Black and White Realities of ADHD

ADHD diagnosis rates vary based on race or ethnicity of children

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) ADHD can be a challenging disorder for children if they do not receive treatment. Getting treatment requires that they be accurately identified in the first place.

A recent study found that African American, Hispanic and other children of non-white ethnicities are diagnosed with ADHD less often than white children are.

ADHD stands for attention deficit hyperactivity disorder. Children with ADHD can have trouble sitting still or concentrating, and may have trouble controlling impulsive behaviors.

"Among children diagnosed with ADHD, racial/ethnic minorities were less likely than whites to be taking prescription medication," these researchers wrote.

"Ask your pediatrician about behavior therapies."

The study, led by Paul L. Morgan, PhD, of the Department of Educational Psychology at Pennsylvania State University, looked at diagnosis and treatment patterns of children with ADHD.

The researchers used data from a long-term study called the Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999, which included 17,100 children.

The researchers looked at the differences in diagnoses of children based on race/ethnicity from kindergarten through eighth grade.

They also looked at differences in treatment based on race/ethnicity for children when they were in fifth grade and eighth grade.

Overall, diagnoses of children with ADHD were most likely in third grade compared to other grades, regardless of children's races.

The researchers found that minority children were less likely than white children to be diagnosed with ADHD, even after controlling for other factors related to their diagnosis.

African American children were 69 percent less likely than white children to be diagnosed with the disorder.

Hispanic children were 50 percent less likely and children of other races/ethnicities were 46 percent less likely than white children to get an ADHD diagnosis.

The researchers found other characteristics that made children more likely to be diagnosed with ADHD.

Boys were more likely than girls, and children being raised by older mothers were more likely than children of younger mothers to be diagnosed with ADHD.

Other characteristics among the children most likely to be diagnosed with the disorder were those raised in an English-speaking household and those who showed externalizing problem behaviors.

Externalizing problems refer to behavior issues like acting out, aggression, rule breaking and hyperactivity.

Children with a lower risk of being diagnosed with ADHD were those who showed learning behaviors like attentiveness, those who performed better academically and those who did not have health insurance.

The researchers also found differences in treatment based on children's race/ethnicity.

After taking into account other characteristics related to treatment, the researchers determined that Hispanic children and children of other races/ethnicities diagnosed with ADHD were half as likely as white children to be taking medication for their condition.

African American children with ADHD were one-third as likely as white children to be taking medication for their condition.

The researchers concluded that inequalities related to children's race/ethnicity existed for ADHD diagnoses as early as kindergarten and continuing through at least eighth grade.

Even taking into account other risk factors for ADHD did not explain the differences in race/ethnicity among those diagnosed.

According to Glen Elliott, MD, PhD, Chief Psychiatrist and Medical Director of  Children's Health Council, there are several aspects of the study to consider.

"It is important to emphasize that the authors are relying on parent report of whether a child does or does not have ADHD," Dr. Elliott said.

"Previous research has shown, for example, marked discrepancies in gender ratios, prevalence and treatment rates depending on where one looks for ADHD and who makes the diagnosis," he said.

In other words, how much ADHD researchers finds depends on who they ask and who diagnosed the child.

"The authors are restricted here to what parents report, so issues of ethnic influence on seeking a diagnosis of ADHD or accepting one if given are outside scope of their study," Dr. Elliott said.

There is no way to know in this study if parents of different races or ethnicities are less likely or more likely to have their children evaluated for ADHD or to accept the diagnosis or reveal that their child has been diagnosed.

"It certainly is possible that actual rates of ADHD might vary across ethnic groups, either because of genetic influences or because of environmental factors," Dr. Elliott said.

"However, it is as least equally likely that these results reflect acceptability of the diagnosis and likelihood that a child with signs and symptoms is identified and referred for assessment," he said.

The authors of the study suggested that more appropriate screening, diagnosis and treatment exist for children of all races/ethnicities.

They suggested more sensitivity toward cultural differences be taken into account in assessing and diagnosing children of all races/ethnicities.

The study was published June 24 in the journal Pediatrics. The authors declared no conflicts of interest.

The research was funded by the National Institutes of Health and by the National Center for Special Education Research at the Institute of Education within the US Department of Education.

Reviewed by: 
Review Date: 
June 21, 2013
Last Updated:
July 25, 2013