We examined racial/ethnic disparities in attention-deficit/hyperactivity disorder (ADHD) diagnosis and medication use and determined whether medication disparities were more likely due to underdiagnosis or undertreatment of African-American and Latino children, or overdiagnosis or overtreatment of white children.
We used a population-based, multisite sample of 4297 children and parents surveyed over 3 waves (fifth, seventh, and 10th grades). Multivariate logistic regression examined disparities in parent-reported ADHD diagnosis and medication use in the following analyses: (1) using the total sample; (2) limited to children with an ADHD diagnosis or symptoms; and (3) limited to children without a diagnosis or symptoms.
Across all waves, African-American and Latino children, compared with white children, had lower odds of having an ADHD diagnosis and of taking ADHD medication, controlling for sociodemographics, ADHD symptoms, and other potential comorbid mental health symptoms. Among children with an ADHD diagnosis or symptoms, African-American children had lower odds of medication use at fifth, seventh, and 10th grades, and Latino children had lower odds at fifth and 10th grades. Among children who had neither ADHD symptoms nor ADHD diagnosis by fifth grade (and thus would not likely meet ADHD diagnostic criteria at any age), medication use did not vary by race/ethnicity in adjusted analysis.
Racial/ethnic disparities in parent-reported medication use for ADHD are robust, persisting from fifth grade to 10th grade. These findings suggest that disparities may be more likely related to underdiagnosis and undertreatment of African-American and Latino children as opposed to overdiagnosis or overtreatment of white children.
Comments
RE: Racial and ethnic disparities in ADHD diagnosis and treatment
Coker et. al. (1) present interesting data showing disparity between racial/ ethnic groups in ADHD diagnosis and treatment and conclude that underdiagnosis and undertreatment of African American and Latino children may be responsible. Some parts of the data appear to contradict or confuse this.
In Table 2, the white group (fifth grade) shows an unlikely pattern in clinical practice: 7% with parent reported symptoms of ADHD, 16% diagnosed with ADHD, and 14% treated with medication. The same pattern occurs in the seventh and 10th grade waves. The other groups all demonstrate a more expected trend, with more children showing symptoms on a screening tool than being given ultimate diagnosis or treatment.
This could be explained by overdiagnosis and overtreatment of the white children. Alternatively, the symptoms variable for ADHD (using the DPS ) may not be reflect accurately the likelihood for diagnosis. The diagnosis of ADHD should not rely solely on parental report but should include input form the school, a physical examination, and a comprehensive medical and social history.
The authors’s call for universal behavioral health screening tools must be approached cautiously to insure that children are accurately diagnosed without overdiagnosis or underdiagnosis. Factors that have led to 19% of the white 10th grade wave in this study being diagnosed with ADHD need further study.
Coker TR, Toomey SL, et.al. Racial and Ethnic Disparities in ADHD Diagnosis and Treatment. Pediatrics. 2016;138(3):e20160407.