Special Education Financing and ADHD Medications: A Bitter Pill to Swallow

Abstract

Accurate diagnosis of attention deficit/hyperactivity disorder (ADHD) in children is difficult because the major symptoms, inattentiveness and hyperactivity, can be exhibited by any child. This study finds evidence of systematic differences in diagnosis and treatment of ADHD due to third party financial incentives. In some states, due to the financing mechanism for special education, schools face a financial incentive to facilitate the identification of children with ADHD. Using variation in special education funding policies across states, we find that children living in states with financial incentives are about 15 percent more likely to report having ADHD and are about 22 percent more likely to be taking medication for ADHD. We provide support that these findings are causal by leveraging variation from two states that implemented policy changes during the time period studied.

Statistical analysis of childhood and early adolescent externalizing behaviors in a middle low income country

“…The diagnosis of hyperactivity is key to proper treatment and counseling. Diagnosis accuracy reduces with decreasing age; because any child can exhibit hyperactivity [99]. Clinical psychologists treat hyperactivity as a neurodevelopmental disorder [100], which can be identified by the use of electroencephalography (EEG), combined with convolutional neural networks [101].…”

State-Level Estimates of the Prevalence of Parent-Reported ADHD Diagnosis and Treatment Among U.S. Children and Adolescents, 2016 to 2019

“…State-level educational or health care system policies could also affect the diagnostic and treatment practices for ADHD in a given state. Some examples of such policies include consequential accountability reforms in education (Bokhari & Schneider, 2011;Fulton et al, 2015), special education funding policies (Morrill, 2018), Medicaid policies such as waivers or medication prior authorization (Hulkower et al, 2017;Lindly et al, 2022;Schor & Johnson, 2021), or pharmaceutical detailing policies (Larkin et al, 2017). Variation by state in the characteristics and density of health care providers may also influence state-level rates of ADHD diagnosis and treatment (Andrilla et al, 2018;Fulton et al, 2009;Harati et al, 2020;McBain et al, 2019), as the availability of trained providers could affect families' ability to get an appropriate ADHD diagnosis or receive certain types of treatment for their children.…”

Family Spillover Effects of Marginal Diagnoses: The Case of Adhd

“…The above analysis suggests that schools and families are more likely to refer to screenings the younger siblings and cousins of older children who are marginally diagnosed with ADHD than the younger family members of older children who are not. Thus, as a consequence of such "hereditary tagging" at the referral stage, more children with an older relative born in 38 See Cullen (2003) and Morrill (2018) for evidence on schools responding to financial incentives to classify students as having ADHD in the United States.…”