Skip to main content

Advertisement

Log in

The Estimated Annual Cost of ADHD to the US Education System

  • Original Paper
  • Published:
School Mental Health Aims and scope Submit manuscript

Abstract

The purpose of this study was to examine and monetize the educational outcomes of students with ADHD. Data were examined from the Pittsburgh ADHD Longitudinal Study, a follow-up study of children diagnosed with ADHD in childhood and recontacted for follow-up in adolescence and young adulthood. A comprehensive educational history was obtained for all participants from Kindergarten through 12th grade. Annual economic impact was derived from costs incurred through special education placement, grade retention, and disciplinary incidents. Results indicated that, as compared to students without ADHD, students with ADHD incurred a higher annual cost to the US Education system. Specifically, a student with ADHD incurred an average annual incremental cost to society of $5,007, as compared with $318 for students in the comparison group. These results suggest that prevention and intervention strategies are greatly needed to offset the large financial impact of educating youth with ADHD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Atkins, M. S., Pelham, W. E., & Licht, M. H. (1985). A comparison of objective classroom measures and teacher ratings of attention deficit disorder. Journal of Abnormal Child Psychology, 13, 155–167.

    Article  PubMed  Google Scholar 

  • Atkins, M. S., Pelham, W. E., & Licht, M. H. (1989). The differential validity of teacher ratings of inattention/overactivity and aggression. Journal of Abnormal Child Psychology, 17, 423–435.

    Article  PubMed  Google Scholar 

  • Barbaresi, W. J., Katusic, S. K., Colligan, R. C., Weaver, A. L., & Jacobsen, S. J. (2007). Long-term school outcomes for children with attention-deficit/hyperactivity disorder: A population based perspective. Journal of Developmental and Behavioral Pediatrics, 28, 265–273.

    Article  PubMed  Google Scholar 

  • Barkley, R. A. (2006). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd ed.). New York: Guilford.

    Google Scholar 

  • Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2006). Young adult outcome of hyperactive children: Adaptive functioning in major life activities. Journal of the American Academy of Child and Adolescent Psychiatry, 45(2), 192–202.

    Article  PubMed  Google Scholar 

  • Barkley, R. A., Murphy, K. R., & Fischer, M. (2007). ADHD in adults: What the science says. New York: Guilford.

    Google Scholar 

  • Biederman, J., Faraone, S., Milberger, S., & Guite, J. (1996). A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders. Archives of General Psychiatry, 53, 437–446.

    PubMed  Google Scholar 

  • Biederman, J., Faraone, S. V., Taylor, A., Sienna, M., Williamson, S., & Fine, C. (1998). Diagnostic continuity between child and adolescent ADHD: Findings from a longitudinal sample. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 305–313.

    Article  PubMed  Google Scholar 

  • Birnbaum, H. G., Kessler, R. C., Lowe, S. W., Secnik, K., Greenberg, P. E., Leong, S. A., et al. (2005). Costs of attention deficit-hyperactivity disorder (ADHD) in the US: Excess costs of persons with ADHD and their family members in 2000. Current Medical Research and Opinion, 21, 195–206.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control (CDC). (2005). Mental health in the United States: Prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder – United States, 2003. Morbidity and Mortality Weekly Report, 54(34), 842–847.

    Google Scholar 

  • Chambers, J. G., Shkolnik, J. & Perez, M. (2003). Total expenditures for students with disabilities, 1999–2000: Spending variation by disability. SEEP: Special education expenditure project by center for special education finance. US Department of Education.

  • Chiles, J. A., Lambert, M. J., & Hatch, A. L. (2002). Medical cost offset: A review of the impact of psychological interventions on medical utilization over the past three decades. In N. A. Cummings, W. T. O’Donohue, & K. E. Ferguson (Eds.), The impact of medical cost offset on practice and research: Making it work for you: A report of the first Reno conference on medical cost offset, healthcare utilization and cost series. Reno, NV: Context Press.

  • DuPaul, G. J., & Stoner, G. (2003). ADHD in the schools: Assessment and intervention strategies (2nd ed.). New York: Guilford.

    Google Scholar 

  • Fabiano, G. A., Pelham, W. E., Pisecco, S., Hannah, J. N., Evans, S., & Manos, M. J., et al. (2001). Nationally representative survey of treatment for ADHD in the school setting: Preliminary results. Poster presented at the eighth annual child health psychology conferences, Gainesville, FL.

  • Faraone, S. V., Biederman, J., Lehman, B. K., Spencer, T., Norman, D., Seidman, L. J., et al. (1993). Intellectual performance and school failure in children with attention deficit hyperactivity disorder and in their siblings. Journal of Abnormal Psychology, 102, 616–623.

    Article  PubMed  Google Scholar 

  • Forness, S. R., & Kavale, K. A. (2002). Impact of ADHD on school systems. In P. S. Jensen & J. R. Cooper (Eds.), Attention deficit hyperactivity disorder (pp. 24–1–24–30). Kingston NJ: Civic Research Institute.

    Google Scholar 

  • Foster, E. M., Dodge, K. A., & Jones, D. (2003). Issues in the economic evaluation of prevention programs. Applied Developmental Science, 7(2), 76–86.

    Article  PubMed  Google Scholar 

  • Foster, E., Jensen, P. S., Schlander, M., Pelham, W. E., Hechtman, L., Arnold, L. E., et al. (2007). Treatment for ADHD: Is more complex treatment cost-effective for more complex cases? Health Services Research, 42, 165–182.

    Article  PubMed  Google Scholar 

  • Gold, M. R., Russell, L. B., Siegel, J. E., & Weinstein, M. C. (Eds.). (1996). Cost-effectiveness in health and medicine. New York: Oxford University Press.

    Google Scholar 

  • Greene, R. W., Beszterczey, S. K., Katzenstein, T., Park, K., & Goring, J. (2002). Are students with ADHD more stressful to teach? Patterns of teacher stress in an elementary school sample. Journal of Emotional & Behavioral Disorders, 10, 79–89.

    Article  Google Scholar 

  • Hakkaart-van Roijen, L., Zwirs, B. C., Bouwmans, C., Tan, S. S., Schulpen, T. W., Vlasveld, L., et al. (2007). Societal cost and quality of life of children suffering from attention deficient hyperactivity disorder (ADHD). European Child and Adolescent Psychiatry, 16(5), 316–326.

    Article  PubMed  Google Scholar 

  • Hinshaw, S. P. (1992). Academic underachievement, attention deficits, and aggression: Comorbidity and implications for intervention. Journal of Consulting and Clinical Psychology, 60(6), 893–903.

    Article  PubMed  Google Scholar 

  • Jensen, P. S., Garcia, J. A., Glied, S., Crowe, M., Foster, M., et al. (2005). Cost-effectiveness of ADHD treatments: Findings from the multimodal treatment study of children with ADHD. American Journal of Psychiatry, 162(9), 1628–1636.

    Article  PubMed  Google Scholar 

  • Jones, D. E., & Foster and Conduct Problems Prevention Research Group. (2009). Service use patterns for adolescents with ADHD and comorbid conduct disorder. The Journal of Behavioral Health Services and Research, 36(4), 436–449.

    Article  Google Scholar 

  • Kelleher, J. K., Childs, G. E., & Harmon, J. S. (2001). Healthcare costs for children with attention-deficit/hyperactivity disorder. Economics & Neuroscience, 3, 60–63.

    Google Scholar 

  • Kenkel, D. (1994). Cost of illness approach. In D. Kenkel & R. Fabian (Eds.), Valuing health for policy: An economic approach. Chicago, IL: University of Chicago Press.

  • Kenkel, D., Berger, M., & Blomquist, G. (1994). Contingent valuation of health. In D. Kenkel & A. Fabian (Eds.), Valuing health for policy: An economic approach. Chicago, IL: University of Chicago Press.

  • Kent, K. M., Pelham, W. E., Molina, B. S. G., Sibley, M. H., Waschbusch, D. A., Yu, J., et al. (2011). The academic experience of male high school students with ADHD. Journal of Abnormal Child Psychology, 39, 451–462.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., Lane, M., Stang, P. E., & Van Brunt, D. L. (2009). The prevalence dn workplace costs of adult attention deficit hyperactivity disorder in a large manufacturing firm. Psychological Medicine, 39(1), 137–147.

    Article  PubMed  Google Scholar 

  • Kleinman, N. L., Durkin, M., Melkonian, A., & Markosyan, K. (2009). Incremental employee health benefit costs, absence days, and turnover among employees with ADHD and among employees with children with ADHD. Journal of Occupational and Environmental Medicine, 51(1), 1247–1255.

    Article  PubMed  Google Scholar 

  • Loe, I. M., & Feldman, H. M. (2007). Academic and educational outcomes of children with ADHD. Journal of Pediatric Psychology, 32, 643–654.

    Article  PubMed  Google Scholar 

  • Mannuzza, S., & Klein, R. G. (1999). Adolescent and adult outcomes in attention-deficit/hyperactivity disorder. In H. C. Quay & A. E. Hogan (Eds.), Handbook of disruptive behavior disorders (pp. 279–294). New York: Kluwer.

    Chapter  Google Scholar 

  • Mannuzza, S., Klein, R. G., & Addalli, K. A. (1991). Young adult mental status of hyperactive boys and their brothers: A prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 30(5), 743–751.

    PubMed  Google Scholar 

  • Mannuzza, S., Klein, R. G., Bessler, A., Malloy, P., et al. (1993). Adult outcome of hyperactive boys: Educational achievement, occupational rank, and psychiatric status. Archives of General Psychiatry, 50(7), 565–576.

    PubMed  Google Scholar 

  • Mash, E. J., & Johnston, C. (1990). Determinants of parenting stress: Illustrations from families of hyperactive children and families of physically abused children. Journal of Clinical Child Psychology, 19(4), 313–328.

    Article  Google Scholar 

  • Molina, B. S. G., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., et al. (2009). MTA at 8 years: Prospective follow-up of children treated for combined type ADHD in a multisite study. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 484–500.

    Article  PubMed  Google Scholar 

  • Patterson, G. R., & Chamberlain, P. (1994). A functional analysis of resistance during parent training therapy. Clinical Psychology: Science and Practice, 1(1), 53–70.

    Article  Google Scholar 

  • Pelham, W. E., & Bender, M. E. (1982). Peer relationships in hyperactive children: Description and treatment. Advances in Learning and Behavioral Disabilities, 1, 365–436.

    Google Scholar 

  • Pelham, W. E., Gnagy, E. M., Greenslade, K. E., & Milich, R. (1992). Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 210–218.

    Article  PubMed  Google Scholar 

  • Pelham, W. E., Foster, E. M., & Robb, J. A. (2007). The economic impact of attention- deficit/Hyperactivity disorder in children and adolescents. Ambulatory Pediatrics, 7(1 supp), 121–131.

    Article  PubMed  Google Scholar 

  • Robin, A. L., & Foster, S. L. (1989). Negotiating parent-adolescent conflict: A behavioral-family systems approach. NY: Guilford Press.

  • Scime, M., Pelham, W. E., Massetti, G., Waschbusch, D. A., O’Dell, S., & Yu, J. (2008). Impact of a school-wide positive behavior program on office referrals and time spent dealing with student misbehavior. Poster presented at the 40th annual convention of the National Association of School Psychologists, New Orleans, LA.

  • Scott, T. M., & Barrett, S. B. (2004). Using staff and student time engaged in disciplinary procedures to evaluate the impact of school-wide PBS. Journal of Positive Behavior Interventions, 6, 21–27.

    Article  Google Scholar 

  • Siegel, J. E., Weinstein, M. C., Russell, L. B., & Gold, M. R. (1996). Recommendations for reporting cost-effectiveness analyses. Journal of the American Medical Association, 276, 1339–1341.

    Article  PubMed  Google Scholar 

  • Swanson, J. M., Hanley, T., Simpson, S., Davies, M., Schulte, A., Wells, K., et al. (2000). Evaluation of learning disorders in children with a psychiatric disorder: An example from the multimodal treatment study for ADHD (MTA study). In L. L. Greenhill (Ed.), Learning disabilities: Implications for psychiatric treatment (pp. 97–128). Washington, DC, US: American Psychiatric Publishing, Inc.

    Google Scholar 

  • US Census. (2000). Retrieved July 1, 2005 from www.census.gov.

  • Weinstein, M. C., Coxson, P. G., Williams, L. W., Pass, T. M., Stason, W. B., & Goldman, L. (1987). Forecasting coronary heart disease incidence, mortality and cost: The coronary heart disease model. American Journal of Public Health, 77, 1417–1426.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This study was supported by grants DA12414, DA05605, F31 DA017546 from the National Institute on Drug Abuse and additionally, AA11873 from the National Institute of Alcohol Abuse and Alcoholism. Research was also supported in part by AA00202, AA08746, AA12342, AA0626, and grants from the National Institute on Mental Health (MH12010, MH4815, MH47390, MH45576, MH50467, MH53554, MH069614), the National Institute of Environmental Health Sciences (ES0515-08), and Institute of Education Sciences (IESLO3000665A, IESR324B060045).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to William E. Pelham Jr.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Robb, J.A., Sibley, M.H., Pelham, W.E. et al. The Estimated Annual Cost of ADHD to the US Education System. School Mental Health 3, 169–177 (2011). https://doi.org/10.1007/s12310-011-9057-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12310-011-9057-6

Keywords

Navigation