Use and costs of medical care for children and adolescent with and without attention-deficit/hyperactivity disorder

Background: The widespread prevalence of attention-deficit/ hyperactivity disorder (ADHD) is in contradiction to the dearth of data on the associated medical costs for persons with the disorder. In this population-based cohort study conducted in Rochester, Minn., use and costs of medical care were compared between individuals with and without ADHD. Method: The study cohort comprised individuals born in Rochester from 1976 through 1982 who were still residing in Rochester in 1987 (N = 4880). Individuals with ADHD were identified using school and medical records. Clinical diagnoses, likelihood and frequency of hospitalizations (both inpatient and outpatient), emergency department admissions, and total medical costs for all cohort members from 1987 through 1995 were obtained from a database that links data from the medical care institutions that serve the majority of Rochester residents. Results: ADHD had been diagnosed in 7.5% (N = 309) of the 4119 birth cohort members still residing in Rochester in 1995. Individuals with ADHD were more likely than those without ADHD to have had sustained major injuries (59% vs. 49%; p <.001) and to have received diagnoses for medical conditions, including asthma (22% vs. 13%; p < .001). Persons with ADHD, compared with persons without ADHD had more inpatient hospitalizations (26% vs. 18%; p<.001 outpatient hospitalizations (41% vs. 33%; p = .006), and emergency department admissions (81% vs. 74%; p = .005). Individuals with ADHD incurred medical care costs from 1987 through 1995 (median = $4306) that were more than twice as high as those incurred by individuals without ADHD (median = $S1994; p < .001 a difference found even among individuals not hospitalized or admitted to the emergency department. Differences between the ADHD and non-ADHD cohorts were independent of sex and age group. Conclusion: In addition to producing detrimental effects on social behavioral, and academic outcomes, ADHD is associated with markedly increased use and costs of medical care.