Research Briefs are brief information about interesting academic work.
White children are especially likely to be overdiagnosed and over-treated for attention-deficit/hyperactivity disorder during primary school. This is an important finding from our recent peer-reviewed study.
We analyzed data from 1,070 US elementary school children who displayed average behavioral, academic or executive functioning one year before their initial ADHD diagnosis. We did not consider these children likely to have ADHD. Children diagnosed and treated for ADHD must exhibit chronically inattentive, hyperactive or impulsive behaviors that impair their functioning and result in below average academic or social development.
Among elementary school children who showed 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 were treated well in earlier classes, 13% of white children versus 8% of non-white children later suffered from ADHD. The socioeconomic status of the families or the age of the children did not explain these disparities.
We found that ADHD diagnosis and treatment is very uncommon in elementary school children who exhibit above average behavioral, academic or executive functioning. We saw ADHD diagnosis and treatment occurring in less than 5% of this group. Our findings are consistent with prior work examining racial and ethnic disparities among children most likely to have ADHD.
why it matters
Among American children and adolescents, the prevalence of ADHD has increased significantly over the past 20 years, from 6% to 10%. Overdiagnosis may contribute to this trend. The increase in the prevalence of ADHD in children is occurring in those exhibiting mild impairment.
Overdiagnosis stretches already limited mental health resources and distances them from the children who need them most. Overdiagnosis may also contribute to stigma and suspicion towards those experiencing significant or moderate impairment.
ADHD diagnosis and treatment has been shown to be beneficial for a large group of children with significant ADHD symptoms and impairments. However, for a small group of children with no or only mild symptoms, an ADHD diagnosis can result in low academic achievement and behavior during primary school.
Children with mild ADHD are more likely to compare themselves with children with disabilities, and therefore adopt negative competence beliefs that interfere with their learning and behavior. Overtreatment also unnecessarily exposes children to negative side effects of the drug, such as sleep problems or depressed appetite.
what is not yet 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 diagnosis and treatment because they are more accepting of ADHD as a health condition. Limited research suggests that some parents may try to get an ADHD diagnosis and medications as a way to increase their children’s academic achievement.
We could not investigate whether white children were more likely to be overdiagnosed and overtreated for ADHD during middle or high school because the data collection of our study ended at the end of primary school.
what will happen next
Researchers are repeatedly calling for an investigation into ADHD overdiagnosis and overtreatment. We are expanding our research by examining whether disparities in ADHD diagnosis and treatment differ for boys and girls by race and ethnicity.