Costs for Family Members

The ADHD family member sample consisted of 3,404 individuals, and the non-ADHD family member sample included 3,933 individuals. Family members of ADHD patients had 60% more medical claims and about twice as many were treated for a psychiatric disorder.

Direct medical care costs per family member was twice as high, i.e., $2060 vs. $1,026. Thus, in combination with the greater costs to the ADHD patient him/herself, the average additional annual medical costs to a 4-person family where one child had ADHD would have been over $4,000 during the year. Although a portion of these additional costs were covered by insurance reimbursements, the additional co-payments required would have resulted in substantial costs to the families as well.

Indirect costs - i.e., disability and absenteeism - were also greater in families with an ADHD patient, i.e., $668 vs. $414.

Summary and Implications

Results from this study document a significant economic burden to families who have a child with ADHD. Medical utilization and costs are substantially and treatment directly related to the disorder explains only a portion of increased costs. In addition to increased costs for the child with ADHD, medical costs for family members were also substantially higher. In fact, the increased costs to the patient and family members appear to be thousands of dollars per year. Although insurance would have covered much of this cost, co-pay requirements for families would have been substantial as well, particularly when one considers that these additional costs are likely to recur each year.

In addition to the economic data, it is noteworthy that only 53% of patients with ADHD received ADHD treatment during the year a physician or allied health professional, e.g., psychologist, social worker. In addition, over 40% of patients had no prescriptions for ADHD medication filled during the year.

It is possible that some patients received care for ADHD that was not coded as an ADHD treatment visit, or received ADHD treatment outside of the traditional medical system. Nonetheless, these findings raise important questions about the type and quality of care that children with ADHD received. These data imply that many children were not receiving care that was consistent with recently published ADHD treatment guidelines from the American Academy of Pediatrics.

The authors note several limitations to their study. First, they emphasize that their sample is not representative of the entire population, as many families have different insurance coverage from the families in their sample or have no insurance at all. The extent to which the current findings would generalize to these other circumstances is unknown.

Second, because this study relied on insurance claims data, the findings are subject to the usual limitations of such data including the possibilities of inaccurate diagnoses, coding inaccuracies on claims forms, and missing data. It is unlikely, however, that such errors would have substantially influenced the results obtained.

Third, the authors acknowledge that they were not able examine the costs of ADHD beyond medical care. Thus, there may be substantial additional expenses for families who have a child with ADHD that are not reflected in this report.

Finally, it is important to emphasize that this study provides no information on the reasons why medical costs in patients with ADHD and their family members were so much higher. Although these costs may be directly related to, or caused by, ADHD itself, e.g., children with ADHD are more accident prone and this results in higher medical costs; the stress that parents experience caring for the child with ADHD has adverse impacts on their own health, no direct information on this issue is provided. Thus, the reasons why ADHD is associated with higher medical costs in children and their family members would be an important question to pursue in future research.

About the author: Dr. Rabiner is a senior research scientist at Duke University, an expert in childhood ADHD and author of the email newsletter "Attention Research Update."

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