Article

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

ABSTRACT 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 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 Clinicaltrials.gov 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 · 3.71 Impact Factor
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    • "Psikiyatride Güncel Yaklaşımlar -Current Approaches in Psychiatry yen önemli bir ruh sağlığı problemidir (Ercan 2010). DEHB'li bireylerde yaşam boyu gözlenen problemler, ülke ekonomisini de ciddi şekilde etkilemektedir (Pelham ve ark. 2007, Le ve ark. 2013). DEHB'nin küratif şekilde tedavi edilmesi için DEHB ile ilişkili etmenlerin net olarak aydınlatılması oldukça önemlidir. Literatür incelendiğinde, demir eksikliğinin DEHB patofizyolojisi için bir risk faktörü olabileceği belirtilmekle birlikte, konu ile ilgili şu ana kadar yapılan çalışmalarda çelişkili sonuçlar elde e"
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    ABSTRACT: Dikkat eksikliği ve hiperaktivite bozukluğu, tıp literatüründe en iyi araştırılmış bozukluklardan biri olmasına rağmen, etiyolojisi halen net olarak açıklığa kavuşturulamamıştır. Dikkat eksikliği ve hiperaktivite bozukluğu’nun küratif şekilde tedavi edilmesi için bozukluk ile ilişkili etmenlerin net olarak aydınlatılması oldukça önemlidir. Literatür incelendiğinde, demir eksikliğinin dikkat eksikliği ve hiperaktivite bozukluğu patofizyolojisi için bir risk faktörü olabileceği belirtilmekle birlikte, konu ile ilgili şu ana kadar yapılan çalışmalarda çelişkili sonuçlar elde edildiği gözlenmektedir. Bu yazıda, dikkat eksikliği ve hiperaktivite bozukluğu patofizyolojisinde etkili olduğu düşünülen demir ve demirle ilişkili parametrelerin kan düzeyleri ile ilgili literatürdeki, çocuk ve ergen yaş grubunda, ülkemizde ve yurt dışında yapılmış konu ile ilgili çalışmaların incelenmesi, genel özelliklerinin derlenmesi ve sonuçlarının sunulması amaçlanmıştır.
    Psikiyatride Guncel Yaklasimlar 12/2014; 2015(7(1)):41-55.
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    • "Specifically, two-thirds of preschoolers with elevated behavior problems go on to receive a mental health diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) or another disruptive disorder by age nine, and receive later special education services (Campbell and Ewing 1990; Redden et al. 2003). The incremental annual cost of providing special education services to children with ADHD in the U.S. has been estimated to be $4,900 per child or between $15 and 22 billion annually (Pelham et al. 2007). Even more significant is that once a child enters special education, they are unlikely to stop receiving such services, despite later interventions, with declassification rates from the OHI and EBD categories ranging from only 5 to 12 % (Halqren and Clarizio 1992; SEELS 2005). "
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    ABSTRACT: To examine a) the feasibility of delivering a summer treatment program for pre-kindergarteners (STP-PreK) with externalizing behavior problems (EBP) and b) the extent to which the STP-PreK was effective in improving children’s school readiness outcomes. Participants for this study included 30 preschool children (77 % boys; Mean age = 5.33 years; 77 % Hispanic background) with at-risk or clinically elevated levels of EBP. The STP-PreK was held at an early education center and ran for 8-weeks (M-F, 8 a.m.–5 p.m.) during the summer between preschool and kindergarten. In addition to a behavioral modification system and comprehensive school readiness curriculum, a social-emotional curriculum was also embedded within the STP-PreK to target children’s self-regulation skills (SR). Children’s pre- and post-school readiness outcomes included a standardized school readiness assessment as well as parental report of EBP, adaptive functioning, and overall readiness for kindergarten. SR skills were measured via a standardized executive functioning task, two frustration tasks, and parental report of children’s emotion regulation, and executive functioning. The STP-PreK was well received by parents as evidenced by high attendance and satisfaction ratings. Additionally, all school readiness outcomes (both parent and observational tasks) significantly improved after the intervention (Cohen’s d effect sizes ranged from 0.47 to 2.22) with all effects, except parental report of emotion regulation, being maintained at a 6-month follow-up. These findings highlight the feasibility and utility of delivering an early intervention summer program that can successfully target multiple aspects of children’s school readiness, including behavioral, social-emotional/self-regulation, and academics.
    Journal of Psychopathology and Behavioral Assessment 12/2014; 36(4). DOI:10.1007/s10862-014-9418-1 · 1.55 Impact Factor
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