AMBULATORY PEDIATRICS
VOLUME 7, NUMBER 1
EMBARGOED UNTIL January 19, 2007
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This issue of Ambulatory Pediatrics includes a special supplement arising from an American Academy of Pediatrics’sponsored conference held in Summer 2005 focused on measuring outcomes for children and adolescents with
Attention Deficit/Hyperactivity Disorder (ADHD). The papers published in this issue will also appear in the Journal of
Pediatric Psychology in its July 2007 issue (Vol 32, No 6). We highlight here three papers from this conference.
Economic Impact of ADHD in Children and Adolescents
Using a cost of illness framework, researchers estimated the annual cost of care in 2005 for children and adolescents
with ADHD. Medical and mental health costs averaged $2636 per child, incremental education costs including
special education, grade retention, and counseling averaged $4900, and marginal crime and delinquency costs
averaged $3518. The total incremental cost for services for a child or adolescent with ADHD was $10691 ($5405$17015 range). Assuming ADHD prevalence of 5%, the aggregate annual average cost for children with ADHD was
$32.1 billion in 2005. Costs for ADHD are comparable to those of other serious medical and mental health conditions:
strokes cost $53.6 billion in 2004 and major depressive disorders cost $44 billion. (Contact William Pelham, PhD,
716-829-2244 Ext 29.)
Peer Functioning in Children with ADHD
Investigators reviewed the literature regarding peer relationships of children with ADHD. The research reviewed
indicates that: 1) having positive peer relationships is developmentally important for all children, whether with ADHD
or not; 2) low acceptance or rejection by peers places children with ADHD at risk for a host of serious negative
outcomes; 3) both boys and girls with ADHD have peer impairment; 4) once rejected, overcoming a negative
reputation with peers is extremely difficult; 5) once labeled “ADHD” by peers, a negative process is set in motion
whereby children suffer more negative treatment by peers; and 6) treatment of peer problems in children with ADHD
is extremely difficult and clinicians have yet to identify treatments that normalize the peer functioning of children with
ADHD. Effective treatments geared at other aspects of dysfunction associated with ADHD do not eradicate the peer
problems children with ADHD face; peer problems need to be targeted directly. These findings have far reaching
implications for future research and treatment programs. (Contact Betsy Hoza, PhD, 802-656-4773.)
Educational Outcomes of Children with ADHD
Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with poor grades, poor reading and math standardized
test scores, and increased grade retention. Children with ADHD also use more school-based services, have
increased rates of detention and expulsion, and ultimately have relatively low rates of high school graduation and
post-secondary education. Children in community samples who show symptoms of inattention, hyperactivity, and
impulsivity with or without formal diagnoses of ADHD also show poor academic and educational outcomes.
Pharmacologic treatment and behavior management are associated with reduction of the core symptoms of ADHD
and increased academic productivity, but not with improved standardized test scores or ultimate educational
attainment. Future research must use conceptually-based outcome measures in prospective, longitudinal, and
community-based studies to determine which pharmacologic, behavioral, and educational interventions can improve
academic and educational outcomes of children with ADHD. (Contact Heidi Feldman, MD, PhD, 650-723-4814.)
Enrollment in State Children’s Health Insurance Program Improves Health Care for
Children
The State Children’s Health Insurance Program (SCHIP) was enacted in 1997 to provide health insurance coverage
for low-income children who have neither private insurance nor Medicaid coverage. Little is known about the effects
of this coverage on children with special health care needs (CSHCN). To assess its impact in New York State,
researchers analyzed statewide survey data of new SCHIP members at enrollment and one year later. Enrollment of
CSHCN in SCHIP was associated with improved access to care. Unmet needs for prescription medications declined
3-fold (36% to 9%). Unmet needs for specialty care was reduced more than 4-fold (48% to 10%) for CSHCN who
were previously uninsured or had mental health/behavioral conditions (32% to 2%). (All p<.05.) Enrollment was
associated with improved continuity of care and better parental-reported quality of care, regardless of prior insurance
or chronic condition. The SCHIP program substantially improves the care of CSHCN in low-income families.
(Contact: Peter Szilagyi, MD, MPH, 716-275-5798.)
Low Parental Literacy Is Associated with Worse Asthma Outcomes for Children
Low literacy in adults is associated with a variety of adverse health outcomes. Because parents are responsible for
the self-care behaviors of their children, researchers sought to determine the affects of parents’ literacy on their
children’s health outcomes for asthma. Compared with children whose parent had higher literacy, children of parents
with low literacy (less than 9th grade level) were more likely to have moderate persistent or severe persistent asthma
(56% vs 35%, p=.03), to miss more school days annually due to asthma (average of 6.7 days vs 3.2 days, p<.05), to
have more yearly emergency department visits (1.53 visits vs 1.08, p<.05), to experience more hospitalizations
(.39/year vs .12, p<.05). After taking into account several key variables including income, race, parental asthma
knowledge, parental smoking, asthma severity, and medication use, children whose parents have low literacy were
4.6 times as likely to be hospitalized and 2.8 times as likely to miss school days as their peers with parents with
higher reading levels (p values < .05). Interventions to improve outcomes for children with asthma must take parental
literacy levels into consideration. (Contact: Darren DeWalt, MD, MPH, 919-966-2276.)
The official journal of the Ambulatory Pediatric Association (APA), Ambulatory Pediatrics provides a muchneeded forum for cutting-edge work in general pediatrics. The journal focuses on areas including child health
services research, emergency medicine, research methodology, complementary and alternative medicine, child
health policy, and adolescent medicine. Ambulatory Pediatrics is indexed in Index Medicus.
ABSTRACTS FOR ALL MANUSCRIPTS WILL BE AVAILABLE AFTER THE EMBARGO FOR REVIEW ON THE
JOURNAL WEBSITE <http://www.ambulatorypediatrics.org>. JOURNALISTS CAN OBTAIN PREPRINTS FROM
THE JOURNAL OFFICE (ambpeds@partners.org <mailto:ambpeds@partners.org>).