Momma Data

Debunking the latest studies about children's health and well-being

Paying Attention to Inattention

Why do minority children have fewer ADHD diagnoses?

Minority children are less likely to be diagnosed with attention deficit/hyperactivity (ADHD) than their white peers. This is hardly groundbreaking news but a recent Pediatrics study following 15,100 kids shows ethnic disparities in ADHD diagnoses appear as early as kindergarten and persist at least to eighth grade.  

By the spring of eighth grade, 7 percent of white kids had received an ADHD diagnosis, their parents reported. In comparison, 3 percent of black kids and just over 4 percent of Hispanic children had been diagnosed. Reuters Health

Or for those who fancy a more dramatic interpretation...

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Compared with white kids, the odds of ADHD diagnosis were 69% lower for black kids, 50% lower for Hispanic kids and 46% lower for children of other race/ethnicities. USA Today

So white kids get handed the label more often than black and Hispanic kids from an early age. Previous research shows Asian/Pacific Islander kids are far less likely to get the label too. Most media as well as the study's authors attribute this disparity to ADHD being overlooked in minority youths. "It's a consistent pattern of what we're interpreting as comparative underdiagnosis for minority populations" Paul Morgan, the lead author from Penn State University told Reuters Health

Another viable explanation? Too many kids in white households coming down with cases of poor impulse control. The authors reluctantly acknowledged this second possibility as do other ADHD experts.

The new study can't prove the findings represent under diagnosis of minorities, rather than over diagnosis of white children, according to [Dr. Tanya Froehlich, an ADHD researcher at Cincinnati Children's Hospital Medical Center]. But if kids are having problems at school or at home and aren't seeing a doctor, that's a concern, she added. Reuters

Translation: It's possible some privileged parents are too quick to seek professional help, rather, advantages for their progeny but we prefer to think not enough minority kids are getting diagnosed and of course treatment.

Now this isn't a forced choice question. Nobody has to choose either a) under diagnosis or b) over diagnosis. Both phenomena likely contribute to the current ADHD rates. Other factors beyond ethnicity are involved. The present study found being male, engaging in lots of disruptive behavior, having a parent who speaks English and an older mom also raises a kid's risk of being diagnosed. 

The implied risk here is not getting diagnosed as much as not getting diagnosed. Significant risk factors for not getting diagnosed include "engaging in learning-related behaviors (e.g., being attentive), displaying greater academic achievement,and not having health insurance." Yes you read that correctly, paying attention at school lowers your chance of not being recognized as having problems paying attention. Reassuring.

So if you're a quiet girl getting good grades who has never been sent to the principal's office and whose mom gave birth as a teen and doesn't speak English, you might be in danger and not know it. On the other hand, if you're a boy bringing home your weekly missed homework assignment to your mother who just got a call from the principal on the way to her Botox appointment, then chill, welcome to ADHD….and here, have some Ritalin. The present study also found white kids are more likely to be using prescription ADHD meds, a finding some interpret as indirect evidence minority parents also might be more reluctant to have children diagnosed with attentional problems. Forget blaming the disparities on parental socio-economic status, education or marital status and child birth weight. None of these appeared to matter in this study though other studies have reported links between ADHD and these variables.

As for the future of inattention, the newly published DSM revised the onset age for the appearance of ADHD symptom. In the past kids had to exhibit trouble with self-control and attention by age 7. Now they have until middle school. The higher onset age might invite even more kids to the party. So the revised onset criteria coupled with growing concern of under diagnosis has the potential to produce (identify?) more ADHD.

More than 7% of U.S. children under the age of 18 have been diagnosed with ADHD according to the CDC. It is unclear how high this rate might go. Although there is evidence the diagnostic gap is narrowing it's uncertain whether it will ever close. It also remains uncertain to what extent researchers, health professionals and the media would express alarm or relief should minority kids ever catch up with their white peers.

 I can see, however, a future news flash.

A new study shows minority children at an increased risk for ADHD. The number of black and Hispanic children diagnosed with the disorder rose sharply over the past decade prompting experts to search for answers why minority kids have faced such a dramatic surge… 

 

 

 

 

 

Polly Palumbo, Ph.D., is a former research psychologist and founder of Momma Data, a non-profit organization that tracks and fact-checks parenting media. more...

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