ADHD Diagnosis and Treatment Less Likely Among Black, Asian and Hispanic Children: Study

Children of color are less likely to be properly diagnosed with ADHD and receive necessary treatment compared to white children, according to the findings of a new study.

Compared to other racial or ethnic groups, white children were more likely to be treated for attention deficit hyperactivity disorder (ADHD). Black, hispanic and especially Asian children had the highest likelihood of receiving no treatment at all, according to findings published March 1, in the medical journal JAMA Network Open.

Researchers from the Mayo Clinic focused on the differences in diagnosis and treatment of ADHD among children by race and ethnicity. The study included 238,000 children, assessing insurance claims data for children born 2006 to 2012, who had continuous insurance coverage for at least four years.

Overall, of the 238,000 children, 5% were diagnosed with ADHD. The cumulative incidence of ADHD at age 12 was 13%.

The data indicated the hazard ratio for developing ADHD was 0.48 for Asian children, 0.83 for Black children and 0.77 for Hispanic children compared to white children.

In the first year after diagnosis, among preschool children roughly 20% received behavior therapy only, 32% were prescribed medications only, 19% were given both medications and behavior therapy, but nearly one-third received no type of treatment whatsoever.

Among school-aged children, more were prescribed medication to treat ADHD, roughly 65%. However, many still received no treatment at all, with roughly 20% not getting any treatment, and 14% receiving therapy only.

Research published in 2017 warned many children with ADHD are overmedicated and prescribed unnecessary antipsychotics and antidepressants, despite having no other mental illness diagnosis. This is especially troubling considering a report published last year indicating more children and teens are overdosing on ADHD medications, including prescribed stimulants.

Asian, Black, and Hispanic children were significantly less likely to be diagnosed with ADHD compared with white children, according to the new findings. Compared with other groups, white children were more likely to receive some kind of treatment than children of color. Asian children had the highest likelihood of receiving no treatment at all.

The findings from this study echo research published in 2016, which indicated minority children, including Black and Latino children, are less likely to be diagnosed with ADHD compared to white children. Both studies point to a disparity in care among children of color.

“These findings suggest that racial and ethnic disparities in the diagnosis and treatment of ADHD are evident,” wrote study authors.

Research indicates people with ADHD have a poorer quality of life and higher medical costs overall compared to those without the condition, but children of color may be lacking much needed medical attention considering the disparities existing during diagnosis.

One suggestion for why minority children are diagnosed with ADHD at lower rates is because they are often identified with other types of disruptive behavior problems, including conduct problems, defiance and learning deficits before ADHD can be considered as part of the challenges they face.

Researchers are unsure why the disparities for ADHD diagnosis exist, but both implicit and explicit bias among doctors may play a role. Families may also be reluctant to seek diagnosis or treatment, lack education regarding the symptoms or long-term effects the condition may have on life overall.

“Racial and ethnic disparities in the diagnosis and treatment of ADHD are evident,” wrote study authors. “Future study is needed to elucidate the mechanism behind these disparities, with special attention to Asian children. Clinicians should provide racially sensitive care in the evaluation and treatment of ADHD.”