Study Finds Racial/Ethnic Disparities in ADHD Diagnoses by Kindergarten Entry

Student smiling

To date, little research has been conducted on health disparities that may be occurring as children enter kindergarten. A recent Penn State study found that, compared to otherwise similar white children, those who are black or from non-English speaking households, are less likely to be diagnosed with attention deficit/hyperactivity disorder.

The study now appears online in The Journal of Child Psychology and Psychiatry. It analyzed longitudinal data from a large, nationally representative cohort of U.S. children.

The researchers found that the odds that black children would receive an ADHD diagnosis were 70 percent lower than the odds for otherwise similar white children. An initially observed disparity for Hispanic children was explained by use of language other than English in the home, suggesting that this may be a barrier to ADHD diagnosis during early childhood.

“This study should give health researchers and practitioners an accurate estimate of the extent to which racial/ethnic minority children may be experiencing disparities in ADHD diagnosis in the U.S.,” said Paul Morgan, Principal Investigator and Associate Professor of Education. “Not much is known about ADHD diagnosis by kindergarten, although the American Academy of Pediatrics considers it a condition that may require behavioral and pharmacological treatment by this time.” The study extensively controlled for potential confounding factors, including socio-economic status, general cognitive functioning, and ADHD-related behavioral functioning.

Morgan stated that cultural and/or linguistic barriers may inhibit health professionals from soliciting developmental concerns as frequently from minority families and so explain the observed disparities.  It also may be that a lack of awareness regarding the early onset of the disorder or reluctance to have their child labeled as disabled may mean that minority parents are less likely to seek a professional evaluation. It may also be that.  

“Certainly you don’t want to diagnose a child with ADHD who doesn’t have it,” he added. “But if a child with the disorder isn’t receiving effective treatment, he or she is at much greater risk for struggling at school. Such difficulties can cascade very quickly over time and place the child at much greater risk for a range of negative outcomes.”

Morgan said he hopes the findings will lead pediatricians, psychiatrists, teachers and school-based health professionals to be sensitive and accurately diagnose ADHD in minority children.

“There are comparatively few studies examining child outcomes as early as school entry,” he said. “We are finding that ADHD diagnosis disparities can occur as early as the beginning of kindergarten, which places undiagnosed children with the disorder at a big disadvantage just as they are beginning their school careers.

Also working on this project were Marianne Hillemeier, Professor of Health Policy and Administration and Demography; George Farkas, Professor of Education at the University of California-Irvine; and Steve Maczuga, Research Programmer with the Population Research Institute.