title: The fiscal consequences of ADHD in Germany: a quantitative analysis based on differences in educational attainment and lifetime earnings.
abstract: OBJECTIVE
  To estimate the long-term fiscal consequences of attention deficit hyperactivity disorder (ADHD) on the German government and social insurance system based on differences in educational attainment and the resulting differences in lifetime earnings compared with non-ADHD cohorts.
  
  
  METHODS
  Differences in educational attainment between ADHD and non-ADHD cohorts were linked to education-specific earnings data. Direct and indirect tax rates and social insurance contributions were linked to differences in lifetime, education-specific earnings to derive lost tax revenue in Germany associated with ADHD. For ADHD and non-ADHD cohorts we derived the age-specific discounted net taxes paid by deducting lifetime transfers from lifetime gross taxes paid.
  
  
  RESULTS
  The lifetime net tax revenue for a non-ADHD individual was approximately EUR 80,000 higher compared to an untreated ADHD individual. The fiscal burden of untreated ADHD, based on a cohort of n=31,844 born in 2010, was estimated at EUR 2.5 billion in net tax revenue losses compared with an equally-sized non-ADHD cohort. ADHD interventions providing a small improvement in educational attainment resulted in fiscal benefits from increases in lifetime tax gains.
  
  
  CONCLUSIONS
  ADHD results in long-term financial loss due to lower education attainment and lifetime reduced earnings and resulting lifetime taxes and social contributions paid. Investments in ADHD interventions allowing more children to achieve their educational potential may offer fiscal benefits generating a positive rate of return.
authors.affiliation: Global Market Access Solutions LLC, Mooresville, NC, USA. n.kotsopoulos@rug.nl
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kotsopoulos
authors.forename: Mark P
authors.initials: MP
authors.lastname: Connolly
authors.forename: Esther
authors.initials: E
authors.lastname: Sobanski
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Postma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001289:Attention Deficit Disorder with Hyperactivity / Q000191:economics*; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D005858:Germany; D006801:Humans; D007182:Income; D007183:Income Tax / Q000191:economics; D008297:Male; D008605:Mental Health Services / Q000191:economics; D008875:Middle Aged; D012456:Salaries and Fringe Benefits / Q000191:economics; D012943:Social Security / Q000191:economics; D055815:Young Adult