The association between likely ADHD and autism, and not being in employment, education, or training: a frequency-matched case-control study in working-age adults in the UK

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Quadt, L., Russell, E., Green, J., Joynson, E., Jones, B., Müller-Sedgwick, U., Davidson, C., Critchley, H. D., & Eccles, J. A. (2026). The association between likely ADHD and autism, and not being in employment, education, or training: a frequency-matched case-control study in working-age adults in the UK [Preprint]. openRxiv. https://doi.org/10.64898/2026.08.03.26359585

Journal or book title
medRxiv
Publisher
openRxiv
Publication date: 5 Aug 2026 Added to AutiHub: 25 Sep 2026 Type: Preprint Article language: English
Publisher source (DOI) Full text OpenAlex source

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Authors

Publication authors
9
Publication authors identified as autistic
2 / 9 (22.2%)
  1. Lisa Quadt *
  2. Emma Russell
  3. Jane Green *
  4. Emily Joynson
  5. Beth Jones
  1. Ulrich Müller-Sedgwick
  2. Conor Davidson
  3. Hugo D. Critchley
  4. Jessica A. Eccles

Abstract

Abstract Background To estimate the frequency of likely, often undiagnosed autism and attention deficit hyperactivity disorder (ADHD) in UK adults of working age (18-66 years) who are not in education, employment, or training (NEET), and to examine whether neurodivergent traits are associated with NEET status directly and indirectly via health burden and educational attainment. Design Frequency-matched online case-control study. Setting UK general population, recruited via online research platform Prolific. Participants Six hundred adults of working age (18-66 years); 300 NEET, 300 in education, employment, or training (EET) matched at the marginal level on age, sex assigned at birth, and ethnicity. Primary and secondary outcome measures Autistic traits (Ritvo Autism and Asperger Diagnostic Scale–14, RAADS-14) and ADHD traits (Adult ADHD Self-Report Scale, ASRS-5) indexed likely autism and ADHD (cut-off ≥14 on each). Physical and mental health conditions were self-reported and aggregated into composite indices of health burden. NEET status was the primary outcome; educational attainment and health burden were tested as parallel mediators of the association between neurodivergent traits and NEET status. Results NEET participants screened positive more frequently for likely autism (66.3% vs 49.0%; OR 2.05, 95% CI 1.48 to 2.85) and likely ADHD (34.3% vs 26.0%; OR 1.46, 95% CI 1.03 to 2.08) than EET participants, despite identical existing formal diagnosis rates. Physical (OR 2.00, 95% CI 1.38 to 2.90) and mental (OR 2.57, 95% CI 1.80 to 3.68) health conditions were also associated with higher odds of NEET status. In mediation analyses, neurodivergent traits predicted NEET status both directly (OR 1.33, 95% CI 1.13 to 1.68) and indirectly via greater health burden (indirect OR 1.13, 95% CI 1.02 to 1.35) and lower educational attainment (indirect OR 1.08, 95% CI 1.03 to 1.15). Conclusion NEET adults showed a marked excess of autism and ADHD traits, alongside elevated physical and mental health burden and lower educational attainment. Earlier recognition of neurodivergent traits, proactive provision of equitable requirements in education and employment, and integrated physical and mental health support may reduce NEET risk in this population. This has considerable implications for policy and practice in health, education, and wider society.

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Cited references
41
With a DOI
36
Without a DOI, from raw bibliography text
5
6 / 41 (14.6%) cited references include at least one author identified as autistic.
References with data to complete
7 / 41 (17.1%)
References with detected author names
34 / 41 (82.9%)
Without detected author names
7
Without a structured title
6
Without a stable identifier
5
References with raw author names still to review
5
References with external metadata lookup issues
1
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
182
From DOI or external metadata
182
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
7
51 / 182 (28.0%) names are linked to an author already present in AutiHub. 131 / 182 (72.0%) names are not yet linked.
Names linked to a person identified as autistic
7 / 182 (3.8%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 7 / 51 (13.7%). Distinct people identified as autistic: 5 / 171 (2.9%).
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