title: Preschool hyperactivity is associated with long-term economic burden: evidence from a longitudinal health economic analysis of costs incurred across childhood, adolescence and young adulthood.
abstract: BACKGROUND
  Preschool hyperactivity is an early risk factor for adult mental health problems and criminality. Little is known about; (a) the patterns of long-term service costs associated with this behavioural marker in the general population and (b) the specific factors predicting hyperactivity-related costs. We undertook a prospective study investigating associations between preschool hyperactivity and average individual annual service costs up to late adolescent and young adulthood.
  
  
  METHODS
  One-hundred and seventy individuals rated as hyperactive by their parents and 88 nonhyperactive controls were identified from a community sample of 4,215 three years olds. Baseline information about behaviour/emotional problems and background characteristics were collected. At follow-up (when individuals were aged between 14 and 25 years) information was obtained on service use, and associated costs since the age of three. Based on this information we calculated the average cost per annum incurred by each individual.
  
  
  RESULTS
  Compared to controls, preschoolers with hyperactivity had 17.6 times higher average costs per annum across domains (apart from nonmental health costs). These were £562 for each hyperactive individual compared with £30 for controls. Average annual costs decreased as a function of age, with higher costs incurred at younger ages. The effects of hyperactivity remained significant when other baseline factors were added to the model. Effects were fully mediated by later psychiatric morbidity. When the hyperactive group were examined separately, costs were consistently predicted by male gender and, for some cost codes, by conduct problems.
  
  
  CONCLUSIONS
  Preventative approaches targeting early hyperactivity may be of value. Services should be targeted towards high-risk individuals with careful consideration given to the cost-to-benefit trade-off of early intervention strategies.
authors.affiliation: Southampton Health Technology Assessment Centre (SHTAC), Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Chorozoglou
authors.affiliation: Department of Psychology, University of Bath, Bath, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Smith
authors.affiliation: Developmental Brain-Behaviour Laboratory, Department of Psychology, University of Southampton, Southampton, UK.
authors.forename: Johanna
authors.initials: J
authors.lastname: Koerting
authors.affiliation: Developmental Brain-Behaviour Laboratory, Department of Psychology, University of Southampton, Southampton, UK.
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Thompson
authors.affiliation: Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.|CANDAL (Centre for ADHD and Neuro-Developmental Disorders Across the Lifespan), Institute of Mental Health, Nottingham, Nottingham, UK.
authors.forename: Kapil
authors.initials: K
authors.lastname: Sayal
authors.affiliation: Developmental Brain-Behaviour Laboratory, Department of Psychology, University of Southampton, Southampton, UK.
authors.forename: Edmund J S
authors.initials: EJ
authors.lastname: Sonuga-Barke
mesh_terms: D000293:Adolescent; D000328:Adult; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000191:economics* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012737:Sex Factors; D055815:Young Adult
keywords: ADHD; Hyperactivity; conduct disorder; health economics evaluation; longitudinal; preschool children