Skip to main content
Log in

Examining the Family-Level and Economic Impact of Complex Child Disabilities as a Function of Child Hyperactivity and Service Integration

  • ORIGINAL ARTICLE
  • Published:
Journal of Developmental and Physical Disabilities Aims and scope Submit manuscript

Abstract

Children with complex disabilities require comprehensive, coordinated and integrated services. However, parents often find themselves navigating fragmentary service systems—a process that may be more difficult when children exhibit behavioral problems such as hyperactivity and inattention. Such problems are more common among children with disabilities. Thus, the present study examined the familial and economic impact of service integration and child hyperactivity among 111 families involved with a children’s treatment network over 2 years. The most dysfunctional families over time were involved with low-integration teams and had children who were highly hyperactive. Children who were hyperactive and their parents had the highest levels of service utilization at baseline, though these patterns reversed or disappeared over time, respectively. Family functioning was also associated with higher service costs for parents, over time. Results highlight the importance of considering the impact of child hyperactivity and inattention, even when children are receiving services for other primary diagnoses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, 4th edition-text revision(DSM-IV-TR). Washington, DC: American Psychiatric Press.

    Book  Google Scholar 

  • Baker, B. L., Blacher, J., Crnic, K. A., & Edelbrock, C. (2002). Behavior problems and parenting stress in families of three-year-old children with and without developmental delays. American Journal of Mental Retardation, 107(6), 433–444.

    Article  PubMed  Google Scholar 

  • Barkley, R. A. (2001). Accidents and attention-deficit/hyperactive disorder. TEN, 3, 64–68.

    Google Scholar 

  • Barkley, R. A. (2002). International consensus statement on ADHD. Clinical Child and Family Psychology Review, 5, 89–111.

    Article  PubMed  Google Scholar 

  • Beresford, B. (1995). Expert opinions: a survey of parents caring for a severely disabled child. Policy Press, Bristol.

  • Borthwick, S. A., Eyman, R. K., & White, J. F. (1987). Client characteristics and residential placement patterns. American Journal of Mental Deficiency, 92, 24–30.

    Google Scholar 

  • Borthwick-Duffy, S. A. (1994). Epidemiology and prevalence of psychopathology in people with mental retardation. Journal of Consulting and Clinical psychology, 62, 17–27.

    Article  PubMed  Google Scholar 

  • Borthwick-Duffy, S. A., & Eyman, R. K. (1990). Who are the dually diagnosed. American Journal of mental Retardation, 94, 586–595.

    PubMed  Google Scholar 

  • Boyle, M. H., Offord, D. R., Racine, Y., Fleming, J. E., Szatmari, P., & Sanford, M. (1993). Evaluation of the revised Ontario child health study scales. Journal of Child Psychology and Psychiatry, 34, 189–213.

    Google Scholar 

  • Browne, G., Byrne, C., Roberts, J., Gafni, A., & Whittaker, S. (2001). When the bough breaks: provider-initiated comprehensive care is more effective and less expensive for sole-support parents on social assistance. Social Science & Medicine, 53, 1697–1710.

    Article  Google Scholar 

  • Browne, G., Gafni, A., & Roberts, J. (2001). Approach to the measurement of resource use and costs. Hamilton: System-Linked Research Unit, McMaster University.

    Google Scholar 

  • Browne, G., Roberts, J., Gafni, A., Byrne, C., Kertyzia, J., & Loney, P. (2004). Conceptualizing and validating the human services integration measure. International Journal of Integrated Care, 4, article e03.

    Google Scholar 

  • Browne, G., Kingston, D., Grdisa, V., & Markle-Reid, M. (2007). Conceptualization and measurement of integrated human service networks for evaluation. International Journal of Integrated Care, 7, article e51.

    Google Scholar 

  • Browne, D. T., Odueyungbo, A. O., Thabane, L., Byrne, C., & Smart, L. A. (2010). Parenting-by-gender interactions in child psychopathology: attempting to address inconsistencies with a Canadian national database. Child and Adolescent Psychiatry and Mental Health, 4(1), 5 (13 pages).

    Article  PubMed  Google Scholar 

  • Browne, D. T., Verticchio, D., Shlonsky, A., Thabane, L., Hoch, J., & Byrne, C. (2010). The family standpoint of investigation: examining the correlates and costs of parental stress in a sample of families involved with Ontario child welfare. Canadian Journal of Community Mental Health, 29(2), 131–154.

    Google Scholar 

  • Browne, D. T., Meunier, J.-C., O’Connor, T. G., & Jenkins, J. M. (2012). The role of parental personality traits in differential parenting. Journal of Family Psychology. doi:10.1037/a0028515.

  • Byles, Byrne, C., Boyle, M. H., & Offord, D. R. (1988). Ontario child health study: reliability and validity of the general functioning subscale of the McMaster family assessment device. Family Process, 27(1), 97–104.

    Article  PubMed  Google Scholar 

  • Cacioppo, J. T., Bernston, G. G., Sheridan, J. F., & McClintock, M. K. (2000). Multilevel integrative analysis of human behaviour: social neuroscience and the complementing nature of social and biological approaches. Psychological Bulletin, 126, 829–843.

    Article  PubMed  Google Scholar 

  • Charach, A., Lin, E., & To, T. (2010). Evaluating the hyperactivity/inattention subscale of the National Longitudinal Survey of Children and Youth. Health Reports, Statistics Canada, 21(2), 1–9.

    Google Scholar 

  • Cossette, L., & Duclos, E. (2002). A profile of disability in Canada, 2001. Statistics Canada Housing Family and Social Statistics Division. Ottawa: Minister of Industry.

    Google Scholar 

  • Eyman, R. K., & Borthwick-Duffy, S. A. (1980). Patterns of care for mentally retarded persons. Mental Retardation, 18, 63–66.

    PubMed  Google Scholar 

  • Eyman, R. K., & Call, T. L. (1977). Maladaptive behavior and community placement of mentally retarded persons. American Journal of Mental Deficiency, 82, 137–144.

    PubMed  Google Scholar 

  • Gadow, K., & DeVincent, C. (2005). Clinical significance of tics and attention-deficit hyperactivity disorder in children with pervasive developmental disabilities. Journal of Child Neurology, 20(6), 481–488.

    PubMed  Google Scholar 

  • Guerriere, D. N., Ungar, W. J., Corey, M., Croxford, R., Tranmer, J. E., Tullis, E., et al. (2006). Evaluation of the ambulatory and home care record: agreement between self-reports and administrative data. International Journal of Technology Assessment in Health Care, 22(2), 203–210.

    Article  PubMed  Google Scholar 

  • Guevara, J., Lozano, P., Wickizer, T., Mell, L., & Gephart, H. (2001). Utilization and cost of health care services for children with attention-deficit/hyperactivity disorder. Pediatrics, 108, 71–78.

    Article  PubMed  Google Scholar 

  • Herring, S., Gray, K. M., Taffe, J., Tonge, B. J., Sweeney, D., & Einfeld, S. L. (2006). Behavioural and emotional problems in toddlers with a pervasive developmental disorder and developmental delay: associations with parental mental health and family functioning. Journal of Intellectual Disability Research, 50(12), 874–882.

    Article  PubMed  Google Scholar 

  • Jenkins, J. M., Rasbash, J., & O’Connor, T. G. (2003). The role of shared family context in differential parenting. Developmental Psychology, 39(1), 99–113.

    Article  PubMed  Google Scholar 

  • Johnston, C., & Mash, E. J. (2001). Families of children with attention-deficit/hyperactivity disorder: review and recommendations for future research. Clinical Child and Family Psychology Review, 4, 183–207.

    Article  PubMed  Google Scholar 

  • Konrad, K., & Kickhoff, S. B. (2010). Is the ADHD brain wired differently? A review on structural and functional connectivity in attention deficit hyperactivity disorder. Human Brain Mapping, 31(6), 904–916.

    Article  PubMed  Google Scholar 

  • Lansisalmi, H., Kivimaki, M., Aalto, P., & Ruoranen, R. (2006). Innovation in healthcare: a systematic review of recent research. Nursing Science Quarterly, 19(1), 66–72.

    Article  PubMed  Google Scholar 

  • Levine, S., & White, P. E. (1969). Exchanges as a conceptual framework for the study of interorganizational relationships). In A. Etzioni (Ed.), A sociological reader on complex organizations (2nd ed., pp. 117–132). New York: Hold, Rinehart & Winston.

    Google Scholar 

  • Lyons, J. S. (2004). Redressing the emperor: Improving the children’s public mental health system. Westport, CT: Praeger.

  • Mannuzza, S., & Klein, R. G. (2000). Long-term prognosis in attention-deficit/hyperactivity disorder. Child Adolescent Psychiatry Clinics of North America, 9, 711–726.

    Google Scholar 

  • Mash, E., & Wolfe, D. A. (2005). Abnormal child psychology (3rd Ed.) Chapter 5: Attention-deficit/hyperactivity disorder (ADHD). Canada: Wadsworth.

    Google Scholar 

  • Matza, L. S., Paramore, C., & Prasad, M. (2005). A review of the economic burden of ADHD. Cost Effectiveness and Resource Allocation, 3, 1–9.

    Article  Google Scholar 

  • Meunier, J. C., Bisceglia, R., & Jenkins, J. M. (2011). Differential parenting and children’s behavioral problems: curvilinear associations and mother-father combined effects. Developmental Psychology. doi:10.1037/a0026321.

  • Milward, H. B., & Provan, K. (2003). Managing the hollow state: collaboration and contracting. Public Management Review, 5(1), 1–18.

    Article  Google Scholar 

  • Owens, P. L., Hoagwood, K., Horwitz, S. M., Leaf, P. J., Poduska, J. M., Kellam, S. G., & Ialongo, N. S. (2002). Barriers to children’s mental health services. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 731–738.

    Article  Google Scholar 

  • Rojahn, J., Borthwick-Duffy, S. A., & Jacobson, J. W. (1993). The association between psychiatric diagnoses and severe behavior problems in mental retardation. Annals of Clinical Psychiatry, 5, 163–170.

    Article  PubMed  Google Scholar 

  • Rosenbaum, P., King, S., Law, M., King, G., & Evans, J. (1998). Family-centered service: a conceptual framework and research review. Physical and Occupational Therapy in Pediatrics, 18, 1–20.

    Google Scholar 

  • Sloper, P., & Turner, S. (1993). Risk and resistance factors in the adaptation of patients of children with severe physical disability. Journal of Child Psychology and Psychiatry, 34, 167–188.

    Article  PubMed  Google Scholar 

  • Sloper, P., Knussen, C., Turner, S., & Cunningham, C. (1991). Factors related to stress and satisfaction with life in families of children with Down’s syndrome. Journal of Child Psychology and Psychiatry, 32, 655–676.

    Article  PubMed  Google Scholar 

  • Statistics Canada. (1994). National longitudinal survey of children and youth, cycle 1—User Guide. Ottawa: Statistics Canada.

    Google Scholar 

  • Statistics Canada. (2008). National longitudinal survey of children and youth. Ottawa: Statistics Canada. http://www.statcan.gc.ca/

  • Swensen, A. R., Birnbaum, H. G., Secnik, K., Marynchenko, M., Greenberg, P., & Claxton, A. (2003). Attention-deficit/hyperactivity disorder: increased costs for patients and their families. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1415–1423.

    Article  PubMed  Google Scholar 

  • Thurston, S., Paul, L., Ye, C., Loney, P., Browne, D., Browne, G., Wong, M., Thabane, L., & Rosenbaum, P. (2010). System integration and its influence on the quality of life of children with complex needs. International Journal of Pediatrics, Article ID 570209, 12 pages.

  • Varni, J. W., & Limbers, C. A. (2009). The Pediatric Quality of Life Inventory: measuring pediatric health-related quality of life from the perspective of children and their parents. Pediatric Clinics of North America, 56, 843–863.

    Article  PubMed  Google Scholar 

  • Widaman, K. F., Givvs, K. W., & Geary, D. C. (1987). Structure of adaptive behavior: in replication across fourteen samples of nonprofoundly mentally retarded people. American Journal of Mental Deficiency, 91, 348–360.

    PubMed  Google Scholar 

  • Widaman, K. F., Stacy, A. W., & Borthwick Duffy, S. A. (1993). Construct validity of dimensions of adaptive behavior: a multitrait-multimethod evaluation. American Journal on Mental Retardation, 98, 219–234.

    PubMed  Google Scholar 

  • Willms, J. D. (2002). Vulnerable children: Findings from Canada’s National Longitudinal Survey of Children and Youth. Edmonton: University of Alberta Press.

    Google Scholar 

  • Wymbs, B. T., Pelham, W. E., Molina, B. S. G., Gnagy, E. M., Wilson, T. K., & Greenhouse, J. B. (2008). Rate and predictors of divorce among parents of youths with ADHD. Journal of Consulting and Clinical Psychology, 76, 735–744.

    Article  PubMed  Google Scholar 

  • Yoshida, Y., & Uchiyama, T. (2004). The clinical necessity for assessing ADHD symptoms in children with high-functioning Pervasive Developmental Disorder. European Child & Adolescent Psychiatry, 13(5), 307–314.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dillon T. Browne.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Browne, D.T., Rokeach, A., Wiener, J. et al. Examining the Family-Level and Economic Impact of Complex Child Disabilities as a Function of Child Hyperactivity and Service Integration. J Dev Phys Disabil 25, 181–201 (2013). https://doi.org/10.1007/s10882-012-9295-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10882-012-9295-z

Keywords

Navigation