The Association Between Race/Ethnicity and Socioeconomic Factors and the Diagnosis and Treatment of Children with Attention-Deficit Hyperactivity Disorder
The Association Between Race/Ethnicity and Socioeconomic Factors and the Diagnosis and Treatment of Children with Attention-Deficit Hyperactivity Disorder
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DOI：
10.1097/dbp.0000000000000626
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发表时间：
2019-02-01
影响因子：
2.4
通讯作者：
Wolraich, Mark L.
中科院分区：
文献类型：
--
作者：
Bax, Ami C.;Bard, David E.;Wolraich, Mark L.
目的：评估种族/民族和社会经济地位（SES）与注意缺陷多动障碍（ADHD）的诊断、治疗和获得护理的关系，通常仅基于父母报告得出了不一致的结果。相比之下，本研究使用了更广泛的ADHD诊断方法，包括病例定义，以多地点小学为基础的样本来检验这些关系。方法：通过简单的双变量/多变量模型，对父母和老师报告的《精神疾病诊断与统计手册》（DSM）标准中患有和没有多动症的儿童进行二次分析，评估社会经济地位、种族/民族和其他变量：父母报告的诊断、药物治疗和满足多动症研究病例定义。结果：总样本中男性占51.9%，白人占51.3%，有私保者占53.1%；10%有父母报告的ADHD诊断，8.3%符合ADHD研究病例定义。在多变量模型中，白人儿童的父母报告诊断的几率高于黑人、西班牙裔和其他种族/族裔儿童（p < 0.05），但只有西班牙裔儿童的病例阳性几率较低（< 0.05）；单亲家庭的男性和儿童报告的诊断和病例阳性的几率更高（p < 0.05）；白人男性和有医疗保险的儿童服药的几率更高（p < 0.05）。在病例阳性的儿童中，医疗补助、怀特和双亲状态的儿童父母报告诊断的几率更高（p < 0.05）。结论：患有潜在ADHD的儿童如果是白人男性，有医疗保险（特别是医疗补助），并且生活在双亲家庭中，则更有可能获得评估/药物治疗。虽然男孩和单亲家庭长大的孩子可能有更高的ADHD诊断率，但假阳性诊断的风险似乎也更高，这需要进一步的调查。
Objective: Assessing race/ethnicity and socioeconomic status (SES) relationships with AttentionDeficit/ Hyperactivity Disorder (ADHD) diagnosis, treatment, and access to care has yielded inconsistent results often based only on parent-report. In contrast, this study used broader ADHD diagnostic determination including case-definition to examine these relationships in a multisite elementary-school-based sample. Method: Secondary analysis of children with and without ADHD per parent and teacher-reported Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria evaluated SES, race/ethnicity, and other variables through simple bivariate/multivariable models within and across: parent-reported diagnosis, medication treatment, and meeting ADHD study case-definition. Results: The total sample included 51.9% male, 51.3% White, and 53.1% with private insurance; 10% had parent-reported ADHD diagnoses while 8.3% met ADHD study case-definition. In multivariable models, White children had higher odds of parent-reported diagnoses than Black, Hispanic, and Other Race/ Ethnicity children (p < 0.05), but only Hispanic children had lower odds of being case-positive (< 0.05); males and children in single-parent households had higher odds of parent-reported diagnoses and being case-positive (p < 0.05); and children who were White, male, and had health insurance had higher odds of taking medication (p < 0.05). Among children who were case-positive, those with Medicaid, White, and 2-parent statuses had higher odds of parent-reported diagnoses (p < 0.05). Conclusion: Children with underlying ADHD appear more likely to have assessment/medication treatment access if they are White, male, have health insurance (particularly Medicaid), and live in 2-parent households. While boys and children raised by single parents may have higher rates of ADHD diagnoses, false-positive diagnostic risk also appeared higher, inviting further investigation.