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

JAMA. 2001 Jan 3;285(1):60-6. doi: 10.1001/jama.285.1.60.


Context: A shortage of data exists on medical care use by persons with attention-deficit/hyperactivity disorder (ADHD).

Objective: To compare medical care use and costs among persons with and without ADHD.

Design and setting: Population-based cohort study conducted in Rochester, Minn.

Subjects: All children born in 1976-1982 were followed up through 1995, using school and medical records to identify those with ADHD. The 4880 birth cohort members (mean age, 7. 3 years) still residing in Rochester in 1987 were followed up in medical facility-linked billing databases until death, emigration, or December 31, 1995.

Main outcome measures: Clinical diagnoses, likelihood and frequency of inpatient and outpatient hospitalizations, emergency department (ED) visits, and total medical costs (including ambulatory care), compared among individuals with and without ADHD.

Results: Among the 4119 birth cohort members who remained in the area through 1995 (mean age, 15.3 years), 7.5% (n = 309) had met criteria for ADHD. Compared with persons without ADHD, those with ADHD were more likely to have diagnoses in multiple categories, including major injuries (59% vs 49%; P<.001) and asthma (22% vs 13%; P<.001). The proportion with any hospital inpatient, hospital outpatient, or ED admission was higher for persons with ADHD vs those without ADHD (26% vs 18% [P<. 001], 41% vs 33% [P =.006], and 81% vs 74% [P =.005], respectively). The 9-year median costs for persons with ADHD compared with those without ADHD were more than double ($4306 vs $1944; P<.001), even for the subset with no hospital or ED admissions (eg, median 1987 costs, $128 vs $65; P<.001). The differences between individuals with and without ADHD were similar for males and females and across all age groups.

Conclusion: In our cohort, compared with persons without ADHD, those with ADHD exhibited substantially greater use of medical care in multiple care delivery settings.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adolescent Health Services / economics*
  • Adolescent Health Services / statistics & numerical data*
  • Ambulatory Care / economics
  • Ambulatory Care / statistics & numerical data
  • Attention Deficit Disorder with Hyperactivity / economics*
  • Attention Deficit Disorder with Hyperactivity / therapy*
  • Child
  • Child Health Services / economics*
  • Child Health Services / statistics & numerical data*
  • Cohort Studies
  • Cost of Illness
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data
  • Humans
  • Longitudinal Studies
  • Minnesota
  • Regression Analysis
  • Statistics, Nonparametric