ADHD may be under-diagnosed in minority children

SEATTLE -- A new study reports black and Hispanic children are half as likely to be diagnosed with attention-deficit/hyperactivity disorder (ADHD) as their white peers, a finding that supports what one Seattle doctor has suspected for years.

“There’s definitely an over diagnosis in some places, but in more places it’s under-diagnosed and certainly under-treated,” said Mark Stein, director of the ADHD program at Seattle Children's Hospital. 

Researchers at Pennsylvania State University followed 15,100 children from the kindergarten class of 1998/1999 through eighth grade using regular parent surveys. At each survey check-in point -- kindergarten and first, third, fifth and eighth grades -- white children were most likely to have been diagnosed with ADHD.

By eighth grade, 7 percent of white kids had received an ADHD diagnosis, their parents reported. By comparison, 3 percent of black kids and just over 4 percent of Hispanic children were diagnosed.

Stein said he is concerned about the low level of diagnosis among minority children because a number of risk factors for ADHD are especially prevalent in African Americans, including younger mothers and lower birth weights.

“They should have higher rates of ADHD,” Stein said.

Stein suspects the disparity is caused in part by reduced access to health care.

"It's important to have regular medical care by a pediatrician who knows your child, follows them and  asks about their school problems," he said.

Stein said there are also biases against ADHD. Some parents may be reluctant to have their child screened because they don't want them to be prescribed behavior-modifying medications.

Besides minority children, Stein said ADHD is often missed in kids who do not demonstrate behavioral problems, children who are gifted and when the youth has other, more obvious problems, such as substance abuse.

Children who do have ADHD have a two-thirds chance of carrying the condition into their teenage years and a 50 percent chance of having it as an adult, so Stein said it is important children receive appropriate treatment, typically a combination of talk therapy and medications.

"Children who go untreated are at risk for a lot of other psychological and medical problems -- substance abuse, depression and accidents," he said.

However, Stein admits it is debatable whether the study shows minority children are under-diagnosed or white children are over-diagnosed.

"IS ADHD good or bad? Neither,” he said. “But if your child has ADHD, you want them evaluated and you want them to get the appropriate treatment."