Economic Evaluations and Interventions for Children and Adolescents with Mental Health Problems

Objectives To compare the cumulative costs of public services used through to adulthood by individuals with three levels of antisocial behaviour in childhood. Design Costs applied to data of 10 year old children from the inner London longitudinal study selectively followed up to adulthood. Setting Inner London borough. Participants 142 individuals divided into three groups in childhood: no problems, conduct problems, and conduct disorder. Main outcome measures Costs in 1998 prices for public services (excluding private, voluntary agency, indirect, and personal costs) used over and above basic universal provision. Results By age 28, costs for individuals with conduct disorder were 10.0 times higher than for those with no problems (95% confidence interval of bootstrap ratio 3.6 to 20.9) and 3.5 times higher than for those with conduct problems (1.7 to 6.2). Mean individual total costs were £70 019 for the conduct disorder group (bootstrap mean difference from no problem group £62 898; £22 692 to £117 896) and £24 324 (£16 707; £6594 to £28 149) for the conduct problem group, compared with £7423 for the no problem group. In all groups crime incurred the greatest cost, followed by extra educational provision, foster and residential care, and state benefits; health costs were smaller. Parental social class had a relatively small effect on antisocial behaviour, and although substantial independent contributions came from being male, having a low reading age, and attending more than two primary schools, conduct disorder still predicted the greatest cost. Conclusions Antisocial behaviour in childhood is a major predictor of how much an individual will cost society. The cost is large and falls on many agencies, yet few agencies contribute to prevention, which could be cost effective.

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“…Few direct studies have looked at the economic costs of conduct disorder or its consequences 7. Related studies suggest that costs are high.…”

Section: Introductionmentioning

confidence: 99%

Financial cost of social exclusion: follow up study of antisocial children into

Scott

Knapp

Henderson

et al. 2001

BMJ

742

545

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“…Prevalence rates vary considerably (3% to 14% of school-age children; Knapp, 1997) with a male-to-female ratio of 3:1 (Szatmari et al, 1989). ADHD can have long-term adverse effects upon academic performance, vocational success and psychosocial functioning and children with ADHD are at a heightened risk of engaging in offending behaviour, having contact with mental health services as adults and misusing substances in adulthood (Biederman et al, 1995;Weiss and Hechtman, 1993).…”

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confidence: 97%

Children's attitudes and behavioural intentions towards a peer with symptoms of ADHD: does the addition of a diagnostic label make a difference?

Law

Sinclair

Fraser

2007

J Child Health Care

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This article explores the impact of diagnostic/psychiatric labelling on the attitudes and behavioural intentions of school-aged children towards a hypothetical peer presented with symptoms of attention deficit hyperactivity disorder (ADHD). A sample of 120 children aged 11-12 years read one of three vignettes describing the behaviour of a gender-neutral, same-age peer presenting with symptoms of ADHD. The participants completed self-report measures of attitudes and behavioural intentions after reading the respective vignettes. The majority of participants perceived the vignette character as being male and the attitude held towards him was predominately negative. Significant positive relationships were found between attitudes and children's willingness to engage in social, academic and physical activities. Diagnostic/psychiatric labelling had no additional influence upon attitudes or behavioural intentions. Children's negative attitude towards peers with symptoms of ADHD, given its association with friendship choice, is an important target for change in reducing stigma.

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“…Dadds, Spence, Holland, Barrett, & Laurens, 1997;Rapee, 2002), but have never been economically evaluated, even though it is important to investigate their economic value in comparison to their effectiveness. The outcomes of economic evaluations are highly relevant for resourceallocation decisions by policy makers and insurers (Knapp, 1997). In an economic evaluation, the relative costs and effects of two or more types of intervention are quantitatively compared (Drummond, O'Brien, Stoddart, & Torrance, 1997), and results guide objective decision making between competing interventions.…”

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confidence: 99%