Implications for expenditures of parent-reported health consequences for children with mental health needs: ADHD, depression, and autism

Research Objective: This research assesses the ability of parent-reported measures to identify clinical subgroups of children with ADHD, depression, or autism who have meaningfully different health expenditures.   Compared to methods relying on administrative data, such measures may efficiently provide a more nuanced understanding of how consequences of children’s health conditions relate to care expenditures.

Study Design: We used pooled, 2002-11 MEPS data to estimate the relationship of the five CSHCN Screener items to health expenditures for children with ADHD, depression, or autism. Screener items assess ongoing prescription medication use; use of more health or educational services than other children; functional limitations; use of special therapies; and need for emotional, developmental or behavioral counseling.  We used OLS regression to model the relationship between Screener items and log-transformed health expenditures.

Principal Findings: Among children with ADHD (n=3,883), the prescription medication, health services, and counseling items were associated with higher expenditures (2.8, 1.2, and 1.4 times higher, respectively; all p<0.001) for mental and non-mental health services.  Among children with depression (n=1,488), the same three items were associated with higher expenditures, largely for mental health services (3.6, 1.3, and 2.0 times; all p<0.04).  Among children with autism (n=398), only prescription medications were associated with higher expenditures (3.4 times; p<0.001).

Conclusions: For children with three common, costly mental health conditions, CSHCN Screener items may be an efficient, patient-centered method of identifying clinical subgroups with greater expenditures.  The ability to correlate Screener responses with expenditures may help families pick insurance plans that best meet their needs.