CoChat
Sign Up
Cited by 88Attention Deficit Hyperactivity DisorderChild and Adolescent Psychosocial and Emotional DevelopmentAutism Spectrum Disorder Research

Prevalence and Risk Factors Associated With Attention-Deficit/Hyperactivity Disorder Among US Black Individuals: A Systematic Review and Meta-analysis

Open access
Cénat, Jude Mary, Blais-Rochette, Camille, Morse, Catherine, Vandette, Marie-Pier, Noorishad, Pari-Gole, Kogan, Cary, Ndengeyingoma, Assumpta, Labelle, Patrick R.·2021·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2020.2788PMC PMC7489386
Open this paper in CoChat — free account

Abstract

Importance: As stated in the DSM-5, it is generally reported that the prevalence of attention-deficit/hyperactivity disorder (ADHD) is lower among Black individuals compared with the general population. However, Black individuals living in countries where they are considered a minority population group (eg, in Northern America and Europe) are underrepresented in studies evaluating ADHD. Objective: To estimate the pooled prevalence of ADHD and identify associated risk factors among US Black individuals. Data Sources: This systematic review and meta-analysis identified peer-reviewed studies published until October 18, 2019, using the APA PsycInfo, MEDLINE, Embase, Cochrane CENTRAL, CINAHL, ERIC, and Education Source databases. Study Selection: Eligible trials were published in French or English, had empirical data on the prevalence of ADHD in samples or subsamples of Black people, and were conducted in countries with Black minority populations. All studies were assessed and passed quality evaluation. Data Extraction and Synthesis: The PRISMA guideline was used for extracting and reporting data. Random-effects meta-analyses were generated to estimate the prevalence of ADHD among Black individuals using the metafor package in R. Main Outcomes and Measures: Prevalence and risk factors associated with ADHD among Black individuals were identified. Results: A total of 24 independent samples and subsamples from 21 studies published between 1979 and 2020 (154 818 Black participants) were included in this systematic review and meta-analysis. All included studies were conducted in the US. Two studies were conducted assessing adults (aged 18 years or older), 8 assessing children (0-12 years), 1 assessing adolescents (aged 13-17 years), and 13 assessing both children and adolescents. The pooled prevalence of ADHD was 14.54% (95% CI, 10.64%-19.56%). In a narrative review of the studies in this analysis, some studies found risk factors associated with ADHD, such as sociodemographic characteristics (age, sex, race, and socioeconomic status), familial factors, environmental factors, and risk behaviors, but the data did not permit a moderation analysis to assess these findings in this study. Conclusions and Relevance: Contrary to what is stated in the DSM-5, the results of this systematic review and meta-analysis suggest that Black individuals are at higher risk for ADHD diagnoses than the general US population. These results highlight a need to increase ADHD assessment and monitoring among Black individuals from different social backgrounds. They also higlight the importance of establishing accurate diagnoses and culturally appropriate care.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jamapsychiatry.2020.2788

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

The citation lists haven’t been fetched yet

References 68 · Cited by 88

Research works printed but not linked: 50

  1. [1]American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013. [Google Scholar]
  2. [2]Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007;164(6):942-948. doi: 10.1176/ajp.2007.164.6.942 [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  3. [5]Assari S, Caldwell CH. Family income at birth and risk of attention deficit hyperactivity disorder at age 15: racial differences. Children (Basel). 2019;6(1):10. doi: 10.3390/children6010010 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  4. [7]Samuel V, Curtis S, Thornell A, et al. The unexplored void of ADHD and African-American research. J Atten Disord. 1997;1(4):197-207. doi: 10.1177/108705479700100401 [DOI] [Google Scholar] · DOI
  5. [8]Moody M. From under-diagnoses to over-representation: black children, ADHD, and the school-to-prison pipeline. J African Am Stud. 2016;20(2):152-163. doi: 10.1007/s12111-016-9325-5 [DOI] [Google Scholar] · DOI
  6. [9]Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States. Am J Psychiatry. 2006;163(4):716-723. doi: 10.1176/ajp.2006.163.4.716 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  7. [10]Kessler RC, Berglund P, Chiu WT, et al. The US National Comorbidity Survey Replication (NCS-R). Int J Methods Psychiatr Res. 2004;13(2):69-92. doi: 10.1002/mpr.167 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  8. [11]Bussing R, Koro-Ljungberg ME, Gary F, Mason DM, Garvan CW. Exploring help-seeking for ADHD symptoms. Harv Rev Psychiatry. 2005;13(2):85-101. doi: 10.1080/10673220590956465 [DOI] [PubMed] [Google Scholar] · DOI
  9. [12]Turygin N, Matson JL, Tureck K. ADHD symptom prevalence and risk factors in a sample of toddlers with ASD or who are at risk for developmental delay. Res Dev Disabil. 2013;34(11):4203-4209. doi: 10.1016/j.ridd.2013.07.020 [DOI] [PubMed] [Google Scholar] · DOI
  10. [13]Lee DH, Oakland T, Jackson G, Glutting J. Estimated prevalence of attention-deficit/hyperactivity disorder symptoms among college freshmen. J Learn Disabil. 2008;41(4):371-384. doi: 10.1177/0022219407311748 [DOI] [PubMed] [Google Scholar] · DOI
  11. [14]Langsdorf R, Anderson RP, Waechter D, Madrigal JF, Juarez LJ. Ethnicity, social class, and perception of hyperactivity. Psychol Sch. 1979;16(2):293-298. doi: 10.1002/1520-6807(197904)16:2<293::AID-PITS2310160221>3.0.CO;2-1 [DOI] [Google Scholar] · DOI
  12. [15]Bussing R, Zima BT, Gary FA, Garvan CW. Barriers to detection, help-seeking, and service use for children with ADHD symptoms. J Behav Health Serv Res. 2003;30(2):176-189. doi: 10.1007/BF02289806 [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  13. [16]Bidaut-Russell M, Valla JP, Thomas JM, Bergeron L, Lawson E. Reliability of the Terry: a mental health cartoon-like screener for African-American children. Child Psychiatry Hum Dev. 1998;28(4):249-263. doi: 10.1023/A:1022636115485 [DOI] [PubMed] [Google Scholar] · DOI
  14. [17]Barbarin OA, Soler RE. Behavioral, emotional, and academic adjustment in a national probability sample of African American children. J Black Psychol. 1993;19(4):423-446. doi: 10.1177/00957984930194004 [DOI] [Google Scholar] · DOI
  15. [18]Alegría M, Lin JY, Green JG, Sampson NA, Gruber MJ, Kessler RC. Role of referrals in mental health service disparities for racial and ethnic minority youth. J Am Acad Child Adolesc Psychiatry. 2012;51(7):703-711.e2. doi: 10.1016/j.jaac.2012.05.005 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  16. [19]Coker TR, Elliott MN, Toomey SL, et al. Racial and ethnic disparities in ADHD diagnosis and treatment. Pediatrics. 2016;138(3):e20160407. doi: 10.1542/peds.2016-0407 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  17. [20]Reyes N, Baumgardner DJ, Simmons DH, Buckingham W. The potential for sociocultural factors in the diagnosis of ADHD in children. WMJ. 2013;112(1):13-17. [PubMed] [Google Scholar]
  18. [21]Baglivio MT, Wolff KT, Piquero AR, Greenwald MA, Epps N. Racial/ethnic disproportionality in psychiatric diagnoses and treatment in a sample of serious juvenile offenders. J Youth Adolesc. 2017;46(7):1424-1451. doi: 10.1007/s10964-016-0573-4 [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  19. [22]Bussing R, Zima BT, Gary FA, et al. Social networks, caregiver strain, and utilization of mental health services among elementary school students at high risk for ADHD. J Am Acad Child Adolesc Psychiatry. 2003;42(7):842-850. doi: 10.1097/01.CHI.0000046876.27264.BF [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  20. [23]Lawson GM, Nissley-Tsiopinis J, Nahmias A, McConaughy SH, Eiraldi R. Do parent and teacher report of ADHD symptoms in children differ by SES and racial status? J Psychopathol Behav Assess. 2017;39(3):426-440. doi: 10.1007/s10862-017-9591-0 [DOI] [Google Scholar] · DOI
  21. [24]Bazargan M, Calderón JL, Heslin KC, et al. A profile of chronic mental and physical conditions among African-American and Latino children in urban public housing. Ethn Dis. 2005;15(4)(suppl 5):S5-S3, 9. [PubMed] [Google Scholar]
  22. [25]Stevens J, Harman JS, Kelleher KJ. Race/ethnicity and insurance status as factors associated with ADHD treatment patterns. J Child Adolesc Psychopharmacol. 2005;15(1):88-96. doi: 10.1089/cap.2005.15.88 [DOI] [PubMed] [Google Scholar] · DOI
  23. [26]Collins KP, Cleary SD. Racial and ethnic disparities in parent-reported diagnosis of ADHD. J Clin Psychiatry. 2016;77(1):52-59. doi: 10.4088/JCP.14m09364 [DOI] [PubMed] [Google Scholar] · DOI
  24. [27]Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group . Preferred reporting items for systematic reviews and meta-analyses. J Clin Epidemiol. 2009;62(10):1006-1012. doi: 10.1016/j.jclinepi.2009.06.005 [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  25. [28]Osei-Assibey G, Boachie C. Dietary interventions for weight loss and cardiovascular risk reduction in people of African ancestry (blacks). Public Health Nutr. 2012;15(1):110-115. doi: 10.1017/S1368980011001121 [DOI] [PubMed] [Google Scholar] · DOI
  26. [29]Riley IL, Murphy B, Razouki Z, et al. A systematic review of patient- and family-level inhaled corticosteroid adherence interventions in black/African Americans. J Allergy Clin Immunol Pract. 2019;7(4):1184-1193. doi: 10.1016/j.jaip.2018.10.036 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  27. [30]Castells X, Blanco-Silvente L, Cunill R. Amphetamines for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database Syst Rev. 2018;8:CD007813. doi: 10.1002/14651858.CD007813.pub3 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  28. [32]Verbeeck W, Bekkering GE, Van den Noortgate W, Kramers C. Bupropion for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database Syst Rev. 2017;10(10):CD009504. doi: 10.1002/14651858.CD009504.pub2 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  29. [33]Osland ST, Steeves TDL, Pringsheim T. Pharmacological treatment for attention deficit hyperactivity disorder (ADHD) in children with comorbid tic disorders. Cochrane Database Syst Rev. 2018;6(6):CD007990. doi: 10.1002/14651858.CD007990.pub3 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  30. [34]Behnken MP, Abraham WT, Cutrona CE, Russell DW, Simons RL, Gibbons FX. Linking early ADHD to adolescent and early adult outcomes among African Americans. J Crim Justice. 2014;42(2):95-103. doi: 10.1016/j.jcrimjus.2013.12.005 [DOI] [Google Scholar] · DOI
  31. [35]Froehlich TE, Lanphear BP, Epstein JN, Barbaresi WJ, Katusic SK, Kahn RS. Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Arch Pediatr Adolesc Med. 2007;161(9):857-864. doi: 10.1001/archpedi.161.9.857 [DOI] [PubMed] [Google Scholar] · DOI
  32. [36]Getahun D, Jacobsen SJ, Fassett MJ, Chen W, Demissie K, Rhoads GG. Recent trends in childhood attention-deficit/hyperactivity disorder. JAMA Pediatr. 2013;167(3):282-288. doi: 10.1001/2013.jamapediatrics.401 [DOI] [PubMed] [Google Scholar] · DOI
  33. [37]Siegel CE, Laska EM, Wanderling JA, Hernandez JC, Levenson RB. Prevalence and diagnosis rates of childhood ADHD among racial-ethnic groups in a public mental health system. Psychiatr Serv. 2016;67(2):199-205. doi: 10.1176/appi.ps.201400364 [DOI] [PubMed] [Google Scholar] · DOI
  34. [38]Xu G, Strathearn L, Liu B, Yang B, Bao W. Twenty-year trends in diagnosed attention-deficit/hyperactivity disorder among US children and adolescents, 1997-2016. JAMA Netw Open. 2018;1(4):e181471. doi: 10.1001/jamanetworkopen.2018.1471 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  35. [40]Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36(3):1-48. doi: 10.18637/jss.v036.i03 [DOI] [Google Scholar] · DOI · Paper page
  36. [41]Hamza TH, van Houwelingen HC, Stijnen T. The binomial distribution of meta-analysis was preferred to model within-study variability. J Clin Epidemiol. 2008;61(1):41-51. doi: 10.1016/j.jclinepi.2007.03.016 [DOI] [PubMed] [Google Scholar] · DOI
  37. [42]Stijnen T, Hamza TH, Özdemir P. Random effects meta-analysis of event outcome in the framework of the generalized linear mixed model with applications in sparse data. Stat Med. 2010;29(29):3046-3067. doi: 10.1002/sim.4040 [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  38. [43]Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-560. doi: 10.1136/bmj.327.7414.557 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  39. [44]Phillips BM, Lonigan CJ. Child and informant influences on behavioral ratings of preschool children. Psychol Sch. 2010;47(4):374-390. doi: 10.1002/pits.20476 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  40. [45]Langsdorf R, Anderson RP, Waechter D, Madrigal JF, Juarez LJ. Ethnicity, social class, and perception of hyperactivity. Psycyol Sch. 1973;16(2):293-298. doi: 10.1002/1520-6807(197904)16:2<293::AID-PITS2310160221>3.0.CO;2-1 [DOI] [Google Scholar] · DOI
  41. [47]Russell G, Rodgers LR, Ukoumunne OC, Ford T. Prevalence of parent-reported ASD and ADHD in the UK: findings from the Millennium Cohort Study. J Autism Dev Disord. 2014;44(1):31-40. doi: 10.1007/s10803-013-1849-0 [DOI] [PubMed] [Google Scholar] · DOI
  42. [48]Lecendreux M, Konofal E, Faraone SV. Prevalence of attention deficit hyperactivity disorder and associated features among children in France. J Atten Disord. 2011;15(6):516-524. doi: 10.1177/1087054710372491 [DOI] [PubMed] [Google Scholar] · DOI
  43. [49]Schlack R, Hölling H, Kurth B-M, Huss M. The prevalence of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents in Germany: initial results from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Article in German. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007;50(5-6):827-835. doi: 10.1007/s00103-007-0246-2 [DOI] [PubMed] [Google Scholar] · DOI
  44. [50]Vasiliadis H-M, Diallo FB, Rochette L, et al. Temporal trends in the prevalence and incidence of diagnosed ADHD in children and young adults between 1999 and 2012 in Canada: a data linkage study. Can J Psychiatry. 2017;62(12):818-826. doi: 10.1177/0706743717714468 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  45. [51]Wolraich ML, Lambert EW, Bickman L, Simmons T, Doffing MA, Worley KA. Assessing the impact of parent and teacher agreement on diagnosing attention-deficit hyperactivity disorder. J Dev Behav Pediatr. 2004;25(1):41-47. doi: 10.1097/00004703-200402000-00007 [DOI] [PubMed] [Google Scholar] · DOI
  46. [52]Cénat JM. How to provide anti-racist mental health care. Lancet Psychiatry. Published online July 8, 2020. doi: 10.1016/S2215-0366(20)30309-6 [DOI] [PubMed] [Google Scholar] · DOI
  47. [53]Migliarini V. “Colour-evasiveness” and racism without race. Race Ethn Educ. 2018;21(4):438-457. doi: 10.1080/13613324.2017.1417252 [DOI] [Google Scholar] · DOI
  48. [54]Rosenthal L, Levy SR. The colorblind, multicultural, and polycultural ideological approaches to improving intergroup attitudes and relations. Soc Issues Policy Rev. 2010;4(1):215-246. doi: 10.1111/j.1751-2409.2010.01022.x [DOI] [Google Scholar] · DOI
  49. [55]Bleich E. Antiracism without races politics and policy in a color-blind state. French Polit Cult Soc. 2000;18(3):49-74. doi: 10.3167/153763700782377941 [DOI] [Google Scholar] · DOI
  50. [56]Simon P. The choice of ignorance: the debate on ethnic and racial statistics in France. French Polit Cult Soc. 2008;26(1):7-31. doi: 10.3167/fpcs.2008.260102 [DOI] [Google Scholar] · DOI

Authors
Cénat, J. M., Blais-Rochette, C., Morse, C., Vandette, M.-P., Noorishad, P.-G., Kogan, C., Ndengeyingoma, A., & Labelle, P. R.
Affiliations
  • University of Ottawa (CA)
  • Université du Québec en Outaouais (CA)
Corresponding author
Cénat, Jude Mary
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2021-01-01
Volume
78
Issue
1
Pages
21
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2020.2788
PMC
PMC7489386
OpenAlex
W3083860936
Cited by
88
References
68
Citations by year
2026: 13 · 2025: 23 · 2024: 13 · 2023: 24 · 2022: 9 · 2021: 6
FWCI
1.61
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Keywords
attention deficit hyperactivity disorder, ADHD prevalence, Black people, risk factors, racial disparities, underrepresentation in research, sociodemographic factors, family factors, environmental risk factors, children and adolescents, DSM-5, health equity, socioeconomic status, risk-taking, racial bias in diagnosis
MeSH terms
Attention Deficit Disorder with Hyperactivity, Black or African American, Humans, Risk Factors, United States, Prevalence

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review