Racial and ethnic disparities exist in ADHD diagnosis

Racial and ethnic disparities exist in ADHD diagnosis
Racial and ethnic disparities exist in ADHD diagnosis

Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavioral disorder of childhood, affecting an estimated 3-5% of school aged children. It affects school performance and interpersonal relationships. Parents of children with ADHD are often exhausted and frustrated. For a child to receive appropriate treatment, the condition must be diagnosed. A new study has found that racial and ethnic disparities exist in the diagnosis of ADHD.

The researchers note that it is currently unknown whether and to what extent racial/ethnic disparities in ADHD diagnosis occur among early and middle childhood. Therefore, the goal of the study was to evaluate this situation. They examined the over-time dynamics of race/ethnic disparities in diagnosis from kindergarten to eighth grade and disparities in treatment in fifth and eighth grade. The investigators analyzed data from the nationally representative Early Childhood Longitudinal Study, Kindergarten Class of 1998–1999 (17,100 students).

The investigators found that minority children were less likely than white children to receive an ADHD diagnosis. With time-invariant and -varying confounding factors statistically controlled the odds of ADHD diagnosis for African Americans, Hispanics, and children of other races/ethnicities were 69%, 50%, and 46%, respectively, than for whites. Factors increasing children’s risk of an ADHD diagnosis included being a boy, being raised by an older mother, being raised in an English-speaking household, and engaging in externalizing problem behaviors. Factors decreasing children’s risk of an ADHD diagnosis included engaging in learning-related behaviors (i.e., being attentive), displaying greater academic achievement, and not having health insurance. Among children diagnosed with ADHD, racial/ethnic minorities were less likely than whites to be taking prescription medication for the disorder.

The authors concluded that racial/ethnic disparities in ADHD diagnosis occur by kindergarten and continue until at least the end of eighth grade. They noted that confounding factors that they measured did not explain racial/ethnic disparities in ADHD diagnosis and treatment. They recommended that culturally sensitive monitoring should be intensified to ensure that all children are appropriately screened, diagnosed, and treated for ADHD.

ADHD is a problem with inattentiveness, over-activity, impulsivity, or a combination. For these problems to be diagnosed as ADHD, they must be out of the normal range for the child’s age and development. It affects school performance and interpersonal relationships. Parents of children with ADHD are often exhausted and frustrated. Neuroimaging studies suggest that the brains of children with ADHD are different from those of other children. These children handle neurotransmitters (including dopamine, serotonin, and adrenalin) differently from their peers.

ADHD is often genetic. Whatever the specific cause may be, it seems to be set in motion early in life as the brain is developing. Depression, sleep deprivation, learning disabilities, tic disorders, and behavior problems may be confused with, or appear along with, ADHD. Every child suspected of having ADHD deserves a careful evaluation to sort out exactly what is contributing to the behaviors causing concern. It is diagnosed much more often in boys than in girls. Most children with ADHD also have at least one other developmental or behavioral problem.

The Diagnostic and Statistical Manual (DSM-IV) divides the symptoms of ADHD into those of inattentiveness and those of hyperactivity and impulsivity. To be diagnosed with ADHD, children should have at least six attention symptoms or six activity and impulsivity symptoms––to a degree beyond what would be expected for children their age. The symptoms must be present for at least six months, observable in two or more settings, and not caused by another problem. The symptoms must be severe enough to cause significant difficulties. Some symptoms must be present before age seven. Older children have ADHD in partial remission when they still have symptoms but no longer meet the full definition of the disorder. Some children with ADHD primarily have the Inattentive Type, some the Hyperactive-Impulsive Type, and some the Combined Type. Those with the Inattentive type are less disruptive and are easier to miss being diagnosed with ADHD.

Inattention symptoms:

Fails to give close attention to details or makes careless mistakes in schoolwork
Difficulty sustaining attention in tasks or play
Does not seem to listen when spoken to directly
Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
Difficulty organizing tasks and activities
Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
Easily distracted
Often forgetful in daily activities

Hyperactivity symptoms:

Fidgets with hands or feet or squirms in seat
Leaves seat when remaining seated is expected
Runs about or climbs in inappropriate situations
Difficulty playing quietly
Often “on the go,” acts as if “driven by a motor,” talks excessively

Impulsivity symptoms:

Blurts out answers before questions have been completed
Difficulty awaiting turn
Interrupts or intrudes on others (butts into conversations or games)

Too often, difficult children are incorrectly labeled with ADHD. On the other hand, many children who do have ADHD remain undiagnosed. In either case, related learning disabilities or mood problems are often missed. The American Academy of Pediatrics (AAP) has issued guidelines to bring more clarity to this issue. The diagnosis is based on very specific symptoms, which must be present in more than one setting. The child should have a clinical evaluation if ADHD is suspected.


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