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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    • "Treatment costs have been identified as an important outcome to study as part of the comparative effectiveness research process (Garber & Sox, 2010). In a review of the economic costs of ADHD,Pelham et al. (2007)found 13 studies with information on the cost of ADHD, with only a small subset including information on costs of treatment. The small number of available studies on treatment costs were from large databases (e.g., Medicaid) that tied clinic-recorded diagnoses to medical costs—typically those of medication. "
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    ABSTRACT: We conducted a cost analysis of the behavioral, pharmacological, and combined interventions employed in a sequential, multiple assignment, randomized, and adaptive trial investigating the sequencing and enhancement of treatment for children with attention deficit hyperactivity disorder (ADHD; Pelham et al., 201X; N = 146, 76% male, 80% Caucasian). The quantity of resources expended on each child’s treatment was determined from records that listed the type, date, location, persons present, and duration of all services provided. The inputs considered were the amount of physician time, clinician time, paraprofessional time, teacher time, parent time, medication, and gasoline. Quantities of these inputs were converted into costs in 2013 USD using national wage estimates from the Bureau of Labor Statistics, the prices of 30-day supplies of prescription drugs from the national Express Scripts service, and mean fuel prices from the Energy Information Administration. Beginning treatment with a low-dose/intensity regimen of behavior modification (large-group parent training) was less costly for a school year of treatment ($961) than beginning treatment with a low dose of stimulant medication ($1,669), regardless of whether the initial treatment was intensified with a higher “dose” or if the other modality was added. Outcome data from the parent study (Pelham et al., 201X) found equivalent or superior outcomes for treatments beginning with low-intensity behavior modification compared to intervention beginning with medication. Combined with the present analyses, these findings suggest that initiating treatment with behavior modification rather than medication is the more cost-effective option for children with ADHD.
    No preview · Article · Jan 2016 · Journal of Clinical Child & Adolescent Psychology
    • "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.
    No preview · Article · Aug 2015 · Asian Journal of Psychiatry
    • "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.
    No preview · Article · Jun 2015 · Australian Occupational Therapy Journal
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