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White children are especially likely to be overdiagnosed and overtreated for ADHD, according to a new study

Children with ADHD typically exhibit a combination of hyperactivity, inattentiveness and/or impulsive behavior. (Klaus Vedfelt/Digital Vision via Getty Images)

The Research Brief is a short take about interesting academic work.

The big idea

White children are especially likely to be overdiagnosed and overtreated for attention-deficit/hyperactivity disorder during elementary school. That is the key finding from our recent peer-reviewed study.

We analyzed data from 1,070 U.S. elementary school children who had displayed above-average behavioral, 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 behaviors 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 nonwhite children were later diagnosed with ADHD. About 20% of white children versus 14% of nonwhite children were using ADHD medication. Among children who had previously been well-behaved in classrooms, 13% of white children versus 8% of nonwhite children were later diagnosed with ADHD. Families’ socioeconomic status or children’s age did not explain these disparities.

We did find that ADHD diagnosis and treatment is very uncommon among elementary school children displaying above-average behavioral, 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 U.S. 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.

Overdiagnosis stretches already limited mental health resources and allocates them away from children who need them most. Overdiagnosis may also contribute to stigma and skepticism 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 behavior 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 behavior. 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 overdiagnosed and overtreated 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 overdiagnosed and overtreated 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 overdiagnosis and overtreatment. We are extending our research by examining whether disparities in ADHD diagnosis and treatment vary for boys and girls by race and ethnicity.The Conversation

Paul L. Morgan, Eberly Fellow, Professor of Education and Demography, and Director of the Center for Educational Disparities Research, Penn State

This article is republished from The Conversation under a Creative Commons license. Read the original article.

5 comments

Niz Judia October 10, 2022 at 4:42 am

I think some w/ ADHD can be treated by first comprehensive blood tests
Hormone panels – balance hormone proper nutrition & minerals
Adjusting what they eat, ensuring a stable home life, that the kid is loved, gets outdoors and has at least 2-4 friends.
After that I cannot comment on. I do not practice medicine and think it’s awful to medicate kids. Even for adults it should be limited until any problem is diagnosed and cured! IJS

Sarah Waters October 10, 2022 at 8:28 am

There are other possible interpretations of this data. Such as under-diagnosis of other groups. Ability to compensate for ADHD. Elementary school offering an environment where compensation for ADHD is easier for some, becomes more difficult to compensate as they get older. The generalizations seem biased. I understand that there may be some kids diagnosed that may be mid/overdiagnosed. But this article seems to follow a different fad. Most services that wealthy kids have access to aren’t transferable to kids with no insurance. These providers refuse to take reduced payments/insurance level payments. Here is another take: https://stacks.cdc.gov/view/cdc/49834/cdc_49834_DS1.pdf

Johnny cardamone October 10, 2022 at 9:50 am

I know someone who is in her 30s and is addicted to Ridellan, Never finished college has trouble keeping a job and experiences homelessness, so this overmedication can have lifelong negative consequences🥵😩👎🏽

David Muccigrosso October 10, 2022 at 9:56 am

I really hope this study is received in the manner it was intended.

As someone who grew up with a genuine case of ADHD, it was frustrating to see other children get labeled with my same condition who honestly either (A) just had general discipline problems, or (B) had deeper issues that were NOT “ADHD” but for which their parents, teachers, and doctors simply lacked any more accurate label.

It wasn’t fair to them – the “A” group was stigmatized and overmedicated while their much more mundane life issues were ignored, and the “B” group was undermedicated and undertreated for their underlying conditions.

And it wasn’t fair to me either – people often either assumed that I was in the “A” group because I am relatively high-functioning, or they associated my behavior problems with the more severe “B” group and rarely gave me the benefit of the doubt, much less any of the gentle extra social instruction that truly would have helped me more than anything else.

I really hope this doesn’t turn into just more fodder for the NoN Commenter Culture Wars. If it’s a real problem that disproportionately affects White children, then we should try to fix it, not let ourselves get distracted by bigots who go around hunting for the slightest hint of secret anti-White bias. And if anyone here is truly being “anti-White”, it’s those distracting us from helping White children, not those who call out the problem.

David Muccigrosso October 11, 2022 at 7:55 am

@Niz, what do you think blood tests are supposed to accomplish therapeutically?

I respect that not everyone is a doctor, but if you’re going to exercise intellectual humility, maybe you can start by not presuming to know how to treat other people’s conditions.

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