Use and Costs of Medical Care for Children and Adolescents With and Without Attention-Deficit/Hyperactivity Disorder

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.