Tuesday, June 25, 2013

ADHD Overlooked in Minority Children?

Black and Hispanic children are less likely to be diagnosed with attention deficit/hyperactivity (ADHD). This is hardly new information but a study in Pediatrics of over 15,000 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...
Compared with whites, 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 slapped with the label more than black and hispanic kids from an early age. Previous research shows Asians far less likely to get the label too. 

The explanation of choice among most news reports? Minority kids have been left undiagnosed and untreated for a variety of reasons. Another explanation? Too many kids in white households have been coming down with cases of bad self-control. Sure, ADHD researchers acknowledge this second possibility...
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: Sure it's possible some white moms and dads are too quick to get diagnoses for their kids but we prefer to think it's the case that not enough kids are getting diagnosed. 

Now this isn't a forced choice, either-or question. It's possible and likely that both phenomenon have occur in the pediatric population. Being a male, engaging in lots of disruptive behavior, having a parent who speaks English and an older mom also raise a kid's risk of being diagnosed.  In this study though though the implied risk is not getting diagnosed as much as not getting diagnosed. So if you're a quiet girl with a twenty-something mom who doesn't speak English, you are at risk of not getting diagnosed. 

Remember, the newly published DSM revised the age at which ADHD symptoms must be present. It raised the age of onset from 7 to 12 years old, thus establishing a lower threshold for a diagnosis.  So the revised onset criteria coupled with the awareness of the under-diagnosis among some children will undoubtedly produce more cases of ADHD. The CDC reports more than 7% of children under the age of 18 have been diagnosed with ADHD with parents reporting rates as high as 9.5%.

Stay tuned for the forthcoming study: Black and hispanic children at increased risk for ADHD.

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