Outpatient rehabilitation utilization and medical expenses in children aged 0-7 years with ADHD: analyses of population-based national health insurance data.
Taiwanese kids 0-7 with ADHD already average 22 yearly rehab visits, so BCBAs should plan care around heavy service loads.
01Research in Context
What this study did
Lin et al. (2013) looked at every rehab bill for Taiwanese kids under seven who carry an ADHD code.
They counted visits, costs, and settings for one whole year.
No tests, no treatment—just the claims picture.
What they found
The average child logged 22 rehab visits in a year.
The 0-2-year-olds ran the biggest bills, even though they are the youngest.
City hospitals, bigger clinics, and certain doctor types sent more bills.
How this fits with other research
Wu et al. (2015) used the same Taiwan database for kids with autism.
They also saw heavy use—about 14 extra doctor visits per year—so high service load is not unique to ADHD.
Harrop (2015) shows that parent-led early programs for autism rarely track rehab visits; Jin-Ding’s paper proves the visits are happening anyway, filling a data gap.
Vassos et al. (2023) found that extra diagnoses push families toward more therapies; Jin-Ding’s toddlers with the highest costs may reflect the same stacking effect.
Why it matters
If you serve preschoolers with ADHD, expect around two therapy visits per month on top of medical care.
Plan your schedule, parent training, and insurance authorizations for that load.
When you see a spike in visits for a two-year-old, question whether multiple providers are duplicating services—you might save the family money and time.
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02At a glance
03Original abstract
Medical costs of attention-deficit/hyperactivity disorder (ADHD) are substantial and have a large impact on the public health system. The present study presents information regarding outpatient rehabilitation care usage and medical expenditure for children with ADHD. A cross-sectional study was conducted by analyzing data from the Taiwan National Health Insurance claims database for the year 2009. A total of 6643 children aged 0-7 years with ADHD (ICD-9-CM codes 314.0x: attention deficit disorder, 314.00: attention deficit disorder without hyperactivity, or 314.01: attention-deficit disorder with hyperactivity) who had used outpatient rehabilitation care were included in the analyses. Results showed that the mean annual rehabilitation care was 22.24 visits. Among the care users, 76% of patients were male, and 24% were female. More than half of the children with ADHD had comorbid mental illnesses as well. A logistic regression analysis of outpatient rehabilitation expenditure (low vs. high) showed that of those children with ADHD, those aged 0-2 years tended to incur more medical costs than those aged 6-7 years. Other factors such as frequency of rehabilitation visits, hospital medical setting and ownership, location of medical care setting, and types of rehabilitation were also significantly correlated with medical expenditure. The results from this study suggest that health care systems should ensure accurate diagnosis and measurement of impairment to maintain appropriate and successful management of rehabilitation needs for children with ADHD.
Research in developmental disabilities, 2013 · doi:10.1016/j.ridd.2013.03.034