Attention Deficit/hyperactivity Disorder: Underwriting Implications

Attention deficit/hyperactivity disorder (AD/HD) encompasses a wide clinical spectrum which can have major significance in the underwriting process of insurance. Recent studies suggest that there is evidence of familial incidence for AD/H D as well as association with affective disorders. The combination of depression and AD/HD is associated with a higher incidence of completed suicide than with depression alone. ATTENTION deficit disorder, with and without hyperactivity, is a heterogenous disorder of unknown etiology characterized by inattentiveness, excessive motor activity, impulsivity, and distractibility. It is a major clinical and public health problem estimated to affect 6% to 9% of school age children. It is one of the most common causes of referrals in family practice, pediatric, neurolog~ and child psychiatry clinics.1 Treatment, which can vary significantly from doctor to doctor and from region to region, can include medical as well as psychotherapy or a combination of both. As such, this disorder has particular significance in the underwriting of life and health insurance policies. In this article we hope to raise consciousness regarding the breadth of symptomatology and severity of attention deficit/hyperactivity disorder (AD/HD), as well as explore underwriting implications. Clinical Perspective As with most psychiatric conditions, AD/HD is a clinical spectrum. This can range from the minimally affected first grader who has reading difficulties to the destructive uncontrollable teen. It is clear that there are certain affective disorders that when present in combination with AD/HD can signal concern for more serious underlying psychiatric needs and concerns. Recent studies have shown that there appears to be a significant correlation between AD/HD and affective disorders. Anderson et al2 found that 15% of children with attention deficit also had a major depressive disM. Moore, Medical Director; L. Karlovec, Manager Psychological Services, Nationwide Insurance, Columbus, Ohio. order. Similar findings were reported by Bird et al.3 In clinical samples, Staton and Brumback reported that 75% of hyperactive children met criteria for depression.4 In addition to affective disorders, AD/HD can be associated with conduct disorders. Conduct disorder is defined by DSM HI as a persistent pattern of conduct in which the basic rights of others and major al~propriate societal norms or rules are violated. Kutcher~ reported that within an adolescent group diagnosed with conduct disorder, the incidence of substance abuse and AD/HD was higher than in the normal population.