Primary Submission Category: Health equity
Socio-demographic Disparities in Attention-deficit/Hyperactivity Disorder Diagnosis and Medication Use Among U.S. Elementary Schoolchildren
Authors: Paul Morgan Eric Hu
Presenting Author: Paul Morgan*
Importance: Whether socio-demographic disparities in ADHD diagnosis and treatment are occurring among U.S. elementary schoolchildren is currently unclear and in dispute.
Objective: We examined which groups of U.S. elementary schoolchildren are relatively less or more likely to be diagnosed and treated for ADHD.
Design: We analyzed observational data collected from a population-based cohort of schoolchildren (N=10,920) participating in the Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011 (ECLS-K: 2011). The cohort was followed from kindergarten entry in 2010 or 2011 until the end of fifth grade.
Setting: Participating children were individually assessed as they attended kindergarten as well as first, second, third, fourth, and fifth grade.
Exposures: Parental report of children having an ADHD diagnosis and using prescription medication for ADHD from first to fifth grade.
Methods: We predicted ADHD diagnosis using 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. Additional analyses were stratified by biological sex. We predicted prescription medication use among those diagnosed with ADHD including separately for boys and girls.
Results: About 8% of children in the full sample were diagnosed with ADHD between first and fifth grade. Children who are Black (aOR, 0.60), girls (aOR, 0.55), and emergent bilinguals (aOR, 0.29) were less likely to have an ADHD diagnosis. Additional explanatory factors included maternal depression, mathematics achievement, inhibitory control, and externalizing problem behaviors. 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.
Conclusions: Socio-demographic disparities in ADHD diagnosis and treatment are occurring among U.S. elementary schoolchildren. Measured confounds including independently assessed symptomatology and impairment do not explain these disparities. Our findings provide additional support for cultural, linguistic, and biological sensitivity in ADHD diagnostic and treatment procedures currently in use for the U.S. pediatric population.