Family cost of raising a child with ADHD

Understanding the big picture on how families suffer with AD/HD is extremely important. This enlightening article by Dr. David Rabiner brings this point home.

by David Rabiner, Ph.D. Research Professor Duke University

Relatively little research on the economic impact on families of raising a child with ADHD has been published. This information is important for better understanding the challenges that many families experience and identifying supports that are needed.

A recently published study titled 'Family burden of raising a child with ADHD' provides a more comprehensive look at this issue than has previously been available [Zhao et al.,(2019). Journal of Abnormal Child Psychology, 47, 1327-1338.]

In this study, family burden was defined to include multiple the challenges related to a the child's ADHD. These challenges include direct costs (e.g., costs of additional educational services), and indirect costs (e.g., absence from work due to child's difficulties).

Participants were parents of 86 children, 50 diagnosed with ADHD between the ages of 4 and 6 and 36 comparison children. These children/families were followed annually many years. When the youth were 16-18 years old, estimates of costs that families experienced during their child's development assessments related to the different types of costs incurred over the years were estimated.

Direct costs included costs connected to behavioral/educational problems, not including direct treatment costs, i.e., medication and/or therapy costs. This included expenses related to academic supports, e.g., tutoring, purchases of educational software, extra books. Also included were costs related to accidents and injury and those related to discipline and legal involvement, e.g., attorney fees and court costs.

Indirect costs included parental loss of income due to missed work, loss of job, additional childcare expenses, and for parents' mental health concerns. When reporting on these issues, parents were specifically asked whether they received mental health treatment, missed activities they would have participated in, or required additional childcare services because of their child's difficulties/special needs.

Results - Families with a child diagnosed with ADHD experienced over 5 times higher total financial burden relative to families of comparison children, an average of $15,036 vs. $2,848. This works out to roughly an additional $1,000 per year.

As noted above, these figures exclude the direct costs of medical treatment/therapy. The estimates also control for other behavioral problems, i.e., symptoms of oppositional defiant disorder and conduct disorder that youth displayed during adolescence. This is important because it allows the authors to be more confident that the additional costs are attributable to a child's ADHD, and not to other behavioral problems that often go along with ADHD.

Occupational and socioemotional burden - Parents of children with ADHD experienced reduced work efficiency relative to parents of comparison children, They reported spending more time unable to concentrate at work, working more slowly than they should have, having d more non-work related conversations, and feeling tired more often.

Twenty percent reported that they needed to reduce their work hours because of their child's difficulties compared to only 3% of comparison parents. Eleven percent either quit a job or were fired versus none of the comparison parents. They were also substantially more likely to receiving their own mental health treatment, i.e., 15% vs. 0%.

Summary and recommendations - Results indicate that the costs associated with raising a child with ADHD are substantial, estimated at an average of over $12K from childhood through adolescence, roughly an additional $1,000 per year. And, this estimate does not include the direct costs associated with ADHD treatment. Much of these costs from the impact that a child's difficulties had on their parents work.

Limitations of the study include a relatively small sample that was drawn from a single metropolitan area. Further investigations with larger and more nationally representative samples would be helpful to better understand the issues investigated here.

Despite this limitation, the study provides important evidence that caregivers of children and adolescents with ADHD experience both financial and socio-emotional burdens. The authors note that practitioners and policy makers "...should ensure families are aware of and have access to existing support programs for which they may be eligible (e.g., Supplemental Security Income, Social Security Disability Insurance, Family Medical Leave, and options for respite care).

In addition, involving parents in evidence-based program such as behavioral parent training may help reduce the additional costs associated with ADHD that family's experience. For example, if parents are able to better manage their child's difficulties, the adverse impact on their own work may be reduced. This would also be an interesting issue to examine.