ADHD is a problem with the way the brain grows and develops. These types of problems are called neurodevelopmental disorders, and ADHD is one of the most common among children.
Just how common is ADHD? That’s a question researchers have struggled with. (Estimates vary, but the CDC says it’s about 9.4% of kids in the U.S.) They’ve also looked at whether there are racial disparities in how ADHD is diagnosed and treated -- and they’ve found few definite answers.
Children with ADHD may struggle to pay attention, may act impulsively, or may be too active. These symptoms can cause trouble at school, at home, and with friends. Studies show that ADHD is linked to poorer quality of life and higher medical costs.
Disparities in Diagnosis
Nearly every study on the issue has found racial and ethnic differences in the diagnosis rate of ADHD. But the results have been inconsistent.
One recent study followed more than 200,000 children for several years. At 4 years old, 0.39% of the children had an ADHD diagnosis. The numbers grew as the children got older:
- Age 6, 2.35%
- Age 8, 6.62%
- Age 10, 10.57%
- Age 12, 13.12%
At age 4, the rate of diagnosis was about the same across all races and ethnicities. By age 12, more white children than any other group in the study had been found to have ADHD – about 14%. The numbers for Black and Hispanic children were close – between 10% and 12%. Asian children were the least likely group to receive an ADHD diagnosis, at around 6%.
Another study compared rates of ADHD diagnoses for minority children in kindergarten through eighth grade with those of white children. The chances of a diagnosis were:
- 69% lower for Black children than white children
- 50% lower for Hispanic children
- 46% lower for children of other races or ethnicities
When researchers ask parents whether their child has an ADHD diagnosis, however, the results look different. In those surveys, Black children were more likely than white children to have an ADHD diagnosis. And Hispanic children were much less likely to have received a diagnosis.
Disparities in Treatment
The American Academy of Pediatrics guidelines for ADHD treatment say that:
- Children ages 4-5 should be treated first with behavioral therapy, with medication added if their symptoms don’t improve.
- Those ages 6-11 should be treated with medication, behavioral therapy, or both
- Ages 12-18 should be treated with medication if they agree, and may also have behavioral therapy
Despite these recommendations, medication isn’t prescribed evenly across all races.
One study that looked at children in fifth, seventh, and 10th grades found that Black and Hispanic children were less likely than white children to take ADHD medication. Black children had lower odds of getting medication than white children in every grade studied. Hispanic children had lower odds in fifth and 10th grades. That held true no matter how serious the child’s symptoms were.
Other research has found that minority children are more likely to stop using their ADHD medication, in part because they receive less follow-up care.
What’s Behind the Numbers?
What accounts for the differences in the way ADHD is diagnosed and treated? Researchers have looked at many theories but don’t know exactly what’s at work.
Are white children diagnosed and treated for ADHD too often? Are Black, Hispanic, and Asian children underdiagnosed and undertreated? Most researchers believe the issue is more complicated than that, in part because so many economic, social, and cultural elements are linked to ADHD.
Among them are:
- How densely populated a child’s neighborhood is
- Lead pollution levels where the child lives
- How many doctors are available in the child’s community
- Household income
- Teacher-student ratios at schools
- Family structure
- Parents’ mental health
When health care providers make an ADHD diagnosis, they rely in part on information from parents, teachers, and others about symptoms such as distractibility. These symptoms can be difficult to measure and can be influenced by personal feelings and beliefs.
Minority children also may be affected by the biases of health care providers. Parents of minority children routinely rate their relationships with doctors lower than white parents do. These parents also report poorer communication and are more likely to feel they’re not included in decision making.
Bias can be explicit, meaning you hold an attitude that you are aware of. Or it can be implicit, which means it’s an attitude you have on an unconscious level.
What Can Be Done?
Scientists are working on more objective ways to diagnose ADHD. One is the Neuropsychiatric Electroencephalograph Based Assessment Aid, or NEBA. This test uses electrodes attached to your head to measure electrical activity in your brain. Certain brain wave ratios are linked to ADHD. It’s not clear yet whether NEBA is a reliable way to help diagnose ADHD.
Education on implicit bias may help health-care providers recognize any shortcomings and give patients fairer treatment. Encouraging doctors to stick to clinical guidelines, use more objective measures for diagnosis and treatment, and improve communication with patients and parents can also lessen the impact of bias.
If your child has ADHD, you can be an effective advocate with their doctors and other health care providers. Steps you can take include:
- Keep records of your child’s diagnosis and treatment plan.
- Alert health care providers to any new information about your child.
- Let the provider know if you think your child’s treatment plan should be updated.
- If you disagree with the provider, speak up.
- Let them know if you think your child’s medication should be adjusted.