Racial and ethnic disparities in ADHD diagnosis from kindergarten to eighth grade
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OBJECTIVE: Whether and to what extent racial/ethnic disparities inattention-deficit/hyperactivity disorder (ADHD) diagnosis occur across early and middle childhood is currently unknown. We examined the over-time dynamics of race/ethnic disparities in diagnosis from kindergarten to eighth grade and disparities in treatment in fifth and eighth grade. METHODS: Analyses of the nationally representative Early Childhood Longitudinal Study, Kindergarten Class of 1998–1999 (N = 17 100)using discrete-time hazard modeling. RESULTS: Minority children were less likely than white children to receive an ADHD diagnosis. With time-invariant and -varying confounding factors statistically controlled the odds of ADHD diagnosis for African Americans, Hispanics, and children of other races/ethnicities were 69% (95% confidence interval [CI]: 60%–76%), 50% (95% CI: 34%–62%), and 46% (95% CI: 26%–61%) lower, respectively, than for whites. Factors increasing children’s risk of an ADHD diagnosis included being a boy,being raised by an older mother, being raised in an English-speaking household, and engaging in externalizing problem behaviors. Factors decreasing children’s risk of an ADHD diagnosis included engaging in learning-related behaviors (eg, being attentive), displaying greater academic achievement, and not having health insurance. Among children diagnosed with ADHD, racial/ethnic minorities were less likely than whites to be taking prescription medication for the disorder. CONCLUSIONS: Racial/ethnic disparities in ADHD diagnosis occur by kindergarten and continue until at least the end of eighth grade. Measured confounding factors do not explain racial/ethnic disparities in ADHD diagnosis and treatment. Culturally sensitive monitoring should be intensified to ensure that all children are appropriately screened, diagnosed,and treated for ADHD.
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Diagnostic heterogeneity and poor reliability of primarily descriptive symptom-based diagnostic procedures have hampered efforts to determine the pathophysiology of ADHD.
“Such diagnostic heterogeneity and its poor reliability have hampered efforts to determine the pathophysiology of ADHD (Morgan et al., 2013).”
From Functional neuroimaging of visuospatial working memory tasks enables accurate detection of attention deficit and hyperactivity disorder (2015) · cites this paper as Morgan et al., 2013
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- Authors
- Morgan, P. L., Staff, J., Hillemeier, M. M., Farkas, G., & Maczuga, S.
- Affiliations
- Pennsylvania State University (US)
- Sociology and Crime, Law, and Justice, and
- University of California, Irvine (US)
- Population Research Institute, Pennsylvania State University, University Park, Pennsylvania
- Venue
- PEDIATRICS
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2013-07-01
- Volume
- 132
- Issue
- 1
- Pages
- 85-93
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC3691530
- OpenAlex
- W2011175687
- Cited by
- 302
- References
- 42
- Citations by year
- 2026: 16 · 2025: 24 · 2024: 40 · 2023: 29 · 2022: 28 · 2021: 28 · 2020: 32 · 2019: 26 · 2018: 15 · 2017: 13 · 2016: 16 · 2015: 18 · 2014: 11 · 2013: 5
- FWCI
- 11.81
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- PEDIATRICS (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24HD041025)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- ADHD diagnosis, racial and ethnic disparities, early childhood, middle childhood, African American children, Hispanic children, externalizing problems, academic performance, health insurance, maternal age
- MeSH terms
- Adolescent, Attention Deficit Disorder with Hyperactivity, Black or African American, Child, Child, Preschool, Cross-Sectional Studies, Female, Health Services Accessibility, Hispanic or Latino, Humans, Internal-External Control, Longitudinal Studies, Male, Mass Screening, Risk, Sex Factors, United States, Odds Ratio, White People, Health Status Disparities, Healthcare Disparities
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