Journal of Abnormal Child Psychology

, Volume 47, Issue 8, pp 1327–1338 | Cite as

Family Burden of Raising a Child with ADHD

  • Xin ZhaoEmail author
  • Timothy F. Page
  • Amy R. Altszuler
  • William E. PelhamIII
  • Heidi Kipp
  • Elizabeth M. Gnagy
  • Stefany Coxe
  • Nicole K. Schatz
  • Brittany M. Merrill
  • Fiona L. Macphee
  • William E. PelhamJr


The purpose of the study was to estimate the burden to families of raising a child with attention-deficit/hyperactivity disorder (ADHD). Data were drawn from a longitudinal sample recruited in western Pennsylvania. When participants were between 14 and 17 years old, parents completed a questionnaire assessing economic burden over the course of raising their children. Domains of economic burden to families included direct costs related to child’s behaviors (excluding treatment expenses) and indirect costs related to caregiver strain. On average, participants with ADHD incurred a total economic burden over the course of child development that was more than five times greater compared to youths without ADHD (ADHD = $15,036 per child, Control = $2,848 per child), and this difference remained significant after controlling for intellectual functioning, oppositional defiant symptoms, or conduct problems. Parents of participants with ADHD were more likely to have changed their job responsibilities or been fired and reported lower work efficiency. The current evaluation of economic burden to individual families extends previous estimates of annual societal cost of illness (COI) of ADHD. Our rough annual estimate of COI for ADHD in children and adolescents is $124.5 billion (2017 US Dollars). Findings underscore the need for interventions to reduce the costly dysfunctional outcomes in families of children with ADHD.


ADHD Cost analysis Family burden Economic impact 



This research was supported by a grant from the National Institute of Mental Health Grant (R01-MH-53554). Additional support was provided by grants from the National Institute of Mental Health (MH069614, MH069434, MH092466, MH065899, MH62988), the Institute of Education Sciences (R324J060024, LO30000665A, R324B060045), the National Institute of Alcohol Abuse and Alcoholism (AA11873), and the National Institute on Drug Abuse (DA12414, DA12986, T32DA039772).


This research was supported by a grant from the National Institute of Mental Health Grant (R01-MH-53554). Additional support was provided by grants from the National Institute of Mental Health (MH069614, MH069434, MH092466, MH065899, MH62988), the Institute of Education Sciences (R324J060024, LO30000665A, R324B060045), the National Institute of Alcohol Abuse and Alcoholism (AA11873), and the National Institute on Drug Abuse (DA12414, DA12986, T32DA039772).

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10802_2019_518_MOESM1_ESM.doc (220 kb)
ESM 1 (DOC 220 kb)


  1. Altszuler, A. R., Page, T. F., Gnagy, E. M., Coxe, S., Arrieta, A., Molina, B. S., & Pelham, W. E., Jr. (2016). Financial dependence of young adults with childhood ADHD. Journal of Abnormal Child Psychology, 44(6), 1217–1229. Scholar
  2. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., revised). Washington, DC: American Psychiatric Association.Google Scholar
  3. Anderson, J. C., Williams, S., McGee, R., & Silva, P. A. (1987). DSM-III disorders in preadolescent children: prevalence in a large sample from the general population. Archives of General Psychiatry, 44(1), 69–76.CrossRefGoogle Scholar
  4. Barkley, R. A. (2014). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York: Guilford.Google Scholar
  5. Bauermeister, J. J. (2016). Parental behavior training and Latino/Hispanic children with ADHD and/or disruptive behaviors. The ADHD Report, 24(8), 9–14.CrossRefGoogle Scholar
  6. Beecham, J. (2014). Annual research review: Child and adolescent mental health interventions: A review of progress in economic studies across different disorders. Journal of Child Psychology and Psychiatry, 55(6), 714–732. Scholar
  7. Bernfort, L., Nordfeldt, S., & Persson, J. (2008). ADHD from a socio-economic perspective. Acta Paediatrica, 97(2), 239–245. Scholar
  8. Birnbaum, H. G., Kessler, R. C., Lowe, S. W., Secnik, K., Greenberg, P. E., Leong, S. A., & Swensen, A. R. (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(2), 195–206. Scholar
  9. Bornstein, M. H., Putnick, D. L., Costlow, K. M., & Suwalsky, J. T. (2018). Retrospective report revisited: long-term recall in European American mothers moderated by developmental domain, child age, person, and metric of agreement. Applied Developmental Science, 1–21.
  10. Brannan, A. M., & Heflinger, C. A. (2001). Distinguishing caregiver strain from psychological distress: Modeling the relationships among child, family, and caregiver variables. Journal of Child and Family Studies, 10(4), 405–418. Scholar
  11. Brewin, C. R., Andrews, B., & Gotlib, I. H. (1993). Psychopathology and early experience: a reappraisal of retrospective reports. Psychological Bulletin, 113(1), 82–98.CrossRefGoogle Scholar
  12. Buescher, A. V., Cidav, Z., Knapp, M., & Mandell, D. S. (2014). Costs of autism spectrum disorders in the United Kingdom and the United States. JAMA Pediatrics, 168(8), 721–728. Scholar
  13. Bussing, R., Gary, F. A., Mason, D. M., Leon, C. E., Sinha, K., & Garvan, C. W. (2003). Child temperament, ADHD, and caregiver strain: exploring relationships in an epidemiological sample. Journal of the American Academy of Child & Adolescent Psychiatry, 42(2), 184–192. Scholar
  14. Bussing, R., Meyer, J., Zima, B. T., Mason, D. M., Gary, F. A., & Garvan, C. W. (2015). Childhood ADHD symptoms: association with parental social networks and mental health service use during adolescence. International Journal of Environmental Research and Public Health, 12(9), 11893–11909. Scholar
  15. Calhoun, P. (2013). Exact: unconditional exact test. R package Version, 1.Google Scholar
  16. Cook, R. D. (1977). Detection of influential observation in linear regression. Technometrics, 19(1), 15–18.Google Scholar
  17. De Ridder, A., & De Graeve, D. (2006). Healthcare use, social burden and costs of children with and without ADHD in Flanders, Belgium. Clinical Drug Investigation, 26(2), 75–90.CrossRefGoogle Scholar
  18. Desmarais, B. A., & Harden, J. J. (2013). Replication data for: Testing for zero-inflation in count models: Bias correction for the Vuong Test (Publication no. hdl/1902.1/21966). Retrieved March 29, 2017 from Harvard Dataverse
  19. Dong, Y., & Peng, C.-Y. J. (2013). Principled missing data methods for researchers. SpringerPlus, 2, 222. Scholar
  20. Doshi, J. A., Hodgkins, P., Kahle, J., Sikirica, V., Cangelosi, M. J., Setyawan, J., et al. (2012). Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. Journal of the American Academy of Child & Adolescent Psychiatry, 51(10), 990–1002.e1002. Scholar
  21. Evans, S. W., Owens, J. S., Wymbs, B. T., & Ray, A. R. (2018). Evidence-based psychosocial treatments for children and adolescents with attention deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 47(2), 157–198.CrossRefGoogle Scholar
  22. Fabiano, G. A., Pelham, W. E. Jr., Waschbusch, D. A., Gnagy, E. M., Lahey, B. B., Chronis, A. M., Onyango, A. N., Kipp, H., Lopez-Williams, A., Burrows-MacLean, L. (2006). A practical measure of impairment: Psychometric properties of the Impairment Rating Scale in samples of children with attention deficit hyperactivity disorder and two school-based samples. Journal of Clinical Child & Adolescent Psychology, 35(3), 369–385.CrossRefGoogle Scholar
  23. Federal Reserve Board. (2017). Report on the economic well-being of U.S. households in 2016. Washington, DC: Federal Reserve Board Publications.Google Scholar
  24. Fletcher, J., & Wolfe, B. (2009). Long-term consequences of childhood ADHD on criminal activities. The Journal of Mental Health Policy and Economics, 12(3), 119–138.PubMedPubMedCentralGoogle Scholar
  25. Flood, E., Gajria, K., Sikirica, V., Dietrich, C. N., Romero, B., Harpin, V., Banaschewski, T., Quintero, J., Erder, M. H., Fridman, M., & Chen, K. (2016). The caregiver perspective on Paediatric ADHD (CAPPA) survey: understanding sociodemographic and clinical characteristics, treatment use and impact of ADHD in Europe. Journal of Affective Disorders, 200, 222–234. Scholar
  26. Fridman, M., Banaschewski, T., Sikirica, V., Quintero, J., Erder, M. H., & Chen, K. S. (2017). Factors associated with caregiver burden among pharmacotherapy-treated children/adolescents with ADHD in the caregiver perspective on pediatric ADHD survey in Europe. Neuropsychiatric Disease and Treatment, 13, 373–386. Scholar
  27. Friedenreich, C. M. (1994). Improving long-term recall in epidemiologic studies. Epidemiology, 5, 1–4.CrossRefGoogle Scholar
  28. Ganz, M. L. (2007). The lifetime distribution of the incremental societal costs of autism. Archives of Pediatrics and Adolescent Medicine, 161(4), 343–349.CrossRefGoogle Scholar
  29. Gardner, W., Mulvey, E. P., & Shaw, E. C. (1995). Regression analyses of counts and rates: poisson, overdispersed poisson, and negative binomial models. Psychological Bulletin, 118(3), 392–404.CrossRefGoogle Scholar
  30. Greenberg, P. E., Fournier, A.-A., Sisitsky, T., Pike, C. T., & Kessler, R. C. (2015). The economic burden of adults with major depressive disorder in the United States (2005 and 2010). The Journal of Clinical Psychiatry, 76(2), 155–162.CrossRefGoogle Scholar
  31. Gupte-Singh, K., Singh, R. R., & Lawson, K. A. (2017). Economic burden of attention-deficit/hyperactivity disorder among pediatric patients in the United States. Value in Health, 20(4), 602–609. Scholar
  32. Hakkaart-van Roijen, L., Zwirs, B. W., Bouwmans, C., Tan, S. S., Schulpen, T. W., Vlasveld, L., & Buitelaar, J. K. (2007). Societal costs and quality of life of children suffering from attention deficient hyperactivity disorder (ADHD). European Child and Adolescent Psychiatry, 16(5), 316–326. Scholar
  33. Harpin, V. A. (2005). The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Archives of Disease in Childhood, 90(Suppl 1), i2–i7. Scholar
  34. Hilbe, J. (2011). Negative binomial regression. Cambridge: Cambridge University Press. Scholar
  35. Hintze, J. L., & Nelson, R. D. (1998). Violin plots: A box plot-density trace synergism. The American Statistician, 52(2), 181–184. Scholar
  36. Jackman, S. (2008). pscl: classes and methods for R developed in the Political Science Computational Laboratory: Stanford University. Department of Political Science, Stanford University, Stanford, California. R package version 0.95. Retrieved March 29, 2017, URL
  37. Jo, C. (2014). Cost-of-illness studies: concepts, scopes, and methods. Clinical and Molecular Hepatology, 20(4), 327–337. Scholar
  38. Johnston, C., & Mash, E. J. (2001). Families of children with attention-deficit/hyperactivity disorder: review and recommendations for future research. Clinical Child and Family Psychology Review, 4(3), 183–207.CrossRefGoogle Scholar
  39. Kuriyan, A. B., Pelham, W. E., Jr., Molina, B. S., Waschbusch, D. A., Sibley, M. H., & Gnagy, E. M. (2014). Concordance between parent and physician medication histories for children and adolescents with attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 24(5), 269–274.CrossRefGoogle Scholar
  40. Lahey, B. B., Pelham, W. E., Stein, M. A., Loney, J., Trapani, C., Nugent, K., et al. (1998). Validity of DSM-IV attention-deficit/hyperactivity disorder for younger children. Journal of the American Academy of Child & Adolescent Psychiatry, 37(7), 695–702.CrossRefGoogle Scholar
  41. Larsson, H., Sariaslan, A., Langstrom, N., D'Onofrio, B., & Lichtenstein, P. (2014). Family income in early childhood and subsequent attention deficit/hyperactivity disorder: a quasi-experimental study. Journal of Child Psychology and Psychiatry, 55(5), 428–435. Scholar
  42. Lavelle, T. A., Weinstein, M. C., Newhouse, J. P., Munir, K., Kuhlthau, K. A., & Prosser, L. A. (2014). Economic burden of childhood autism spectrum disorders. Pediatrics, 133(3), e520–e529.CrossRefGoogle Scholar
  43. Lydersen, S., Fagerland, M. W., & Laake, P. (2009). Recommended tests for association in 2 x 2 tables. Statistics in Medicine, 28(7), 1159–1175. Scholar
  44. Marks, D. J., Mlodnicka, A., Bernstein, M., Chacko, A., Rose, S., & Halperin, J. M. (2009). Profiles of service utilization and the resultant economic impact in preschoolers with attention deficit/hyperactivity disorder. Journal of Pediatric Psychology, 34(6), 681–689. Scholar
  45. Matza, L. S., Paramore, C., & Prasad, M. (2005). A review of the economic burden of ADHD. Cost Effectiveness and Resource Allocation, 3, 5. Scholar
  46. Mehrotra, D. V., Chan, I. S. F., & Berger, R. L. (2003). A cautionary note on exact unconditional inference for a difference between two independent binomial proportions. Biometrics, 59(2), 441–450. Scholar
  47. Meyers, J., Classi, P., Wietecha, L., & Candrilli, S. (2010). Economic burden and comorbidities of attention-deficit/hyperactivity disorder among pediatric patients hospitalized in the United States. Child and Adolescent Psychiatry and Mental Health, 4(1), 31.CrossRefGoogle Scholar
  48. Moon, R. J., Lim, A., Farmer, M., Segaran, A., Clarke, N. M., Harvey, N. C., et al. (2016). Validity of parental recall of children’s fracture: implications for investigation of childhood osteoporosis. Osteoporosis International, 27(2), 809–813.CrossRefGoogle Scholar
  49. Pelham III W. E., Page T. F., Altszuler, A. R., Gnagy, E. M., & Pelham Jr W. E. (under review). The Long-term financial outcome of children diagnosed with ADHD: a prospective, longitudinal, case-control study.Google Scholar
  50. Pelham, W. E., Jr., & Lang, A. R. (1993). Parental alcohol consumption and deviant child behavior: laboratory studies of reciprocal effects. Clinical Psychology Review, 13(8), 763–784.CrossRefGoogle Scholar
  51. Pelham, W. E., Jr., 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 & Adolescent Psychiatry, 31(2), 210–218. Scholar
  52. Pelham, W. E., Jr., Lang, A. R., Atkeson, B., Murphy, D. A., Gnagy, E. M., Greiner, A. R., et al. (1997). Effects of deviant child behavior on parental distress and alcohol consumption in laboratory interactions. Journal of Abnormal Child Psychology, 25(5), 413–424.CrossRefGoogle Scholar
  53. Pelham, W. E., Jr., Fabiano, G. A., & Massetti, G. M. (2005). Evidence-based assessment of attention deficit hyperactivity disorder in children and adolescents. Journal of Clinical Child & Adolescent Psychology, 34(3), 449–476. Scholar
  54. Pelham, W. E., Jr., Foster, E. M., & Robb, J. A. (2007). The economic impact of attention-deficit/hyperactivity disorder in children and adolescents. Ambulatory Pediatrics, 7(1 Suppl), 121–131. Scholar
  55. Pilapil, M., Coletti, D. J., Rabey, C., & DeLaet, D. (2017). Caring for the caregiver: supporting families of youth with special health care needs. Current Problems in Pediatric and Adolescent Health Care, 47(8), 190–199. Scholar
  56. R Core Team (2016). R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing. URL
  57. Richters, J. E. (1992). Depressed mothers as informants about their children: a critical review of the evidence for distortion. Psychological Bulletin, 112(3), 485–499.CrossRefGoogle Scholar
  58. Robb, J. A., Sibley, M. H., Pelham, W. E., Jr., Foster, E. M., Molina, B. S., Gnagy, E. M., & Kuriyan, A. B. (2011). The estimated annual cost of ADHD to the U.S. education system. School Mental Health, 3(3), 169–177. Scholar
  59. Sales, E. (2003). Family burden and quality of life. Quality of Life Research, 12(1), 33–41. Scholar
  60. Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39(1), 28–38. Scholar
  61. Shin, S. H., & Brown, T. A. (2009). Racial and ethnic disparities in caregiver strain and the use of child mental health services: a structural equation model. Psychiatric Services, 60(8), 1039–1045.CrossRefGoogle Scholar
  62. Sibley, M. H., Pelham, W. E., Jr., Molina, B. S. G., Gnagy, E. M., Waschbusch, D. A., Biswas, A., et al. (2011). The delinquency outcomes of boys with ADHD with and without comorbidity. Journal of Abnormal Child Psychology, 39(1), 21–32. Scholar
  63. Stata Corp (2015). Statistical Software: Release 14. College Station: Stata Corp LP.Google Scholar
  64. Theule, J., Wiener, J., Tannock, R., & Jenkins, J. M. (2010). Parenting stress in families of children with ADHD. Journal of Emotional and Behavioral Disorders, 21(1), 3–17. Scholar
  65. Thompson, A. L., Molina, B. S., Pelham, W., Jr., & Gnagy, E. M. (2007). Risky driving in adolescents and young adults with childhood ADHD. Journal of Pediatric Psychology, 32(7), 745–759.CrossRefGoogle Scholar
  66. U.S. Census Bureau (2017). Current Population Survey, 2016. Retrieved October 15, 2017 from
  67. U.S. Department of Labor Bureau of Labor Statistics (2016) National Occupational Employment and Wage Estimates United States, 2015. Retrieved March 29, 2017 from
  68. Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., Perou, R., & Blumberg, S. J. (2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011. Journal of the American Academy of Child & Adolescent Psychiatry, 53(1), 34–46 e32. Scholar
  69. Wehmeier, P. M., Schacht, A., & Barkley, R. A. (2010). Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life. Journal of Adolescent Health, 46(3), 209–217. Scholar
  70. Wymbs, B. T., Pelham, W. E., Jr., Molina, B. S., Gnagy, E. M., Wilson, T. K., & Greenhouse, J. B. (2008). Rate and predictors of divorce among parents of youths with ADHD. Journal of Consulting and Clinical Psychology, 76(5), 735–744. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Xin Zhao
    • 1
    • 2
    Email author
  • Timothy F. Page
    • 2
    • 3
  • Amy R. Altszuler
    • 1
    • 2
  • William E. PelhamIII
    • 4
  • Heidi Kipp
    • 5
  • Elizabeth M. Gnagy
    • 2
  • Stefany Coxe
    • 1
    • 2
  • Nicole K. Schatz
    • 1
    • 2
  • Brittany M. Merrill
    • 1
    • 2
  • Fiona L. Macphee
    • 1
    • 2
  • William E. PelhamJr
    • 1
    • 2
  1. 1.Department of PsychologyFlorida International UniversityMiamiUSA
  2. 2.Center for Children and FamiliesFlorida International UniversityMiamiUSA
  3. 3.Department of Health Policy and ManagementFlorida International UniversityMiamiUSA
  4. 4.Department of PsychologyArizona State UniversityTempeUSA
  5. 5.Department of PsychiatryUniversity of PittsburghPittsburghUSA

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