title: Parent-Reported Health Consequences and Relationship to Expenditures in Children with ADHD.
abstract: OBJECTIVE
  (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.
authors.affiliation: Division of General Pediatrics and Adolescent Medicine, UNC-Chapel Hill School of Medicine, 260 MacNider Building, CB #7220, Chapel Hill, NC, 27599-7220, USA. neal.dejong25@gmail.com.
authors.forename: Neal A
authors.identifier: http://orcid.org/0000-0002-8638-939X
authors.initials: NA
authors.lastname: deJong
authors.affiliation: Cecil G. Sheps Center for Health Services Research, UNC-Chapel Hill, CB #7590, 725 Martin Luther King, Jr. Blvd., Chapel Hill, NC, 27599-7590, USA.
authors.forename: Christianna S
authors.initials: CS
authors.lastname: Williams
authors.affiliation: Cecil G. Sheps Center for Health Services Research, UNC-Chapel Hill, CB #7590, 725 Martin Luther King, Jr. Blvd., Chapel Hill, NC, 27599-7590, USA.
authors.forename: Kathleen C
authors.initials: KC
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000191:economics / Q000628:therapy*; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D020380:Needs Assessment; D010290:Parents; D055656:Prescriptions / Q000191:economics*; D014481:United States
keywords: Attention deficit hyperactivity disorder (ADHD); CSHCN Screener; Children with Special Health Care Needs (CSHCN); Medical Expenditure Panel Survey (MEPS)