Abstract
Objectives (1) To describe parents’ report of special needs for children with ADHD on the Children with Special Health Care Needs (CSHCN) Screener; and (2) to assess the association between responses to Screener items and annual mental health and total health expenditures per child. Methods In pooled 2002–2011 Medical Expenditure Panel Survey (MEPS) data, we identify children ages 4–17 years with ADHD. We use OLS and two-part regressions to model the relationship between CSHCN Screener items and mental health and total health expenditures. Based on these models we estimate adjusted, average total health expenditures for children with ADHD—both with and without a co-morbid mental health condition—and different combinations of endorsed Screener items. This research was conducted in accordance with prevailing ethical principles. Results There were 3883 observations on 2591 children with ADHD. Without a co-morbid mental health condition, average total expenditures per year from adjusted, model-based estimates were $865 for those meeting no Screener items, $2664 for those meeting only the medication item, $3595 for those meeting the medication and counseling items, and $4203 for those meeting the medication, counseling, and use of more health services items. Children with a co-morbid mental health condition had greater total health expenditures for each combination of Screener items. The associations between Screener items and mental health expenditures were similar, but with a slightly lower marginal effect of the medication item (p < 0.001 for all comparisons). Conclusions Parents’ responses on the CSHCN Screener are associated with meaningful variation in expenditures for children with ADHD. Though cross-sectional, this study suggests that the CSHCN Screener can be a useful categorization scheme for children with ADHD. It may be an efficient, standardized tool at the point of care for identifying children who need more resources and for targeting intensive interventions in the context of population health management.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Class 242 includes antipsychotics (phenothiazines, thioxanthenes, atypicals), antidepressants (monoamine oxidase inhibitors, SSRIs, SSNRIs, tricyclics, tetracyclics), barbiturates, benzodiazepines, CNS stimulants, phenylpiperazines, and a category for miscellaneous psychiatric agents.
References
Bethell, C. D., Blumberg, S. J., Stein, R. E., Strickland, B., Robertson, J., & Newacheck, P. W. (2014). Taking stock of the CSHCN screener: A review of common questions and current reflections. Academic Pediatric,. doi:10.1016/j.acap.2014.10.003.
Bethell, C. D., Read, D., Stein, R. E., Blumberg, S. J., Wells, N., & Newacheck, P. W. (2002). Identifying children with special health care needs: development and evaluation of a short screening instrument. Ambulatory Pediatrics, 2(1), 38–48.
Biederman, J., Faraone, S., Milberger, S., Curtis, S., Chen, L., Marrs, A., & Spencer, T. (1996). Predictors of persistence and remission of ADHD into adolescence: results from a four-year prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 35(3), 343–351. doi:10.1097/00004583-199603000-00016.
Bramlett, M. D., Read, D., Bethell, C., & Blumberg, S. J. (2009). Differentiating subgroups of children with special health care needs by health status and complexity of health care needs. Maternal and Child Health Journal, 13(2), 151–163. doi:10.1007/s10995-008-0339-z.
Brown, R. T., Freeman, W. S., Perrin, J. M., Stein, M. T., Amler, R. W., Feldman, H. M., & Wolraich, M. L. (2001). Prevalence and assessment of attention-deficit/hyperactivity disorder in primary care settings. Pediatrics, 107(3), E43.
CAHMI. (2014). Using the CSHCN Screener. Retrieved November 20, 2014, from http://www.cahmi.org/wp-content/uploads/2014/06/CSHCNS-usingcshcnscreener.pdf
Chan, E., Zhan, C., & Homer, C. J. (2002). Health care use and costs for children with attention-deficit/hyperactivity disorder: national estimates from the medical expenditure panel survey. Archives of Pediatrics and Adolescent Medicine, 156(5), 504–511.
Cohen, J. W. (1997). Design and methods of the Medical Expenditure Panel Survey, household component. US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research.
Duan, N. (1983). Smearing estimate: a nonparametric retransformation method. Journal of the American Statistical Association, 78(383), 605–610.
Epstein, J. N., Kelleher, K. J., Baum, R., Brinkman, W. B., Peugh, J., Gardner, W., & Langberg, J. (2014). Variability in ADHD care in community-based pediatrics. Pediatrics, 134(6), 1136–1143. doi:10.1542/peds.2014-1500.
Ezzati-Rice, T. M., Rohde, F., & Greenblatt, J. (2008). Sample design of the Medical Expenditure Panel Survey household component, 1998–2007. US Department of Health and Human Services, Agency for Healthcare Research and Quality.
Gelberg, L., Andersen, R. M., & Leake, B. D. (2000). The behavioral model for vulnerable populations: application to medical care use and outcomes for homeless people. Health Services Research, 34(6), 1273–1302.
Guevara, J., Lozano, P., Wickizer, T., Mell, L., & Gephart, H. (2001). Utilization and cost of health care services for children with attention-deficit/hyperactivity disorder. Pediatrics, 108(1), 71–78.
Kessler, R. C., Adler, L. A., Barkley, R., Biederman, J., Conners, C. K., Faraone, S. V., et al. (2005). Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the national comorbidity survey replication. Biological Psychiatry, 57(11), 1442–1451. doi:10.1016/j.biopsych.2005.04.001.
Kolko, D. J., Campo, J., Kilbourne, A. M., Hart, J., Sakolsky, D., & Wisniewski, S. (2014). Collaborative care outcomes for pediatric behavioral health problems: a cluster randomized trial. Pediatrics, 133(4), e981–e992. doi:10.1542/peds.2013-2516.
Kuo, D. Z., Melguizo-Castro, M., Goudie, A., Nick, T. G., Robbins, J. M., & Casey, P. H. (2014). Variation in child health care utilization by medical complexity. Maternal and Child Health Journal,. doi:10.1007/s10995-014-1493-0.
Leibson, C. L., Katusic, S. K., Barbaresi, W. J., Ransom, J., & O’Brien, P. C. (2001). Use and costs of medical care for children and adolescents with and without attention-deficit/hyperactivity disorder. JAMA, 285(1), 60–66.
Machlin, S. R., & Dougherty, D. D. (2007). Overview of methodology for imputing missing expenditure data in the Medical Expenditure Panel Survey. US Department of Health and Human Services, Agency for Healthcare Research and Quality.
McPherson, M., Arango, P., Fox, H., Lauver, C., McManus, M., Newacheck, P. W., et al. (1998). A new definition of children with special health care needs. Pediatrics, 102(1 Pt 1), 137–140.
MEPS HC144A Codebook: 2011 Prescribed Medicines. http://meps.ahrq.gov/mepsweb/data_stats/download_data/pufs/h144a/h144acb.pdf
Ray, G. T., Levine, P., Croen, L. A., Bokhari, F. A., Hu, T. W., & Habel, L. A. (2006). Attention-deficit/hyperactivity disorder in children: excess costs before and after initial diagnosis and treatment cost differences by ethnicity. Archives of Pediatrics and Adolescent Medicine, 160(10), 1063–1069. doi:10.1001/archpedi.160.10.1063.
Szatmari, P., Offord, D. R., & Boyle, M. H. (1989). Correlates, associated impairments and patterns of service utilization of children with attention deficit disorder: findings from the Ontario Child Health Study. Journal of Child Psychology and Psychiatry, 30(2), 205–217.
Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., et al. (2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. J Am Acad Child Adolesc Psychiatry, 53(1), 34–46. doi:10.1016/j.jaac.2013.09.001.
Wolraich, M., Brown, L., Brown, R. T., DuPaul, G., Earls, M., Feldman, H. M., & Visser, S. (2011). ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 128(5), 1007–1022. doi:10.1542/peds.2011-2654.
Wolraich, M. L., Lambert, W., Doffing, M. A., Bickman, L., Simmons, T., & Worley, K. (2003). Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. Journal of Pediatric Psychology, 28(8), 559–567.
Acknowledgments
This study was supported by Grant, R40 MC 26196, R40 MCH Autism Secondary Data Analysis Studies (SDAS) Program, from the Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services. The authors have no financial or intellectual conflicts of interest to declare and agree to be fully accountable for the content of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Appendix
From the Child and Adolescent Health Measurement Initiative (CAHMI); accessed on 12/15/2014 at http://www.cahmi.org/projects/children-with-special-health-care-needs-screener/ and reproduced with permission (personal email from Caitlin Murphy, 2/3/15)
Appendix
See Fig. 2.
The Children with Special Health Care Needs Screener (reproduced with permission from the Child and Adolescent Health Measurement Institute)
Rights and permissions
About this article
Cite this article
deJong, N.A., Williams, C.S. & Thomas, K.C. Parent-Reported Health Consequences and Relationship to Expenditures in Children with ADHD. Matern Child Health J 20, 915–924 (2016). https://doi.org/10.1007/s10995-015-1880-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-015-1880-1