- Researchers say Black, Hispanic, and Asian children are less likely to receive an ADHD diagnosis and treatment for the condition.
- Experts aren’t sure why the disparity exists, but they say it’s important to investigate it.
- They note that children with undiagnosed ADHD are less likely to succeed in school and life in general.
Having a child receive an attention deficit hyperactivity disorder (ADHD) diagnosis can be a double-edged sword.
Some parents see the diagnosis as an unwanted label that can stigmatize their child, while others see it as a way to help their child get the necessary resources to help them better succeed in school and life.
That includes access to therapy and medications, specialized learning plans, and even giving parents a chance to better understand how to best help their children navigate the systems around them.
But new research suggests there are wide gaps in who gets those diagnoses.
Researchers from the Mayo Clinic looked at children born between 2006 and 2012. They found continued racial disparities in who gets an ADHD diagnosis and treatment.
Black, Asian, and Hispanic children were also less likely to receive treatment for ADHD.
“Compared with other groups, white children were more likely to receive some kind of treatment. Asian children had the highest odds of receiving no treatment,” the study authors wrote.
That’s significant, researchers noted, because people with ADHD have an overall poorer quality of life and higher medical costs.
That’s why clinical guidelines suggest preschool-aged children with an ADHD diagnosis receive behavioral therapy as a first-line treatment, and then medication starting in elementary school.
Researchers aren’t entirely sure why the disparities exist. It appears to be a mix of both explicit and implicit bias among physicians, distrust of the healthcare system, and reluctance to seek such a diagnosis or treatment.
The Mayo Clinic team acknowledged in their study that since they used information from a national commercial insurance database, their underlying data may not be representative of all children in the United States.
Mayra Mendez, PhD, a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services at Providence Saint John’s Child and Family Development Center in Santa Monica, California, said the disparities could be partially explained by the fact that researchers were looking at populations with private insurance.
“The sample of upper income and possibly white populations may have been inflated, thus resulting in a smaller pool of racially diverse populations,” she said.
“I am not surprised by the research finding that children of color are diagnosed at lower rates than white children, because children of color are often identified as presenting with disruptive behavior problems, conduct problems, oppositional/defiance and learning deficits before considering neurodevelopmentally based explanations for challenges,” Mendez said.
“Also, cultural factors strongly influence identification of behavioral and/or learning challenges, resulting in increased tolerance for behavioral differences in some cultures and over-responded to in other cultures,” she said.
Dr. Bruce Wexler is a professor emeritus at Yale University in Connecticut and founder of C8 Sciences, a company that provides brain training programs to improve ADHD.
To him, fewer children receiving an ADHD diagnosis might be a good thing, considering what other facts the study laid out.
The researchers noted that about half of the diagnoses were made by pediatricians, not psychologists, psychiatrists, or neurologists, who may have a better idea of treatment options available besides powerful, short-term stimulant medications.
“The second you stop taking [the medications], the benefits are gone,” he said.
Wexler said it’s hard to tell whether one group is overdiagnosed or another group is underdiagnosed because there’s no reference point to what the rates of ADHD in any racial or age group should be.
“We don’t know what the real level is,” he said.
But Wexler said there does appear to be differences in some groups, particularly white parents, who are more likely to engage in “permissive parenting” and a “culture of medicalization of problems” rather than accepting their child is different from others.
“Let’s call it a medical problem and get a pill for it,” he said.
Research into who gets an ADHD diagnosis and who doesn’t is important as some research has suggested that behavior that’s now attributed to ADHD was positive in terms of evolution.
Our hunter-gatherer ancestors survived longer if they were constantly processing the stimuli around them, as doing so could signal potential food or predators.
While children are more likely to receive an ADHD diagnosis while in school, the modern classroom hasn’t evolved to meet students with those traits.
“The schools are a major factor,” Wexler said. “That’s when they’re given demands that haven’t been asked of them before.”
That, for people with ADHD, means learning to survive in a new world, one that now includes endless distractions from pocket-sized supercomputers and other items.
Regardless of what an ideal world looks like for a child with ADHD, Mendez said everyone can have a role in closing the disparity gap.
That includes critical stakeholders such as psychotherapists, psychiatrists, mental health professionals, teachers, school psychologists, nurses, principals, and behavior support staff.
Mendez said those stakeholders can address social inequities for children of color and close the gaps of racial disparities by increasing awareness and information about symptoms associated with ADHD.
They can also recognize cultural differences and increase awareness of differing cultural norms with respect to development, education, learning, and behavioral expression.
Professionals can also dispel misconceptions and myths about ADHD symptoms and treatment as disadvantaging, hurtful, and damaging to a child, among other things.
“It is also extremely important to provide accurate, culturally sensitive, and realistically available intervention options for parents as stakeholders who know their children best. Well-informed parents are more likely to weigh the options and approach information openly,” Mendez said.
“Accurate information provided to parents increases the chances of them taking objective consideration,” she said, “and decreases defenses that trigger their parenting insecurities.”