Section on Developmental and Behavioral Pediatrics, Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
Department of Psychiatry, College of Medicine, University of Florida, Jacksonville, FL.
J Dev Behav Pediatr. 2019 Feb/Mar;40(2):81-91. doi: 10.1097/DBP.0000000000000626.
Assessing race/ethnicity and socioeconomic status (SES) relationships with Attention-Deficit/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.
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.
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).
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.
评估种族/民族和社会经济地位（SES）与注意力缺陷/多动障碍（ADHD）诊断、治疗和获得治疗的关系，其结果不一致，这往往仅基于父母报告。相比之下，本研究使用更广泛的 ADHD 诊断确定方法，包括病例定义，在多地点小学基础样本中检查这些关系。
根据父母和教师报告的《精神疾病诊断与统计手册》（DSM）标准，对患有和不患有 ADHD 的儿童进行二次分析，通过简单的单变量/多变量模型，在父母报告的诊断、药物治疗和符合 ADHD 研究病例定义内和跨内评估 SES、种族/民族和其他变量。
总样本包括 51.9%的男性、51.3%的白人，53.1%的人有私人保险；10%的儿童有父母报告的 ADHD 诊断，而 8.3%的儿童符合 ADHD 研究病例定义。在多变量模型中，白人儿童被诊断为父母报告的 ADHD 的可能性高于黑人、西班牙裔和其他种族/民族的儿童（p<0.05），但只有西班牙裔儿童被诊断为阳性的可能性较低（<0.05）；单亲家庭的男孩和儿童被诊断为阳性的可能性更高（p<0.05）；白人、男性和有医疗保险的儿童服用药物的可能性更高（p<0.05）。在被诊断为阳性的儿童中，那些有医疗补助、白人、双亲家庭状况的儿童被诊断为阳性的可能性更高（p<0.05）。
如果患有潜在 ADHD 的儿童是白人、男性、有医疗保险（特别是医疗补助）且生活在双亲家庭中，他们更有可能获得评估/药物治疗。虽然男孩和由单亲父母抚养的儿童可能有更高的 ADHD 诊断率，但假阳性诊断风险似乎也更高，需要进一步调查。
