How race, income and gender affect ADHD in children

Aug 18, 2011

Nearly one in 10 U.S. children is being diagnosed with attention deficit hyperactivity disorder (ADHD), according to a new analysis of federal data released Thursday. Dr. Lara Akinbami, one of the researches who worked on the analysis, will answer reader questions about the study and what they found, including how ADHD affects children by age, race, gender, location and more.

Ask your question now!

Good afternoon--I'm happy to answer questions about the data from CDC on Attention Deficit Hyperactivity Disorder in kids.

My husband has ADHD. My son is 4 and has some symptoms of ADHD. Is he pre-destined for it?

ADHD certainly does run in families, but that doesn't necessarily mean your son is predestined to have ADHD.  We don't fully understand what causes ADHD or know how to prevent it.  The signs and symptoms usually appear before age 7 and can be related to either inattention (distracted easily, being forgetful), or the hyperactivity and impulsivity (being "driven by a motor" or not waiting your turn to talk or play). An official diagnosis often isn't made until children are in school because more symptoms may become apparent when children are required to perform tasks in which they may not necessarily be interested or find fun.  I would  ask your son's doctor more about the diagnosis process, but don't be surprised if they advise you to wait and see how he grows and develops.  Try not to worry and just enjoy his childhood!

How did you conduct the research? What steps were taken to come to these conclusions?

The data that show that ADHD has been increasing over the past decade come from the National Health Interview Survey that is administered by the National Center for Health Statistics (part of the Centers for Disease Control and Prevention).  Each year, about 40,000 households undergo face-to-face interviews with detailed health questions.  Depending on the year, about 8,000 to 12,000 children ages 0-17 are included to represent the total population of children in the United States. The ADHD data are based on a parent reporting for these sampled children that they had received a diagnosis of ADHD from a doctor or other health professional at some point in the past.  We then assess trends in the percent of children diagnosed with ADHD by race and ethnicity, by income, and by geographic region.

Would you say that nutrition ( or lack thereof) is a major contributor to ADHD in children from low-income areas?

I wish we had the information to answer that great question.  There are many factors that likely come into play.   But at present, we do not know which factors determine who gets ADHD, how to predict who will get ADHD, or to prevent it from occuring.  There is effective treatment once a child is diagnosed. 

The increased prevalence of ADHD in low income children over the past decade is very interesting.   We think it has to do primarily with better opportunities among this population to get diagnosed through increased access to healthcare and increased recognition of the condition by parents, teachers, and doctors.

I wonder what we know about rates of diagnosis in racial groups and, not unrelated, what we know about diagnosis and family income?

The patterns of ADHD prevalence by race and family income over the past decade are interesting.  At the beginning of the decade, non-Hispanic white children had higher ADHD prevalence than other race groups.  By the end of the decade, non-Hispanic black children and Puerto Rican children had caught up to non-Hispanic white children so that they all had about 10% prevalence of ADHD.  Mexican children, however, had lower ADHD prevalence throughout the decade and had about 4% ADHD prevalence at the end of the decade.  We don't have the data from the National Health Interview Survey to understand exactly why these difference exist or why the patterns have changed over the past decade, but as said above, it may have to do a lot with the opportunities of different groups to obtain a diagnosis.  The diagnosis actually takes many steps and requires continued evaluation.  Ideally, a family will have a sustained relationship with the health care provider guiding through the process.

For income, the pattern also changed through the decade where all income groups had similar prevalence at the beginning of the decade, but prevalence rose steadily for low income children.  At the end of the decade, children with family income below 200% of the federal poverty level had higher prevalence of ADHD compared with children with family income above 200% of the poverty level.  Again, this may be due to changing access to healthcare, or better recognition of the condition among low income children.

My daughter was diagnosed iwth ADHD in the second grade (after spending most of the first grade in the hall). After trying a modified diet and behavioural therapy we finally agreed to drug therapy which has been moderately successful. What is the prevalence of ADHD in girls and what are the long-term outcomes for girls as a group diagnosed with ADHD.

Oh, sorry about all the hallway time!  The prevalence in girls (5.5%)  is lower than in boys (12.3%), and this has been consistent over time--prevalence in boys and girls has grown over the past decade at about the same rate.

Girls are more likely to have the inattentive symptoms rather than the hyperactive symptoms, but it varies from individual to individual.  And while the prognosis for children with ADHD is lower academic achievement and socialization problems, this varies from person to person.  The noteworthy risk is higher incidence of automobile accidents as teenagers.   It is great that you have already started with behavioral therapy.  Coping skills in staying organized and establishing a routine are wonderful tools to help your daughter successfully navigate her way.  And your  staying engaged in her childhood to help her make good choices will also be key.  And don't be shy about helping her become a safe driver:) 

Probably 100% of our woman took birth control pills one time or another. Has there ever been a connection let alone a long term study to connect the pill to our children's chronic ailments?

 I am not aware of any theories or studies linking contraception to ADHD or other chronic conditions. 

I am curious what the percentage of European children diagnosed with ADD and ADHD is. Do you have this data? I have brought 2 children up in New York with one being diagnosed when he was about 6. He is now 16 and living in Europe and doctors there say he is a perfectly normal child. Is there a case of over diagnosis in the US?

I don't have a recent estimate of ADHD in European countries, but there have been studies in the past that suggest that on a population level, the prevalence of ADHD in other countries is similar to that in the US.

I can't really comment on the 16 year old living in Europe, except to suggest that perhaps he has learned to cope with the symptoms and could look a lot different than when he was 6 years old.  Also, in some people, the symptoms do seem to abate with age.  Or perhaps he is eating some wonderful Belgium chocolate.  That cures all ills...

OK, enough of chocolate reverie--I don't have the data to be able to comment on whether ADHD is over-diagnosed in the US.  But I will say that the established diagnostic criteria is specific, it requires the symptoms to be present at a young age, that the symptoms be persistent for at least 6 months, and that the symptoms be present in multiple settings.  It shouldn't be a diagnosis made at one point in time, but after some in-depth assessment.  

In sum, you may have a good idea for some additional research.

What I find fascinating about the increase in diagnosis in low-income children, and in racial/ethnic minorities, is suggested by one of your answers. Ideally, diagnosis is a multi-step process that requires continuity of contact with a health care professional, who is consulting with the child, the parents, and the school. It seems unlikely to me that kind of care is available to low-income children than to middle- and high-income children. I wonder if what we are also seeing is a decline in the quality of the diagnostic process. Maybe low-income kids are getting diagnosed more now because doctors are increasingly willing to cut corners to make the diagnosis.

That is one possible theory, and healthcare quality and its variation by setting is a complex realm.  But I will say that even if true, I think it is unlikely on its own to explain the very large increase in ADHD prevalence among non-Hispanic black and Puerto Rican children. 

How does race play a factor in ADHD?

This is a great, and perhaps thorny question.  For many health conditions, race and ethnicity has been recognized to be associated with prevalence and outcome.  However, with the interventions and research geared toward reducing racial disparities, it is better understood that this relationship is complex.  There are many other related factors, such as income level, place of residence, culture, health habits, etc. that are related both to race and to health.  What we do know about ADHD is that prevalence has increased greatly among some groups of minority children, that children with ADHD require more health care and education resources than children without ADHD, and thus this pattern in ADHD likely has implications for future efforts to address racial disparities.

Have there been any studies evaluating whether ADHD and IQ are correlated?

I wish I could answer definitively.  I do know that children with ADHD can have the whole range of IQ, and that high IQ isn't protection against being diagnosed with ADHD.  I haven't seen studies that assess if the two are systematically linked--but they may be out there.

Thank you everyone for the thoughtful questions.  Enjoy the rest of summer.  Lara

In This Chat
Lara Akinbami
Lara Akinbami is a Medical Officer with the National Center for Health Statistics, CDC located in Hyattsville, MD. She is a board-certified pediatrician and conducts epidemiologic research on child health and chronic conditions, and focuses on childhood asthma.
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