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ADHD costly before and after diagnosis

October 03, 2006

Children with attention-deficit/hyperactivity disorder (ADHD) use more health services in the two years before and two years after they are diagnosed than do children without ADHD, with white children accumulating more expenses than those of other ethnicities, according to a report in the October issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Approximately 8 percent of children age 4 to 17 have ADHD, according to background information in the article. The condition affects social behaviors and achievement at school and work. Treatment can include medications and behavioral approaches and is often expensive, and costs can begin to add up before treatment starts. "Excess use of services prior to an ADHD diagnosis may signal an existing problem for which the family may be seeking a diagnosis and may indicate that assessment protocols are not identifying these children early enough," the authors write.

G. Thomas Ray, M.B.A., Kaiser Permanente Medical Care Program, Northern California Region, Oakland, and colleagues used health plan records to identify 3,122 children between the ages of 2 and 10 who had been diagnosed with ADHD between 1996 and 2004. They compared health care costs, including pharmacy expenses, for these children to those of 15,899 control children who were the same age and sex but did not have ADHD. Approximately six children without ADHD were matched to every one child with ADHD and also were assigned an index date that corresponded to the child with ADHD's diagnosis date.

The average age at ADHD diagnosis was 6.7. Compared with children without ADHD, those with ADHD had average health care costs that were $488 higher in the second year before diagnosis, $678 higher in the year before diagnosis, $1,328 higher in the year following diagnosis and $1,040 higher in the second year after diagnosis. Among children with ADHD, Asian Americans, African Americans and Hispanic Americans had lower yearly costs for ADHD medications compared with white Americans, and Asian Americans had overall lower spending on ADHD services than white Americans ($221 or 30 percent lower).

"Parents commonly state that behavioral problems predate their child's ADHD diagnosis, often by several years, and these problems may affect their use of health services," the authors write. "In our study sample, costs were significantly higher in the two years before the index date among children subsequently diagnosed with ADHD, and costs remained higher for at least two years following the initial ADHD diagnosis. Much of the excess cost was due to increased pediatric and psychiatric services, which were higher in the first year after diagnosis than in the second year."

Differences in costs and use of ADHD medications by ethnicity could be related to cultural acceptance of diagnosis and treatment, they continue. "Future studies, particularly those involving interviews of the parents of children with ADHD and their health care providers, could shed light on the reasons for these differences."

JAMA and Archives Journals