What a child looks like, how much money their parents make, and whether or not they have insurance may significantly alter the chances that they've been diagnosed with ADHD. The statistics come from a broad, national look at who is being diagnosed with attention deficit hyperactivity disorder in the US. The study, which comes from the CDC's National Center for Health Statistics, doesn't say why these disparities in diagnosis exist, but the reasonable implication is that some children may not be receiving a diagnosis when they should be, potentially leaving them without care.
"There may be some barriers that relate to the likelihood of receiving a diagnosis."
The differences that the researchers found cover age, sex, race, insurance status, and economic situation. Among the more striking findings are those on race and insurance. For race, 11.5 percent of non-Hispanic white children were found to have ever been diagnosed with ADHD; 8.9 percent of non-Hispanic black children had; and 6.3 percent of Hispanic children had. When it came to insurance, the study found that more children with public or private insurance had received an ADHD diagnosis, at 11.7 percent and 8.6 percent respectively, than children without insurance, just 5.7 percent of whom had been diagnosed.
As of 2011, 6.4 million school-aged children were reported by their parents to have ever been diagnosed with ADHD, a prior CDC study found. The newly released NCHS study adds that, in total, 9.5 percent of children between the ages of 4 and 17 are reported to have ever been diagnosed with ADHD.
The trouble with just looking at statistics is that, while the disparities in diagnosis become very obvious, it isn't necessarily clear what they mean. Are people without insurance just less likely to have ADHD? That's probably not what's going on — and it'll be up to further studies to determine what's occurring. "There are kids out there who aren't diagnosed with ADHD who may actually have this condition, and they don't have access to care or their parents have chosen not to take them in to be diagnosed," Patricia Pastor, the study's lead author and an NCHS researcher, tells The Verge. "None of those issues can be covered by this study."
The study is based on data collected in the National Health Interview Survey between 2011 and 2013. It was conducted using interviews, meaning parents are relied upon to provide answers about whether or not their children have been diagnosed with ADHD, a behavioral disorder that can lead to children having difficulty staying focused, paying attention, or controlling their behavior. In addition to its findings on race and insurance status, it also found that more than twice as many boys have received an ADHD diagnosis than girls, that more children are diagnosed in families farther from the poverty line, and that more adolescents are diagnosed than young children.
If children aren't being properly diagnosed, they can't receive treatment
"I think their findings suggest that there may be some barriers that relate to the likelihood of receiving a diagnosis," Paul Morgan, an associate professor of education at Penn State who has done prior research on ADHD diagnosis, but was not involved in this study, tells The Verge. Barriers to diagnosis, he says, seem to be a more likely answer to explaining why these disparities exist. In fact, prior research already points to some of these.
Studies have shown that children from minority groups are more likely to display symptoms of ADHD, Morgan says. Studies have also shown that these children are exposed to more risk factors of ADHD, too. There could be a number of reasons why they aren't diagnosed, he says, including parents trying to avoid a stigmatized label within their community, pediatricians being less likely to evaluate certain children for the condition, or even language barriers at the doctor's office.
"It's a serious issue that there should be disparities in ADHD diagnosis."
"There's probably a combination of factors at work," Morgan says. "The problem is if children who are, say, black or don't have access to health insurance aren't identified, it's increasing the likelihood they're experiencing a number of different negative outcomes, including struggles in school."
Of course, ADHD diagnosis is also controversial, with some experts viewing its prevalence as a sign of over-diagnosis. (This study's figure for total children diagnosed — 9.5 percent — is lower than the CDC's previous figure, that 11 percent of all kids aged 4 to 17 had received an ADHD diagnosis by 2011; however, the two studies are based on different parent-reported surveys.) There's also potential for misdiagnosis. As The Atlantic reported last year, signs of trauma can be mistaken for ADHD.
The NCHS makes a point of not commenting on policy issues, so it doesn't have much to say about what we're looking at. But the information it's presenting gives researchers important new data for researching ADHD.
"It's a serious issue that there should be disparities in ADHD diagnosis, that it should essentially matter what your family's characteristics are or your own characters are should matter in terms of access to treatment for a disorder you may have," Morgan says. "I think that's a serious issue. It's public health issue. And a better understanding of the mechanisms that are responsible for the observed disparities is an important next step for the field."