our covariates SUD and criminal convictions are robust real-life measures but are indicators of the most severe end of externalizing problem and is probably lacking sensitivity as indicators of more moderate forms of externalizing problems. Since BPD is underdiagnosed in clinical practice and therefore also in the registers, this covariate probably lacks sensitivity as well [50]. Our selected covariates only adjust for measured confounding. It is possible that the associations would have further attenuated if we also adjusted for unmeasured confounding. Lastly, using job shifting as a measure of real-life instability in young adulthood (18–29 years at start of follow up in our cohort) is not ideal since a lot of people in those ages are studying and a relatively high degree of job shifting is also normative. This can be a possible explanation to why we did not see an increased risk of job shifting in individuals with ADHD in younger adulthood.


Both men and women with a diagnosis of ADHD present with an increased risk of real-life instability in different domains; a behavioral pattern that is not limited to childhood or adolescence but also exist well into adulthood. Clearly, it is important to have a lifespan perspective on ADHD for individuals, relatives and the health care sector.

Data Availability

The data that support the findings of this study are available from Statistics Sweden but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors ( upon reasonable request and with permission of Statistics Sweden.


  1. Franke B, Michelini G, Asherson P, Banaschewski T, Bilbow A, Buitelaar JK, et al. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. Eur Neuropsychopharmacol. 2018;28(10):1059–88.

    PubMed  PubMed Central  CAS  Google Scholar 

  2. Sibley MH, Arnold LE, Swanson JM, Hechtman LT, Kennedy TM, Owens E, et al. Variable patterns of Remission from ADHD in the Multimodal treatment study of ADHD. Am J Psychiatry. 2022;179(2):142–51.

    PubMed  Google Scholar 

  3. Faraone SV, Rostain AL, Blader J, Busch B, Childress AC, Connor DF, et al. Practitioner review: emotional dysregulation in attention-deficit/hyperactivity disorder - implications for clinical recognition and intervention. J Child Psychol Psychiatry. 2019;60(2):133–50.

    PubMed  Google Scholar 

  4. Shaw P, Stringaris A, Nigg J, Leibenluft E. Emotion dysregulation in attention deficit hyperactivity disorder. Focus (Am Psychiatr Publ). 2016;14(1):127–44.

    PubMed  Google Scholar 

  5. Krause-Utz A, Sobanski E, Alm B, Valerius G, Kleindienst N, Bohus M, et al. Impulsivity in relation to stress in patients with borderline personality disorder with and without co-occurring attention-deficit/hyperactivity disorder: an exploratory study. J Nerv Ment Dis. 2013;201(2):116–23.

    PubMed  Google Scholar 

  6. Lampe K, Konrad K, Kroener S, Fast K, Kunert HJ, Herpertz SC. Neuropsychological and behavioural disinhibition in adult ADHD compared to borderline personality disorder. Psychol Med. 2007;37(12):1717–29.

    PubMed  CAS  Google Scholar 

  7. Ortal S, van de Glind G, Johan F, Itai B, Nir Y, Iliyan I, et al. The role of different aspects of Impulsivity as Independent Risk factors for Substance Use Disorders in patients with ADHD: a review. Curr Drug Abuse Rev. 2015;8(2):119–33.

    PubMed  Google Scholar 

  8. Storebø OJ, Simonsen E. The Association between ADHD and antisocial personality disorder (ASPD): a review. J Atten Disord. 2016;20(10):815–24.

    PubMed  Google Scholar 

  9. Moffitt TE, Arseneault L, Belsky D, Dickson N, Hancox RJ, Harrington H, et al. A gradient of childhood self-control predicts health, wealth, and public safety. Proc Natl Acad Sci U S A. 2011;108(7):2693–8.

    PubMed  PubMed Central  CAS  Google Scholar 

  10. Robson DA, Allen MS, Howard SJ. Self-regulation in childhood as a predictor of future outcomes: a meta-analytic review. Psychol Bull. 2020;146(4):324–54.

    PubMed  Google Scholar 

  11. Simsek M, Costa R, de Valk HAG. Childhood residential mobility and health outcomes: a meta-analysis. Health Place. 2021;71:102650.

    PubMed  Google Scholar 

  12. Cherkasova MV, Roy A, Molina BSG, Scott G, Weiss G, Barkley RA et al. Review: Adult Outcome as Seen Through Controlled Prospective Follow-up Studies of Children With Attention-Deficit/Hyperactivity Disorder Followed Into Adulthood.J Am Acad Child Adolesc Psychiatry. 2021.

  13. Jennum P, Hastrup LH, Ibsen R, Kjellberg J, Simonsen E. Welfare consequences for people diagnosed with attention deficit hyperactivity disorder (ADHD): a matched nationwide study in Denmark. Eur Neuropsychopharmacol. 2020;37:29–38.

    PubMed  CAS  Google Scholar 

  14. Wymbs BT, Canu WH, Sacchetti GM, Ranson LM. Adult ADHD and romantic relationships: what we know and what we can do to help. J Marital Fam Ther. 2021;47(3):664–81.

    PubMed  Google Scholar 

  15. Hinshaw SP, Nguyen PT, O’Grady SM, Rosenthal EA. Annual Research Review: Attention-deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions. J Child Psychol Psychiatry. 2022;63(4):484–96.

    PubMed  Google Scholar 

  16. VanderDrift LE, Antshel KM, Olszewski AK. Inattention and Hyperactivity-Impulsivity: their detrimental effect on romantic relationship maintenance. J Atten Disord. 2019;23(9):985–94.

    PubMed  Google Scholar 

  17. McCarthy JF, Valenstein M, Blow FC. Residential mobility among patients in the VA health system: associations with psychiatric morbidity, geographic accessibility, and continuity of care. Adm Policy Ment Health. 2007;34(5):448–55.

    PubMed  Google Scholar 

  18. Yuan Y, Manuel JI. The relationship between residential mobility and behavioral Health Service Use in a national sample of adults with Mental Health and/or substance abuse problems. J Dual Diagn. 2018;14(4):201–10.

    PubMed  Google Scholar 

  19. Weiss G, Hechtman L, Perlman T, Hopkins J, Wener A. Hyperactives as young adults: a controlled prospective ten-year follow-up of 75 children. Arch Gen Psychiatry. 1979;36(6):675–81.

    PubMed  CAS  Google Scholar 

  20. Bangma DF, Tucha L, Fuermaier ABM, Tucha O, Koerts J. Financial decision-making in a community sample of adults with and without current symptoms of ADHD. PLoS ONE. 2020;15(10):e0239343.

    PubMed  PubMed Central  CAS  Google Scholar 

  21. Brook JS, Brook DW, Zhang C, Seltzer N, Finch SJ. Adolescent ADHD and adult physical and mental health, work performance, and financial stress. Pediatrics. 2013;131(1):5–13.

    PubMed  PubMed Central  Google Scholar 

  22. Jelleyman T, Spencer N. Residential mobility in childhood and health outcomes: a systematic review. J Epidemiol Community Health. 2008;62(7):584–92.

    PubMed  CAS  Google Scholar 

  23. Du Rietz E, Kuja-Halkola R, Brikell I, Jangmo A, Sariaslan A, Lichtenstein P, et al. Predictive validity of parent- and self-rated ADHD symptoms in adolescence on adverse socioeconomic and health outcomes. Eur Child Adolesc Psychiatry. 2017;26(7):857–67.

    PubMed  PubMed Central  Google Scholar 

  24. Du Rietz E, Cheung CH, McLoughlin G, Brandeis D, Banaschewski T, Asherson P, et al. Self-report of ADHD shows limited agreement with objective markers of persistence and remittance. J Psychiatr Res. 2016;82:91–9.

    PubMed  PubMed Central  Google Scholar 

  25. Sibley MH, Pelham WE, Molina BSG, Gnagy EM, Waxmonsky JG, Waschbusch DA, et al. When diagnosing ADHD in young adults emphasize informant reports, DSM items, and impairment. J Consult Clin Psychol. 2012;80(6):1052–61.

    PubMed  PubMed Central  Google Scholar 

  26. Russell AE, Ford T, Williams R, Russell G. The Association between Socioeconomic disadvantage and attention Deficit/Hyperactivity disorder (ADHD): a systematic review. Child Psychiatry Hum Dev. 2016;47(3):440–58.

    PubMed  Google Scholar 

  27. Sundquist J, Ohlsson H, Sundquist K, Kendler KS. Attention-deficit/hyperactivity disorder and risk for drug use disorder: a population-based follow-up and co-relative study. Psychol Med. 2015;45(5):977–83.

    PubMed  CAS  Google Scholar 

  28. Kuja-Halkola R, Lind Juto K, Skoglund C, Ruck C, Mataix-Cols D, Perez-Vigil A, et al. Do borderline personality disorder and attention-deficit/hyperactivity disorder co-aggregate in families? A population-based study of 2 million swedes. Mol Psychiatry. 2021;26(1):341–9.

    PubMed  Google Scholar 

  29. Amundsen EJ, Bretteville-Jensen AL, Rossow I. Patients admitted to treatment for substance use disorder in Norway: a population-based case-control study of socio-demographic correlates and comparative analyses across substance use disorders. BMC Public Health. 2022;22(1):792.

    PubMed  PubMed Central  Google Scholar 

  30. Miller CE, Lewis KL, Huxley E, Townsend ML, Grenyer BFS. A 1-year follow-up study of capacity to love and work: what components of borderline personality disorder most impair interpersonal and vocational functioning? Personal Ment Health. 2018;12(4):334–44.

    PubMed  Google Scholar 

  31. Ludvigsson JF, Almqvist C, Bonamy AK, Ljung R, Michaëlsson K, Neovius M, et al. Registers of the swedish total population and their use in medical research. Eur J Epidemiol. 2016;31(2):125–36.

    PubMed  Google Scholar 

  32. Ludvigsson JF, Otterblad-Olausson P, Pettersson BU, Ekbom A. The swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol. 2009;24(11):659–67.

    PubMed  PubMed Central  Google Scholar 

  33. Ekbom A. The swedish multi-generation Register. Methods Mol Biol. 2011;675:215–20.

    PubMed  CAS  Google Scholar 

  34. Ludvigsson JF, Svedberg P, Olén O, Bruze G, Neovius M. The longitudinal integrated database for health insurance and labour market studies (LISA) and its use in medical research. Eur J Epidemiol. 2019;34(4):423–37.

    PubMed  PubMed Central  Google Scholar 

  35. Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, et al. External review and validation of the swedish national inpatient register. BMC Public Health. 2011;11:450.

    PubMed  PubMed Central  Google Scholar 

  36. Wettermark B, Hammar N, Fored CM, Leimanis A, Otterblad Olausson P, Bergman U, et al. The new Swedish prescribed Drug Register–opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiol Drug Saf. 2007;16(7):726–35.

    PubMed  Google Scholar 

  37. Zetterqvist J, Asherson P, Halldner L, Langstrom N, Larsson H. Stimulant and non-stimulant attention deficit/hyperactivity disorder drug use: total population study of trends and discontinuation patterns 2006–2009. Acta Psychiatr Scand. 2013;128(1):70–7.

    PubMed  CAS  Google Scholar 

  38. Larsson H, Rydén E, Boman M, Långström N, Lichtenstein P, Landén M. Risk of bipolar disorder and schizophrenia in relatives of people with attention-deficit hyperactivity disorder. Br J Psychiatry. 2013;203(2):103–6.

    PubMed  PubMed Central  Google Scholar 

  39. Latvala A, Kuja-Halkola R, Almqvist C, Larsson H, Lichtenstein P. A longitudinal study of resting heart rate and violent criminality in more than 700 000 men. JAMA Psychiatry. 2015;72(10):971–8.

    PubMed  Google Scholar 

  40. StataCorp. Stata Statistical Software: release 15. College Station, TX: StataCorp LLC; 2017.

    Google Scholar 

  41. Dobrosavljevic M, Solares C, Cortese S, Andershed H, Larsson H. Prevalence of attention-deficit/hyperactivity disorder in older adults: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2020;118:282–9.

    PubMed  Google Scholar 

  42. Lillehagen M, Isungset MA. New Partner, New Order? Multipartnered Fertility and Birth Order Effects on Educational Achievement. Demography. 2020;57(5):1625–46.

    PubMed  Google Scholar 

  43. Blanco-Vieira T, Santos M, Ferrão YA, Torres AR, Miguel EC, Bloch MH, et al. The impact of attention deficit hyperactivity disorder in obsessive-compulsive disorder subjects. Depress Anxiety. 2019;36(6):533–42.

    PubMed  Google Scholar 

  44. Castellano-García F, Benito A, Jovani A, Fuertes-Sáiz A, Marí-Sanmillán MI, Haro G. Sex Differences in Substance Use, Prevalence, Pharmacological Therapy, and Mental Health in Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD).Brain Sci. 2022;12(5).

  45. Mustonen A, Alakokkare AE, Scott JG, Halt AH, Vuori M, Hurtig T et al. Association of ADHD symptoms in adolescence and mortality in Northern Finland Birth Cohort 1986.Nord J Psychiatry. 2022:1–7.

  46. Olsson P, Wiktorsson S, Strömsten LMJ, Salander Renberg E, Runeson B, Waern M. Attention deficit hyperactivity disorder in adults who present with self-harm: a comparative 6-month follow-up study. BMC Psychiatry. 2022;22(1):428.

    PubMed  PubMed Central  Google Scholar 

  47. Simon V, Czobor P, Bálint S, Mészáros A, Bitter I. Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. Br J Psychiatry. 2009;194(3):204–11.

    PubMed  Google Scholar 

  48. Polyzoi M, Ahnemark E, Medin E, Ginsberg Y. Estimated prevalence and incidence of diagnosed ADHD and health care utilization in adults in Sweden - a longitudinal population-based register study. Neuropsychiatr Dis Treat. 2018;14:1149–61.

    PubMed  PubMed Central  CAS  Google Scholar 

  49. Dahlén T, Zhao J, Magnusson PKE, Pawitan Y, Lavröd J, Edgren G. The frequency of misattributed paternity in Sweden is low and decreasing: a nationwide cohort study. J Intern Med. 2022;291(1):95–100.

    PubMed  Google Scholar 

  50. Tyrer P. Accurate recording of personality disorder in clinical practice. BJPsych Bull. 2018;42(4):135–6.

    PubMed  PubMed Central  Google Scholar 

Download references


Not applicable.


Open access funding provided by Örebro University. This study was supported by award 2018–02599 from the Swedish Research Council (Vetenskapsrådet) (Dr Larsson), a grant from Shire International GmbH, a member of the Takeda group of companies (Dr Larsson), and by grant PD20-0036 from the Swedish Society for Medical Research (SSMF) (Dr Du Rietz), and Funds from the Strategic Research Program in Epidemiology at Karolinska Institutet, Fonden för Psykisk Hälsa and Fredrik & Ingrid Thurings Stiftelse (Dr Du Rietz). Although employees of the sponsors were involved in the editing and fact checking of information, the sponsors had no role in the content of this manuscript, the design and conduct of the study, collection, management, analysis, and interpretation of the data, preparation, review, or approval of the manuscript, and decision to submit the manuscript for publication.

Author information

Authors and Affiliations



Mr Ahlberg, Dr Garcia-Argibay and Dr Larsson had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis Concept and design: Ahlberg, Garcia-Argibay, Ahnemark, Werner-Kiechle, Andersson, Larsson. Acquisition, analysis, or interpretation of data: Ahlberg, Du Rietz, Ahnemark, Andersson, Werner-Kiechle, Lichtenstein, Larsson and Garcia-Argibay Drafting of the manuscript: Ahlberg, Larsson, Garcia-Argibay. Critical revision of the manuscript for important intellectual content: Ahlberg, Du Rietz, Ahnemark, Andersson, Werner-Kiechle, Lichtenstein, Larsson and Garcia-Argibay. Statistical analysis: Ahlberg, Garcia-Argibay. Supervision: Larsson, Werner-Kiechle, Garcia-Argibay.

Corresponding author

Correspondence to Rickard Ahlberg.

Ethics declarations

Ethics approval and consent to participate.

This study was approved by the regional ethical review board in Stockholm, Sweden (reference number: 2013/862 − 31/5). The informed consent of the participants is not required for pseudo-anonymized register-based research according to Swedish law (2003:640, § 34) See Ludvigsson et al. (2015) for a review of ethical aspects of registry-based research in the Nordic countries. All methods in the present study were carried out in accordance with relevant guidelines and regulations. Ludvigsson, et al., (2015). Ethical aspects of registry-based research in the Nordic countries. Clinical Epidemiology, 7, 491–508.

Consent for publication

Not applicable.

Competing interests

Dr Du Rietz reported serving as a speaker for Shire Sweden AB outside the submitted work. Dr Werner-Kiechle reported having stock options in Shire International GmbH and employment by and owning stock or having stock options in Janssen pharmaceuticals. LM Andersson are employed by Takeda Pharma AB. Dr Larsson reported serving as a speaker for Medice, Evolan Pharma AB, and Shire/Takeda and has received grants from Shire/Takeda outside the submitted work. No other disclosures were reported. The other authors do not have any competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1 Table S1 and Table S2

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ahlberg, R., Du Rietz, E., Ahnemark, E. et al. Real-life instability in ADHD from young to middle adulthood: a nationwide register-based study of social and occupational problems. BMC Psychiatry 23, 336 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: