Are Minority Kids Being Missed In ADHD Diagnosis?

For years, doctors, teachers and parents have fretted that attention deficit hyperactivity disorder (ADHD) is overdiagnosed and that children are overprescribed the stimulants that treat the brain disorder too often.

But, as EdSource Today reports, that's not the case in California. According to new data from the National Survey of Children's Health, California ranks 5th lowest in the country in diagnosis. The national average of children with ADHD is 7.9 percent, but in California, the rate is 5.2 percent.

That 5.2 percent rate may be a low one nationally. But globally, rates vary between 3 and 9 percent, "with the average closer to 5," Prof. Joshua Israel told EdSource Today.

Still, within ethnic groups in California, the diagnosis rates drop dramatically. Kaiser researchers published data earlier this year which showed white children had a 5.6 percent rate -- well in line with global averages. But other groups had much lower ADHD diagnosis rates as follows:

• Black children: 4.1 percent
• Latino children:  2.5 percent
• Asian American children: 1.9 percent

Which leads us to the question not of overdiagnosis, but underdiagnosis for some groups of children -- and potentially serious consequences, says Prof. Sandra Loo, an ADHD researcher at UCLA.

From EdSource Today:

“There is a common perception that ADHD is not as severe as other disorders, when in fact the long-term outcomes of people with untreated ADHD are really horrible,” [Loo] said, including high rates of dropping out of school.

In fact, nearly one-third of children with ADHD drop out or delay high school graduation, according to research conducted at the UC Davis School of Medicine. ...

To avoid over- or under-diagnosis of ADHD, the evaluation process is supposed to be thorough. Yet at every step of the way the process can go awry, subject to pressures from schools, doctors and families.

Schools are on the front lines of identifying children who may have ADHD, working with their families and doctors and creating educational plans or accommodations if necessary.

But schools do not do a uniform job in identifying children. Ruth Hughes, CEO of the Maryland-based advocacy group Children and Adults with Attention Deficit Hyperactivity Disorder, tells EdSource Today that "subtle, powerful messages in schools" can determine whether children with ADHD are diagnosed:

“The same kid who was never identified as having ADHD in one school system can move to another school system and be identified.”

Families, too, vary in their willingness to consider that their child might have a brain disorder, and their willingness to discuss the matter with teachers and doctors.

Another obstacle is that pediatricians, who make the bulk of diagnoses of childhood ADHD, typically aren’t reimbursed for the time it takes to conduct a rigorous evaluation, making the process “particularly challenging for primary care clinicians,” the American Academy of Pediatrics noted.

The need for appropriate diagnosis is considerable, researchers said, given risks at both ends of the spectrum: medicating children who don’t have ADHD or under-treating children who suffer from a disorder that may seriously impair their social and educational functioning.

“I am a researcher, but I am also a medical doctor, and I see the benefit of a carefully made diagnosis,” said Darios Getahun, lead author of the Kaiser Permanente study. “If you identify a child with ADHD in a timely way, and initiate treatment, the outcome will be better learning and better functioning in social situations.”