Study Finds Substantial Economic Impact of ADHD in the United States
A study published in the Journal of the American Academy of Child and Adolescent Psychiatry found a substantial economic impact of attention deficit/hyperactivity disorder (ADHD) in the United States. The findings suggest that employers may benefit from taking steps to address ADHD at the workplace.
ADHD is often considered a disorder that occurs in childhood, but it can persist into adulthood. According to the American Psychiatric Association, common symptoms in adults include difficulty following directions, remembering information, concentrating, organizing tasks, or completing work within time limits. A diagnosis requires an assessment that these symptoms impair one’s ability to function in at least two settings (e.g. home, work, and/or school).
“ADHD is often perceived as a childhood disease, but this analysis demonstrates that at a national level, the economic impact of ADHD on adults may be larger than that on children,” says Peter Neumann, ScD, who is director of the Center for the Evaluation of Value and Risk in Health at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center and professor of medicine at Tufts University School of Medicine.
The prevalence of ADHD in the US is 5.5% to 9.3% in children and adolescents age 4 to 17 years. Children and adolescents who have the disorder experience educational difficulties, problems with self-esteem, significantly impaired family and peer relationships, and an overall decrease in quality of life. The prevalence in US adults age 18 to 44 years is estimated to be 4.4%. Impairments from ADHD in adults may be responsible for occupational difficulties, criminal activity, substance abuse problems, and traffic accidents and citations.
The study, “Economic Impact of Childhood and Adult Attention-Deficit/Hyperactivity Disorder in the United States,” estimated that annual national “excess costs” for ADHD ranged from $143 billion to $266 billion. “Excess costs” are the incremental costs over and above those for people without ADHD and include costs associated with overall healthcare, productivity and income losses, and effects on the educational and judicial systems.
ADHD Costs in Adults
More than 70% to 80% of these overall excess costs were attributable to adults with ADHD or to adult family members of patients with ADHD. The analysis estimated that the national excess costs for adults with ADHD or adult family members of patients with ADHD were almost three times higher than for children and adolescents with ADHD. Workplace productivity and income losses were the largest contributor to the economic burden associated with adults with ADHD, ranging from $87 billion to $138 billion.
ADHD Costs in Children & Adolescents
The economic burden to the US for children and adolescents with ADHD was also substantial, ranging from $38 billion to $72 billion. Excess costs for children and adolescents were associated with healthcare costs, which ranged from $21 billion to $44 billion annually, and education costs, which ranged from $15 billion to $25 billion annually.
Due to a lack of data, the analysis did not evaluate the impact of treatment interventions on excess costs. Therefore, the cost-benefit associated with treatment was not examined. Still, the study is considered to be the most comprehensive analysis of published data of costs associated with ADHD across age groups, including children, adolescents, and adults. According to Neumann, “Additional research to understand and quantify the potential impact of treatment of ADHD in all age groups is needed.”
Diagnosis & Treatment
Results of a World Health Organization survey showed that, despite public perception that ADHD is over treated, very few people with ADHD received treatment. In the US, only 13% of workers with ADHD who participated in the survey reported receiving treatment. Adults with ADHD are treated with medication, psychotherapy, or a combination of the two. Behavior management strategies, such as ways to minimize distractions and improve organization, can also be helpful.
According to the American Psychiatric Association, adult ADHD can be comorbid with anxiety, depression, or bipolar disorder, further complicating diagnosis and treatment. Overlapping symptoms can make an accurate diagnosis difficult, which can delay the start of effective treatment
Tips For Employers
Review Benefit Coverage
Check your benefit plans to ensure that they do not arbitrarily limit coverage for ADHD to children and adolescents only. Be certain that benefits provide coverage for medication and psychotherapy for children, adolescents, and adults with the condition. In addition, review pharmacy coverage to be certain that the plan design provides unrestricted access to a range of medication options for providers to choose from, as patients respond differently to different drug therapies.
Given the low numbers of people with ADHD who do receive treatment, educating the workforce about the disorder and how to get help is important. Consider providing educational materials through the company intranet and wellness efforts. Include information about ADHD when addressing conditions that are frequently comorbid with ADHD, such as anxiety, depression, and bipolar disorder.
Tap into national organizations focused on ADHD that can provide helpful information for employee educational materials such as the American Psychiatric Association, Children and Adults with AttentionDeficit/Hyperactivity Disorder, and the Attention Deficit Disorder Association.
Promote the Use of Employee Assistance & Health Programs
Early intervention is key. Remind employees of the availability of resources for staying healthy and productive. Ensure that employees know how to access care confidentially and quickly by providing information on how to do so through multiple forms of communication and throughout the year. Increase visibility of these messages during known times of stress, such as during the holidays, busy work times, etc.
People with ADHD may benefit from strategies that focus on deficits in time management, concentration, and memory. For example:
Make changes to workspaces to reduce visual and auditory distractions (remove clutter, use noise-cancelling headphones, etc.).
Implement organizational systems for approaching work, such as checklists and flow charts that sequence project tasks.
Utilize technology such as voice memos and calendar alerts.
Check out the Job Accommodation Network for more strategies.
By Clare Miller
American Psychiatric Association. (2009). Let’s talk facts about attention-deficit/hyperactivity disorder (ADHD).
De Graaf, R., Kessler, R. C., Fayyad, J., ten Have, M., Alonso, J., Angermeyer, M., . . . Posada-Villa, J. (2008). The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: Results from the WHO World Mental Health Survey Initiative. Journal of Occupational and Environmental Medicine. Electronic publication. doi:10.1136/oem.2007.038448
Doshi, J. A., Hodgkins, P., Kahle, J., Sikirica, V., Cangelosi, M. J., Setyawan, J., . . . Neumann, P. J. (2012). Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. Journal of the American Academy of Child and Adolescent Psychiatry, 51(10), 990– 1002. doi: 10.1016/j.jaac.2012.07.008