The Economic Impact of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

University of North Carolina at Chapel Hill, North Carolina, United States
Journal of Pediatric Psychology (Impact Factor: 2.91). 08/2007; 32(6):711-27. DOI: 10.1093/jpepsy/jsm022
Source: PubMed


Using a cost of illness (COI) framework, this article examines the economic impact of attention-deficit/hyperactivity disorder (ADHD) in childhood and adolescence. Our review of published literature identified 13 studies, most conducted on existing databases by using diagnostic and medical procedure codes and focused on health care costs. Two were longitudinal studies of identified children with ADHD followed into adolescence. Costs were examined for ADHD treatment-related and other health care costs (all but 1 study addressed some aspect of health care), education (special education, 2 studies; disciplinary costs: 1 study), parental work loss (2 studies), and juvenile justice (2 studies). Based on this small and as yet incomplete evidence base, we estimated annual COI of ADHD in children and adolescents at $14,576 per individual (2005 dollars). Given the variability of estimates across studies on which that number is based, a reasonable range is between $12,005 and $17,458 per individual. Using a prevalence rate of 5%, a conservative estimate of the annual societal COI for ADHD in childhood and adolescence is $42.5 billion, with a range between $36 billion and $52.4 billion. Estimates are preliminary because the literature is incomplete; many potential costs have not been assessed in extant studies. Limitations of the review and suggestions for future research on COI of ADHD are provided.

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    • "ADHD is associated with impairment in daily activities, 18 academic performance, peer relations and family functioning 19 (Sawyer et al., 2002; Bastiaansen et al., 2004; Danckaerts et al., 20 2010). 21 Because of the impact of ADHD on patient and their family, the 22 disorder is likely to have significant economic implications for the 23 patient, family and society as a whole (Coghill et al., 2008; 24 Hakkaart-van Roijen et al., 2007; Pelham et al., 2007; Harpin, 2005; 25 Klassen et al., 2004). 26 It has been seen that despite the availability of evidence-based 27 treatments of psychiatric disorders in general and ADHD in 28 particular, there is low use of specialist services and only a 29 minority of children with mental health problems access specialist 30 mental health services (Ford, 2008; Canino et al., 2004; Sayal and 31 Taylor, 2004; Garralda, 2001). "
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    ABSTRACT: Attention deficit hyperactivity disorder (ADHD) is associated with impairment in all aspects of the patient's life. Despite availability of effective treatments for ADHD, a majority of the patient lack access to or have a significant delay in seeking help. This study aimed to assess the pathway of care in ADHD among patients attending the outpatient psychiatric services of a tertiary care centre in India. 57 newly registered cases of the age group 6-16 years with the diagnosis of ADHD as per DSM-IV-TR criteria were included in the study. Pathway of care was assessed on the semi structured proforma. The mean duration of delay in seeking help for ADHD symptoms was 3.96 Years (SD=1.96). Only 50% of the subjects consulted psychiatrists as first contact. Majority of the patients (45.61%) were referred by school teachers. Major reason given by the family members was that the patient was naughty rather than having any disorder for not seeking treatment in (89.47%). Our study showed that there was lack of recognition of ADHD at the level of other qualified practitioners and subsequent delay in referral to CAMHS. Sociocultural beliefs affected the help seeking by the parents. Copyright © 2015 Elsevier B.V. All rights reserved.
    Asian Journal of Psychiatry 08/2015; DOI:10.1016/j.ajp.2015.07.013
    • "Children with ADHD continue to experience social difficulties into adulthood (Mrug et al., 2012), which impacts both the individual and the community (Bagwell , Molina, Pelham & Hoza, 2001; Mrug et al., 2012; Pelham et al., 2007). Negative outcomes for individuals include the following: social delinquency, substance abuse, anxiety and decreased quality of life (Bagwell et al., 2001; Mrug et al., 2012); with an estimated societal cost of $12,005–$17,548 USD per child per year (Pelham et al., 2007). Hence, there is an urgent need for children with ADHD to receive interventions that address their social difficulties. "
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    ABSTRACT: Background Children with attention deficit hyperactivity disorder (ADHD) experience significant ongoing social difficulties which occur in multiple contexts. Interventions designed to improve these social difficulties have demonstrated minimal effectiveness. Thus, there is a clear need to establish interventions that are effective in addressing the social difficulties of children with ADHD across contexts and in the long term. Aim: To examine the long-term effectiveness and appropriateness of a pilot parent-delivered intervention designed to improve the social play skills of children with ADHD and their playmates.Method Participants included five children with ADHD who had completed the intervention 18-months prior, their typically developing playmates and mothers of children with ADHD. Blinded ratings from the Test of Playfulness were used to measure children's social play: post-intervention and 18-months following the intervention in the home and clinic. Wilcoxon signed-ranks and Cohen's-d calculations were used to measure effectiveness. Parents’ perspectives of the appropriateness of the intervention were explored through semi-structured interviews and data were analysed thematically.ResultsThe social play skills of children with ADHD and their playmates were maintained following the intervention in the home and clinic. Thematic analysis revealed four core-themes against an intervention appropriateness framework: new parenting tools, a social shift, adapting strategies over time and the next developmental challenge.Conclusion The parent-delivered intervention demonstrated long-term effectiveness and appropriateness for improving children's social play skills.SignificanceThese preliminary results are promising as maintaining treatment effects and achieving generalisation across contexts has remained an unachieved goal for most psycho-social interventions.
    Australian Occupational Therapy Journal 06/2015; 62(3):197-207. DOI:10.1111/1440-1630.12203 · 0.85 Impact Factor
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    • "ADHD is a disorder with a high impact on the healthcare system and the community in terms of economic costs, family stress, academic and vocational adversity (Matza et al., 2005). From an economic perspective, healthcare costs are greater for children and adults with ADHD compared with those without (Pelham et al., 2007). According to the European guidelines, the management of ADHD consists of nonpharmacological options, including behavioral therapy, and pharmacological options, including stimulants and nonstimulants . "
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    ABSTRACT: There is a lack of comparative effectiveness research among attention deficit hyperactivity disorder (ADHD) drugs in terms of efficacy and acceptability, where bupropion is compared with atomoxetine, lisdexamfetamine and methylphenidate. The main aim of this work was to compare the efficacy and acceptability of these drugs in children and adolescents using a metaanalysis. A literature search was conducted to identify double-blind, placebo-controlled, noncrossover studies of ADHD. PubMed/Medline and were searched. Comparative drug efficacy to placebo was calculated based on the standardized mean difference (SMD), while the comparative drug acceptability (all cause discontinuation) to placebo was estimated on the odds ratio (OR). In total 28 trials were included in the meta-analysis. Efficacy in reducing ADHD symptoms compared to placebo was small for bupropion (SMD=-0.32, 95% CI; -0.69, 0.05), while modest efficacy was shown for atomoxetine (SMD=-0.68, 95% CI; -0.76, -0.59) and methylphenidate (SMD=-0.75, 95% CI; -0.98, -0.52) and high efficacy was observed for lisdexamfetamine (SMD=-1.28, 95% CI; -1.84, -0.71). Compared to placebo treatment discontinuation was statistically significantly lower for methylphenidate (OR=0.35, 95% CI; 0.24, 0.52), while it was not significantly different for atomoxetine (OR=0.91, 95% CI; 0.66, 1.24), lisdexamfetamine (OR=0.60, 95% CI, 0.22, 1.65), and bupropion (OR=1.64, 95% CI; 0.5, 5.43). The heterogeneity was high, except in atomoxetine trials. The crossover studies were excluded. The effect sizes at specific time points were not computed. Studies with comorbid conditions, except those reporting on oppositional defiant disorder, were also excluded. All studies involving MPH were combined. The results suggest that lisdexamfetamine has the best benefit risk balance and has promising potential for treating children and adolescents with ADHD. More research is needed for a better clinical evaluation of bupropion. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 03/2015; DOI:10.1016/j.jad.2015.03.006 · 3.38 Impact Factor
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