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

The Research Brief is a brief summary of interesting academic work.

Big idea

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

We analyzed data from 1,070 US elementary school children who demonstrated above-average behavioral, academic, or executive functioning a year before their initial ADHD diagnosis. We think these children are unlikely to have ADHD. Children diagnosed and treated for ADHD must exhibit chronic inattentive, hyperactive or impulsive behavior that interferes with their functioning and results in below-average academic or social development.

Among elementary school children who had demonstrated above-average academic performance, 27% of white children versus 19% of nonwhite children were later diagnosed with ADHD. About 20% of white children versus 14% of nonwhite children are taking ADHD medications. Among children who were previously well behaved in the classroom, 13% of white children versus 8% of nonwhite children were later diagnosed with ADHD. The socioeconomic status of the family or the age of the children did not explain this difference.

We found that ADHD diagnosis and treatment was very rare among elementary school children who displayed above average behavioral, academic or executive functioning. We observed diagnosis and treatment of ADHD in less than 5% of this group. Our findings are consistent with previous studies examining racial and ethnic differences among children who are not likely to have ADHD.

Why is that important?

Among US children and adolescents, the prevalence of ADHD has increased significantly, from 6% to 10% over the past 20 years. Overdiagnosis may be contributing to this trend. An increased prevalence of ADHD in children occurs among those with mild impairment.

Overdiagnosis stretches already limited mental health resources and allocates them away from children who need them most. Overdiagnosis can also contribute to stigma and skepticism towards those with significant or moderate impairment.

The diagnosis and treatment of ADHD has been shown to be beneficial for a larger group of children with significant ADHD symptoms and disorders. However, for a smaller group of children with no or only mild symptoms, a diagnosis of ADHD may result in lower academic and behavioral achievement during elementary school.

Children with mild ADHD may be more likely to compare themselves to children without disabilities, and to adopt negative ability beliefs that interfere with their learning and behavior. Over-treatment also need not expose children to negative side effects of the drug, such as sleep problems or suppressed appetite.

What is still unknown?

We don’t know why white children in elementary school are so 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 treatment as a way to improve their children’s academic performance.

We were unable to investigate whether white children were more likely to be diagnosed and overtreated for ADHD during middle or high school because our study data collection ended at the end of elementary school.

What’s next

Researchers have repeatedly called for an investigation into ADHD overdiagnosis and overtreatment. We expanded our study by examining whether differences in ADHD diagnosis and treatment varied for boys and girls by race and ethnicity.

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