Sociodemographic disparities in ADHD diagnosis and treatment among U.S. elementary schoolchildren

• Published in: Psychiatry research 2023-09, Vol.327, p.115393-115393, Article 115393
• Main Authors: Morgan, Paul L., Hu, Eric Hengyu
• Format: Article
• Language: English
• Subjects: Attention Deficit Disorder with Hyperactivity - diagnosis; Attention Deficit Disorder with Hyperactivity - epidemiology; Attention Deficit Disorder with Hyperactivity - therapy; Attention-deficit/hyperactivity disorder; Birth Weight; Black or African American; Child; ECLS-K: 2011; Elementary school; Ethnicity; Executive Function; Female; Healthcare Disparities; Humans; Language minorities; Longitudinal; Male; Multilingualism; Racial and ethnic disparities; Racial/ethnic minorities; Sociodemographic Factors; United States
• ISSN: 0165-1781; 1872-7123; 1872-7123
• DOI: 10.1016/j.psychres.2023.115393

•Whether sociodemographic disparities occur in ADHD diagnosis and treatment is unclear.Methodological limitations may help explain prior work's conflicting findings.•We predicted ADHD diagnosis and medication use in analyses adjusting for clinical need.•Black children, girls, and emergent bilinguals were less likely to have an ADHD diagnosis.•Black children's under-diagnosis occurred among boys.•Among those with ADHD, girls and emergent bilinguals were less likely to use medication. We examined whether some groups of U.S. elementary schoolchildren are less likely to be diagnosed and treated for ADHD in analyses of a population-based cohort (N = 10,920). We predicted ADHD diagnosis using measures of race and ethnicity, age, socioeconomic status, birthweight, individually assessed academic, behavioral, and executive functioning, family language use, mental health, health insurance coverage, marital status, school composition, and geographic region. We predicted prescription medication use among those diagnosed with ADHD. We stratified additional analyses by biological sex. Black children (aOR, 0.60), girls (aOR, 0.55), and emergent bilinguals (aOR, 0.29) were less likely to have an ADHD diagnosis than observationally similar White children, boys, or those from English-speaking households. Black children's under-diagnosis occurred among boys. Emergent bilingual children's under-diagnosis occurred among both boys and girls. Girls (aOR, 0.52) and emergent bilinguals (aOR, 0.24) with ADHD were less likely to use prescription medication. Sociodemographic disparities in ADHD diagnosis and treatment occur among U.S. elementary schoolchildren. Measured confounds including independently assessed ADHD symptomatology and impairment do not explain the disparities. The findings empirically support cultural, linguistic, and biological sensitivity in the ADHD diagnostic and treatment procedures in use for the U.S. pediatric population.