Racial and Ethnic Disparities in ADHD Diagnosis From Kindergarten to Eighth Grade
Summary & key facts
Researchers followed about 17,100 children from kindergarten to eighth grade using a national study. They looked at who got an ADHD diagnosis and who was taking medication by fifth and eighth grade. They found that Black, Hispanic, and other nonwhite children were much less likely than white children to be diagnosed with ADHD, and minority children who were diagnosed were also less likely to be on prescription medicine. These differences were already present by kindergarten and continued through eighth grade. The study found that the measured family, school, and behavior factors did not explain the gap, and the researchers recommended more culturally sensitive monitoring so all children are screened and treated appropriately.
- The study followed about 17,100 children from the start of kindergarten through eighth grade using national survey data.
- By the end of eighth grade, African American children were about 70% less likely than white children to be diagnosed with ADHD, even after accounting for measured factors.
- Hispanic children were about 50% less likely than white children to be diagnosed with ADHD after accounting for measured factors.
- Children of other nonwhite races were about 45% less likely than white children to receive an ADHD diagnosis after accounting for measured factors.
- The racial and ethnic differences in diagnosis were already visible by kindergarten and continued through eighth grade.
- Among children who had an ADHD diagnosis, racial and ethnic minority children were less likely than white children to be taking prescription medication for ADHD.
- Measured factors that raised the chance of diagnosis included being a boy, having an older mother, living in an English-speaking household, and showing outward problem behaviors.
- Measured factors that lowered the chance of diagnosis included being attentive in class, having higher school achievement, and not having health insurance.
- The researchers said the measured family, school, and behavior information they had did not explain the racial and ethnic gaps in diagnosis and treatment.
Abstract
OBJECTIVE: Whether and to what extent racial/ethnic disparities inattention-deficit/hyperactivity disorder (ADHD) diagnosis occur across early and middle childhood is currently unknown. We 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. METHODS: Analyses of the nationally representative Early Childhood Longitudinal Study, Kindergarten Class of 1998–1999 (N = 17 100)using discrete-time hazard modeling. RESULTS: 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% (95% confidence interval [CI]: 60%–76%), 50% (95% CI: 34%–62%), and 46% (95% CI: 26%–61%) lower, 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 (eg, 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. CONCLUSIONS: Racial/ethnic disparities in ADHD diagnosis occur by kindergarten and continue until at least the end of eighth grade. Measured confounding factors do not explain racial/ethnic disparities in ADHD diagnosis and treatment. Culturally sensitive monitoring should be intensified to ensure that all children are appropriately screened, diagnosed,and treated for ADHD.
