Racial and Ethnic Disparities in ADHD Diagnosis From Kindergarten to Eighth Grade
Racial and Ethnic Disparities in ADHD Diagnosis From Kindergarten to Eighth Grade
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DOI：
10.1542/peds.2012-2390
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发表时间：
2013-07-01
期刊：
影响因子：
8
通讯作者：
Maczuga, Steven
中科院分区：
文献类型：
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作者：
Morgan, Paul L.;Staff, Jeremy;Maczuga, Steven
目的：在儿童早期和中期，注意缺陷多动障碍(ADHD)的诊断是否存在种族/民族差异，以及差异程度如何，目前尚不清楚。我们考察了从幼儿园到八年级诊断的种族/民族差异以及五年级和八年级治疗差异的时间动态。方法：使用离散时间风险模型对1998-1999幼儿园班级(N=17100)具有全国代表性的幼儿纵向研究进行分析。结果：少数民族儿童比白人儿童更不容易被诊断为ADHD。在统计控制非裔美国人、西班牙裔和其他种族/民族儿童ADHD的时间不变和不同混杂因素后，分别比白人低69%(95%可信区间：60%-76%)、50%(95%可信区间：34%-62%)和46%(95%可信区间：26%-61%)。增加儿童ADHD诊断风险的因素包括男孩、由年长的母亲抚养长大、在讲英语的家庭长大，以及参与外在的问题行为。降低儿童ADHD诊断风险的因素包括参与与学习相关的行为(例如，专心)、表现出更高的学业成就，以及没有医疗保险。在被诊断为ADHD的儿童中，种族/民族少数群体比白人更不可能为这种疾病服用处方药。结论：在ADHD诊断中，种族/民族差异从幼儿园就开始出现，并至少持续到八年级末。衡量的混杂因素不能解释ADHD诊断和治疗中的种族/民族差异。应加强对文化敏感的监测，以确保所有儿童都得到适当的ADHD筛查、诊断和治疗。
OBJECTIVE: Whether and to what extent racial/ethnic disparities in attention-deficit/hyperactivity disorder (ADHD) diagnosis occur across early and middle childhood is currently unknown. We examined the over-time dynamics of race/ethnic disparities in diagnosis from kindergarten to eighth grade and disparities in treatment in fifth and eighth grade.METHODS: Analyses of the nationally representative Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999 (N = 17 100) using discrete-time hazard modeling.RESULTS: Minority children were less likely than white children to receive an ADHD diagnosis. With time-invariant and -varying confounding factors statistically controlled the odds of ADHD diagnosis for African Americans, Hispanics, and children of other races/ethnicities were 69% (95% confidence interval [CI]: 60%-76%), 50% (95% CI: 34%-62%), and 46% (95% CI: 26%-61%) lower, respectively, than for whites. Factors increasing children's risk of an ADHD diagnosis included being a boy, being raised by an older mother, being raised in an English-speaking household, and engaging in externalizing problem behaviors. Factors decreasing children's risk of an ADHD diagnosis included engaging in learning-related behaviors (eg, being attentive), displaying greater academic achievement, and not having health insurance. Among children diagnosed with ADHD, racial/ethnic minorities were less likely than whites to be taking prescription medication for the disorder.CONCLUSIONS: Racial/ethnic disparities in ADHD diagnosis occur by kindergarten and continue until at least the end of eighth grade. Measured confounding factors do not explain racial/ethnic disparities in ADHD diagnosis and treatment. Culturally sensitive monitoring should be intensified to ensure that all children are appropriately screened, diagnosed, and treated for ADHD.