The high cost of undiagnosed and untreated ADHD: Unequal mental-health access and the care economy

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that can persist from childhood into older adulthood. It impacts 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 due to differences in presentation.

A recent study suggests that women tend to be diagnosed five years later than men. This gap is significant as 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.”

Read more:
Not just boys: The overlooked story of ADHD in women and girls

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 behaviours.

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 in 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 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 per cent 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 decreased 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 per cent of GDP and 21 per cent 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 continues 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.