5.19 A Literature Review: Racial and Ethnic Disparities in the Diagnosis and Treatment of ADHD

Abstract

ADHD is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity. ADHD has a prevalence rate of approximately 5% in children and responds well to therapeutic interventions. If untreated, ADHD can cause impairment in academic and social functioning. This review aims to study the current literature to identify disparities in diagnoses and treatment among non-Hispanic White and ethnic and racial minority patients. A literature review was conducted among studies from the last 10 years from PubMed and PsycINFO. The search terms used in PsycINFO were “treat/intervention or diagnosis/assess or clinical decision” and “ADHD and racial bias/racial or ethnic differences.” The search terms used in PubMed were “ADHD,” “ADHD and racial disparity,” and “ADHD, treatment and racial disparities.” Combined, 36 studies were imported for screening from 2 sources with 9 duplicates, leaving 27 studies. Of these, 5 were considered irrelevant by authors. A full-text review was done for 22 studies. Nearly all studies showed that ethnic and racial minority children, mainly African Americans and Latinx, were less likely to be diagnosed with ADHD when compared to the non-Hispanic White youth. These disparities remained even after various environmental and sociocultural confounding factors were statistically controlled for by logistic regression. Furthermore, minority children were also less likely to receive care and were at risk of early discontinuation of treatment. Two recent studies have shown increasing rates of diagnosis and treatment of ADHD in Black children; however, the disparity remains. Although ethnic and racial minority children exhibit the same severity of ADHD symptoms when compared to non-Hispanic White youth, they are less likely to be diagnosed with ADHD and have decreased odds of receiving appropriate psychopharmacologic and other treatment modalities. Barriers to care included minority status, less parental education, and lack of insurance, which decreased the chances of getting a comprehensive evaluation and which also decreased the odds of identifying comorbidities associated with ADHD. When ethnic minority children receive less comprehensive evaluations, there may be more opportunities for unconscious bias to impact diagnosis and treatment.