Abstract
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.

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Notes
Although the negative binomial model (NB) (Model 1) has better fit statistics than the zero-inflated negative binomial model (ZINB) (Model 2) (BIC-corrected Vuong z = 1.67, p = 0.05) (Desmarais and Harden 2013), results from ZINB were presented to account for zero-inflation and measurement errors.
The ZINB has two parts: (a) a logistic regression to predict the presence of any excessive zero economic burden (i.e., whether burden > 0) and (b) a negative binomial model to predict total monetary burden, conditional on burden being present. In contrast, in hurdle models, all zeroes come from one “structural” source (i.e., all zeroes suggested that families experienced zero monetary burden in the given categories). The ZINB was chosen because zeroes in our dataset included families who reported zeroes due to recall errors (e.g., some caregivers had difficulty remembering the costs across the entire 14 to 17 years assessed in the survey), as well as the families who actually experienced zero monetary burden in the given categories.
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Acknowledgments
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).
Funding
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).
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Zhao, X., Page, T.F., Altszuler, A.R. et al. Family Burden of Raising a Child with ADHD. J Abnorm Child Psychol 47, 1327–1338 (2019). https://doi.org/10.1007/s10802-019-00518-5
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DOI: https://doi.org/10.1007/s10802-019-00518-5