MHW: Study Links ADHD with Health, Productivity & Income Losses

Study Examines Economic Impact of Childhood, Adult ADHD

Mental Health Weekly   October 22, 2012


A new study examining the economic costs associated with attention deficit hyperactivity disorder (ADHD) in children and adults found the costs to be substantial and persistent in the areas of healthcare, productivity and income losses, warranting the need for the development of public policies to address the burden of the condition, according to research published in the October issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).


Researchers note that ADHD is one of the most prevalent mental disorders in children in the U.S. and often persistent into adulthood with associated symptomatology and impairments. The current prevalence rate is 5.5 percent in children and adolescents ages 4 to 17. Current prevalence rates in U.S. adults 18 to44 years old are reported to be 4.4 percent and highlight the chronicity of this disorder, the study stated.


According to the study, ADHD related impairments may underlie subsequent problems in adulthood such as occupational difficulties, criminal activity, substance abuse problems, and traffic accidents and citations. Moreover, the difficulties faced by children and adults with ADHD may have spillover effects and can negatively affect the health and work productivity of family members.


While hundreds of studies have reported on the negative outcomes of ADHD in childhood and adulthood in such areas as health, education, occupation and antisocial behavior, few have monetized these outcomes to provide an estimate of the economic impact of ADHD in different sectors of society, the authors stated. The study was led by Jalpa A. Doshi, Ph.D., associate professor in the Perelman School of Medicine at the University of Pennsylvania.


A comprehensive understanding of the incremental costs of ADHD (i.e., excess costs over and above those of individuals without ADHD) from a societal perspective is important to inform, plan and justify policies and interventions to help alleviate the numerous negative consequences associated with this disorder, the authors stated.


Study Details

Researchers conducted a systematic search for primary U.S.-based studies published from Jan. 1, 1990, through June 30, 2011, on costs of children/adolescents and adults ages 0 to 64 with ADHD and their family members. Only studies in which mean annual incremental costs per individuals with ADHD above non-ADHD controls were reported or could be derived were included.


Nineteen studies met the inclusion criteria. Eleven of the 19 studies examined costs incurred by children with ADHD and their family members, and 10 studies examined costs incurred by adults with ADHD or their family members (two studies examined children/adolescents and adults).


Nine studies examined costs related to income and productivity losses. Only three studies examined education costs, and two studies examined justice system costs. None of the studies meeting the inclusion criteria evaluated costs related to traffic accidents or substance abuse problems.



The societal costs of ADHD were multifaceted, including four major categories: healthcare, education, productivity and justice system costs. Overall, national annual incremental costs of ADHD ranged from $143 to $266 billion (B). Most of these costs were incurred by adults ($105B to $194B) compared with children/adolescents ($38B to $72B).


The study indicated that workforce productivity costs in adults with ADHD are the single largest contributor to the economic burden associated with the condition, amounting to $87B to $138B and accounting for more than 70 to 80 percent of the overall ADHD costs. The vast majority of these costs were attributed to income losses owing to lack of full-time employment and/or lower wages when employed.


For costs due to income losses, two studies examined costs to patients with ADHD owing to lower wages and/or unemployment. One study found that young adults (19 to 25 years) with current or childhood ADHD had a significantly higher incremental mean annual salary ($3,744) than non-ADHD controls, likely because a significantly smaller proportion was enrolled in college and thus more likely to be employed, the report stated. The second study reported that the annual household income was lower by $10,532 to $12,189 per adult with ADHD when examined across the entire typical working age range of 18 to 64 years.


For children, the largest cost categories were healthcare ($21B to $44B) and education ($15B to $25B). Spillover costs borne by the family members of individuals with ADHD were also substantial ($33B to $43B). For the category of education costs, one study reported the annual ADHD-related incremental costs of education in 3- to 4-year-olds at

$12,447 per student and included costs related to special education, occupational, speech and physical therapy.


The annual incremental costs in 5- to 18-year-olds ranged from $2,222 to $4,690 per student across two studies - the former estimate included costs related to special education, grade retention and school counseling, whereas the latter included costs related to special education, grade retention and disciplinary incidents.


The estimates across the three studies on education costs translated to annual national incremental costs ranging from approximately $15B to $25B in 3- to 18-year-olds.


For justice system costs, two studies reported costs related to criminal offenses by individuals with ADHD. The per-person annual incremental costs of detention center and arrest expenditures derived from one study of 13- to 17-year-old adolescents with ADHD was $267.


Another study of 18- to 28-year-old young adults reported annual incremental costs ranging from $1,204 to $2,742 to the victim and society owing to burglary, robbery, larceny, arrests/convictions and selling of drugs. The estimates across these two studies translated to annual national incremental costs ranging from approximately $3B to $6B in 13- to 28-year-olds.


Given the substantial societal costs of ADHD, public policy to address the burden of the condition is warranted. Moreover, further research to better understand ADHD costs and the costs and benefits of interventions is warranted. Programs to facilitate collaboration among payers, patients, employers and educational institutions may provide opportunities to create strategies to consider the societal impact of ADHD and strategies to mitigate its burden, they concluded.



Psychiatrists and other mental health professionals bear daily witness to the debilitating and costly effects of psychiatric symptoms on patients and their families and the challenges in identifying adequate resources for treatment, but evidence regarding the costs of psychiatric disorders has been slow to accumulate, particularly with regard to those that affect children and adolescents, wrote Reese Abright, M.D., director of child and adolescent psychiatry at the Mount Sinai School of Medicine-Elmhurst Hospital Center in Elmhurst, N.Y., in an accompanying editorial.


In her editorial, “Estimating the Costs of Attention-Deficit/Hyperactivity Disorder,” Abright calls the new study timely. “Their article is notable for its findings and the clarity with which the authors describe the methodology used in their review of the literature and derivations of estimates for mean annual incremental costs of children and adults with ADHD, defined as costs over and above those of the individuals without ADHD, and spillover costs in family members,” she wrote.


The quest for valid and reliable estimates of the burden of psychiatric disorders and the effectiveness of prevention and intervention strategies stands at the intersection of epidemiology, nosology, therapeutics, economics and public policy

and offers abundant avenues for further research regarding ADHD and other psychiatric disorders that begin in childhood, she wrote.