Meta-Analysis: Prevalence of ADHD Diagnoses Higher Among Black Americans
In a recent meta-analysis, researchers found a greater prevalence of ADHD diagnoses among Black adults and children compared to the American population at large.
September 22, 2020
Black Americans are more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD or ADD) than the general population, according to findings of a systematic review and meta-analysis published in JAMA Psychiatry.1 These findings seem to contradict the DSM-5, which suggests that the prevalence of ADHD is relatively lower among Black individuals. The new meta-analysis did not determine whether the higher diagnosis rate is due to elevated risk factors for Black Americans, culturally insensitive evaluation tools, racial bias, other factors, or some combination therein.
Black individuals living in countries where they are considered a minority are underrepresented in studies evaluating ADHD. Joel Nigg, Ph.D., explains that “Most research on ADHD has studied male children of European-Caucasian ancestry in North America, Europe, and Oceana. Relatively few studies specifically examine aspects of race or cultural variation.” For the current meta-analysis, researchers reviewed 21 studies published between 1979 and 2020 that included data from 154,818 Black participants. Two studies assessed adults, 8 assessed children, 1 assessed adolescents, and 13 assessed both children and adolescents. Results showed a pooled prevalence of ADHD around 14.5% (95% CI, 10.64%-19.56%); the prevalence of ADHD is closer to 10% in the general population.
The meta-analysis did not directly compare risk factors facing Black patients and other patients. However, several of the studies used noted relatively higher diagnosis rates for ADHD and learning disabilities among Black children, and they noted that teacher ratings typically factor heavily into those evaluations. Recent research has shown that teachers are more likely to ascribe a student’s behaviors to ADHD if the student is Black.2
Several studies found significant differences in risk factors associated with ADHD — such as socioeconomic status and access to health care — among Black populations and the general population. Still, researchers did not prescribe any cause and effect for the ADHD diagnosis disparity found.
Rather, they said these findings demonstrate the need for more research with the ultimate goal of creating culturally appropriate assessment and monitoring tools to improve the accuracy of diagnoses and impact of treatment for Black individuals. Sarah Vinson, M.D., says that “to ensure more equitable health care, clinicians must recognize these issues in broader society without assuming that a universal African American experience exists; great care requires clinicians to probe and consider each individual patient’s unique experiences.”
The authors of the study concluded, “Although there is still much work to be done to better understand these data and to study the barriers associated with culturally appropriate ADHD diagnoses and care for Black individuals, the present study provides important insights for both research and clinical practice. It offers key avenues to consider the reduction of disparities associated with ADHD diagnoses among Black individuals. These considerations include research that can help to establish accurate diagnoses and culturally appropriate care for Black youth with ADHD symptoms.”
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1 Cénat JM, Blais-Rochette C, Morse C, et al. Prevalence and Risk Factors Associated With Attention-Deficit/Hyperactivity Disorder Among US Black Individuals: A Systematic Review and Meta-analysis. JAMA Psychiatry. Published online September 09, 2020. doi:10.1001/jamapsychiatry.2020.2788
2 Kang, Sungha, et al. “Racial Differences between Black Parents’ and White Teachers’ Perceptions of Attention-Deficit/Hyperactivity Disorder Behavior.” Journal of Abnormal Child Psychology (Dec. 2019) https://link.springer.com/article/10.1007/s10802-019-00600-y