Racial/ethnic disparities in attention-deficit/hyperactivity disorder in kindergarten: Evidence from a nationally-representative cohort

Background: Racial/ethnic disparities in ADHD diagnosis are known to occur in school-aged populations, but whether and to what extent these disparities occur as early as kindergarten is unknown. This study investigates racial/ethnic disparities in the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in a nationally-representative cohort of kindergarten children. Methods: Data from the Early Childhood Longitudinal Study-Birth Cohort (N=6,550) were analyzed using descriptive statistics and multivariate regressions to identify 24-month socio-demographic, gestational, birth, and other characteristics predictive of parent-reported ADHD diagnosis by 60 months. Results: Black children were 66% less likely to receive an ADHD diagnosis than Whites, controlling for confounding factors. Unadjusted analyses showed Hispanic children to be under-diagnosed for ADHD; their disparity was explained in multivariate analyses by whether a language other than English was primarily spoken in the home. Follow up analyses of kindergarten teacher-reported classroom behavior indicated that neither Blacks nor those primarily speaking a language other than English in the home displayed less frequent ADHD-related symptomology than Whites. Conclusions: Children who are Black or who primarily speak a language other than English at home are less likely to be diagnosed with ADHD, but are not less likely to display ADHD symptomology. Because these children appear to have unmet treatment needs, there should be increased focus on culturally-sensitive screening in these subpopulations.