The economic case for treating childhood behavioural problems There is compelling economic evidence for treating childhood behavioural problems. The benefits of tested interventions far outweigh the costs and have a life-long impact on the children, families and society. What is conduct disorder? Some children display behavioural problems which are so severe, frequent and persistent that they justify diagnosis as a mental health condition: conduct disorder. Depending on age, problem behaviours may include: persistent disobedience, angry outbursts and tantrums, physical aggression, fighting, destruction of property, stealing, lying and bullying. For about half of the children concerned, these problems will persist into adolescence and beyond and are associated with a wide range of damaging and costly outcomes throughout life and even extending into succeeding generations. What is ADHD? ADHD is a childhood behavioural disorder characterised by high levels of inattention, hyperactivity and impulsiveness. The estimated prevalence of ADHD among children aged 5-16 in Britain is 1.5%. ADHD is much more common among boys than girls and children with ADHD are very likely to have another mental health condition at the same time. Around two-thirds of people diagnosed with ADHD in childhood continue to have some symptoms into adulthood. The costs of conduct disorder Good quality parenting programmes can make a real difference to children with conduct disorder, helping parents pick up simple techniques to more effectively manage behaviour and support their child’s wellbeing. They also potentially contribute to substantial cost savings in the public sector. Despite these opportunities, only a small minority of children and families get the help they need to protect their children’s life chances. The costs of ADHD ADHD can have a number of long-lasting adverse outcomes because its impact in childhood can have enduring effects even after symptoms of the condition have resolved. Such long-term consequences suggest that the most appropriate way to measure the costs of ADHD is on a lifetime basis. The areas of potential cost are the use of health services, educational provision, crime and lifetime earnings. In all these areas there is evidence that the presence of ADHD in childhood is associated with increased long-term costs. But association is not the same as causation and the attribution of costs also needs to take into account influences other than ADHD, particularly the presence of co-morbid mental health conditions. Estimates of long-term costs per case of ADHD are as follows (all figures at 2012/13 prices): Extra costs of health care: £22,315 Extra costs of educational provision: £45,075 Reduced earnings: £34,745. The aggregate costs of ADHD are thus estimated at around £102,135 per case. Based on the number of children born each year in England and the 1.5% prevalence of ADHD, about 10,500 of children will become new cases which implies that the total long-term cost of ADHD for each one-year cohort of children in this country comes to around £1,070 million. Implications Parenting programmes Provided that they are well implemented, parenting programmes are very good value for money. The potential benefits of early intervention are so high relative to its cost that only a modest improvement in outcomes is needed to support a strong economic case. These programmes more than pay for themselves through future savings in public spending, spread across a range of budgets including education, health, social care and criminal justice. And there are also substantial benefits to wider society and to individuals and their families, not all of which can easily be measured in monetary terms. ADHD The high costs of ADHD support an economic case for early intervention, as they imply that even relatively modest improvements in outcomes would yield significant financial returns. This case is further strengthened by a growing body of evidence which demonstrates the effectiveness of a range of interventions for the treatment of ADHD in childhood, including parenting programmes, social skills training and cognitive behavioural therapy, combined with medication for severe cases.