Kids With ADHD Have Higher Healthcare Costs

Medically Reviewed by Jacqueline Brooks, MBBCH, MRCPsych
From the WebMD Archives

Jan. 2, 2001 -- Children and teens with attention deficit hyperactivity disorder (ADHD) are much more likely than other kids to need hospital care, and more of it, for a range of nonbehavioral problems including serious injuries and asthma.

The study -- which analyzed health records of more than 4,000 young people -- found that "children with ADHD have a significantly higher likelihood of having a number of clinical diagnoses," says Cynthia L. Leibson, PhD, an assistant professor at Mayo Clinic in Rochester, Minn. Her study is published in Tuesday's Journal of the American Medical Association.

"Not only are they more likely to get diagnosed, but they are more likely to require hospital inpatient, hospital outpatient, and emergency room [ER] admissions -- with all the associated costs," Leibson tells WebMD. "In fact, they had more ER visits in almost every year we studied."

"This is a ... a powerful new finding," says Ann Abramowitz, PhD, associate professor of psychiatry at Emory University School of Medicine in Atlanta. "People don't fully appreciate the burden of ADHD," she tells WebMD. "It's not just noisy kids in the classroom. This is a real phenomenon."

Leibson's study contributes to a growing body of literature showing that those with ADHD have more psychosocial problems (like depression or difficulty getting along with others), automobile collisions, and incidences of poisonings, fractures, and substance abuse.

In addition, Leibson and colleagues pinpointed a chronic condition -- asthma -- that seems to plague ADHD kids more than others.

In their research, Leibson and colleagues examined the records of 4,119 young people born and still living in the Rochester area. Of that group, 7.5% had ADHD, according to medical and school records.

Those children were compared with those without ADHD. Among the findings: Fifty-nine percent of ADHD kids had major injuries vs. 49% of non-ADHD kids; 22% of ADHD kids had asthma, compared with 13% of non-ADHD kids. Also, 26% of the ADHD kids had required at least one hospitalization, and 81% had required emergency care vs. 18% and 74% of the non-ADHD kids, respectively.

On average, medical costs for those with ADHD were more than double the costs for those without.

The differences were similar for males and females, Leibson says.

Why all these accidents and chronic conditions? Some of the problems -- like depression or reactions to stress -- may be the consequences of dealing with ADHD, Leibson tells WebMD.

"We may also be seeing the frustrated parent who knows something is wrong and keeps bringing the child to see a doctor," she says. "The kids therefore have more diagnoses simply because they have been brought in so frequently."

As far as healthcare costs related to ADHD, Leibson says her research team noticed a pattern. "They were admitted more to the ER, that's true, but were the increased hospital costs due to number of visits -- or to the number of specialists who saw them? Because they have all these problems, they often are seen by many doctors -- and with each referral, there are additional costs."

Also, did treatment for ADHD make any difference in numbers of hospital visits? Did visits decline after treatment began? In her study, some children with ADHD diagnoses were not treated for the disorder. Some children with ADHD may not have been diagnosed, she says.

"Our study raises many more questions than it answers," Leibson tells WebMD. "But with further analysis, we can tease some of those answers out."

Abramowitz questions whether families living within driving distance of the Mayo Clinic are representative of the general population across the U.S.

"They conducted this study in a very health-conscious community, she says. "People in that community, with their rather unique access to information about healthcare, may be more likely to go to a doctor when something is wrong. ... Maybe some of these parents aren't so typical."

"It's true that those in our study were 95% Caucasian ... and that we do have a large population in the healthcare profession," Leibson says. "So the sensitivity to these healthcare issues might be heightened. But the prevalence of ADHD we found was comparable to other geographical areas, which shows we are not under- or overdiagnosing ADHD."

Researchers received funding for this study from Eli Lilly Co. and from the Public Health Service of the National Institutes of Health.