White children are especially likely to be over-diagnosed and over-treated for attention-deficit/hyperactivity disorder (ADHD) during elementary school, according to a key finding from our recent peer-reviewed study, writes Paul Morgan, director of the Centre for Educational Disparities Research, Penn State University, USA,
In The Conversation, he writes that his team analysed data from 1,070 US elementary school children who had displayed above-average behavioural, academic or executive functioning the year before their initial ADHD diagnoses.
We considered these children as unlikely to have ADHD. Children diagnosed and treated for ADHD should display chronically inattentive, hyperactive or impulsive behaviours that impair their functioning and result in below-average academic or social development.
Among elementary school children who had shown above-average academic achievement, 27% of white children versus 19% of non-white children were later diagnosed with ADHD. About 20% of white children versus 14% of non-white children were using ADHD medication. Among children who had previously been well-behaved in classrooms, 13% of white children versus 8% of non-white children were later diagnosed with ADHD. Families’ socioeconomic status or children’s age did not explain these disparities.
We found that ADHD diagnosis and treatment is very uncommon among elementary school children displaying above-average behavioural, academic or executive functioning. We observed ADHD diagnosis and treatment to occur in less than 5% of this group. Our findings are consistent with prior work examining racial and ethnic disparities among children unlikely to have ADHD.
Why it matters
Among US children and adolescents, ADHD prevalence has increased significantly, from 6% to 10% over the past 20 years.
Overdiagnosis may be contributing to this trend. Increases in ADHD prevalence in children are occurring among those displaying mild impairments.
Over-diagnosis stretches already limited mental health resources and allocates them away from children who need them most. Over-diagnosis may also contribute to stigma and scepticism toward those experiencing significant or moderate impairments.
ADHD diagnosis and treatment has been shown to be beneficial for the larger group of children with significant ADHD symptoms and impairments. However, for the smaller group of children with no or only mild symptoms, ADHD diagnosis may result in lower academic achievement and behaviour during elementary school.
Children with mild ADHD may be more likely to compare themselves with children without disabilities, and so adopt negative ability beliefs that interfere with their learning and behaviour. Overtreatment also unnecessarily exposes children to medication’s negative side effects, such as sleep problems or depressed appetites.
What still isn’t known
We don’t know why white children in elementary school are especially likely to be over-diagnosed and over-treated for ADHD. One possibility is that white parents are more likely to seek diagnoses and treatments because they are more accepting of ADHD as a health condition. Limited research suggests that some parents may be attempting to obtain ADHD diagnoses and medications as a way to increase their children’s academic achievement.
We couldn’t investigate whether white children are more likely to be over-diagnosed and over-treated for ADHD during middle or high school because our study’s data collection ended at the end of elementary school.
What’s next
Researchers are repeatedly calling for investigations of ADHD over-diagnosis and over-treatment. We are extending our research by examining whether disparities in ADHD diagnosis and treatment vary for boys and girls by race and ethnicity.
Study details
Sociodemographic Disparities in Attention-Deficit/Hyperactivity Disorder Overdiagnosis and Overtreatment During Elementary School
Paul L. Morgan, Adrienne D. Woods, Yangyang Wang.
Published in Journal of Learning Disabilities on 8 June 2022
Abstract
Attention-deficit/hyperactivity disorder (ADHD) overdiagnosis and overtreatment unnecessarily exposes children to potential harm and contributes to provider and community skepticism toward those with moderate or severe symptoms and significant impairments, resulting in less supportive care. Yet which sociodemographic groups of children are overdiagnosed and overtreated for ADHD is poorly understood.
We conducted descriptive and logistic regression analyses of a population-based subsample of 1,070 U.S. elementary schoolchildren who had displayed above-average levels of independently assessed behavioural, academic, or executive functioning the year prior to their initial ADHD diagnoses and who did not have prior diagnostic histories. Among these children, (a) 27% of White children versus 19% of non-White children were later diagnosed with ADHD and (b) 20% of White children versus 14% of non-White children were later using medication. In adjusted analyses,
White children are more likely to later be diagnosed (odds ratio [OR] range = 1.70–2.62) and using medication (OR range = 1.70–2.37) among those whose prior behavioural, academic, and executive functioning suggested that they were unlikely to have ADHD.
Paul Morgan is Professor of Education and Demography, as well as director of the Centre for Educational Disparities Research at Penn State.
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