Childhood attention-deficit/hyperactivity disorder (ADHD) has long-term associations with both psychiatric and somatic disorders, resulting in large financial costs, according to a study published in The Journal of Child Psychology and Psychiatry. Individuals with ADHD commonly experience an increased risk for a variety of behavioral, psychiatric, and somatic health issues, which poses significant clinical and public health problems.
The study used comprehensive data from the Swedish National Registers to prospectively follow a cohort (N=445,790; 52% male) aged 18 to 26 years. They investigated patterns of healthcare utilization and costs of multimorbidity across young adulthood in individuals with a childhood ADHD diagnosis (n=3534). Additionally, they looked at individuals who continue to have ADHD-related contact with health services (persisters; n=2203) and those who do not (remitters; n=1331).
The average annual costs per capita from multimorbidity was $1223 in individuals with a childhood ADHD diagnosis (persisters vs remitters: $1456 vs $837) and $418 in individuals without a diagnosis. Costs in patients with childhood ADHD were largely driven by inpatient care, mainly due to drug abuse, injuries, and autism spectrum disorders. Nearly 75% of the persisting group received ADHD medications in adulthood and still had an ADHD diagnosis.
Healthcare utilization and expenditures on psychiatric and somatic disorders at 18 years were significantly higher in patients with a childhood diagnosis of ADHD for most outcomes, including inpatient days, outpatient visits, and prescriptions. These group differences in the ADHD group remained stable or increased over time. Furthermore, greater group differences were generally observed in women compared to men for outpatient visits and costs and for the number of medication prescriptions for only somatic conditions. Moreover, ADHD remitters continued to display significantly increased healthcare utilization and costs compared to individuals without childhood ADHD, though their profiles were not as severe as those of ADHD persisters.
The study included a lower prevalence of ADHD (0.8%) compared to the literature, and the study may be limited by an underestimation of the childhood ADHD prevalence rate. There was also a lack of access to data on all healthcare services, which may have led to an underestimation of health expenditures.
Overall, the study revealed that childhood ADHD has long-term effects on psychiatric and somatic disorders, resulting in major costs. The investigators noted that the findings “highlight the importance of early preventative efforts of multimorbidity in ADHD and point towards specific targets for intervention, such as drug abuse and injuries.”
Rietz ED, Jangmo A, Kuja-Halkola R, Chang Z, D’Onofrio BM, Ahnemark E, et al. Trajectories of healthcare utilization and costs of psychiatric and somatic multimorbidity in adults with childhood ADHD: a prospective register-based study [published online March 12, 2020]. J Child Psychol Psychiatry. doi: 10.1111/jcpp.13206.