Los Angeles—Research leaves little question that white children are more likely to be treated for attention-deficit/hyperactivity disorder (ADHD) than African-American or Latino children.

The question answered by a study published recently in the journal Pediatrics, however, is whether that disparity in diagnosis and medication use is more likely due to under-diagnosis or under-treatment of African-American and Latino children, or if the cause is over-diagnosis or over-treatment of white children.

To do that, a study team led by researchers from Mattel Children’s Hospital and the David Geffen School of Medicine at UCLA used a population-based, multisite sample of 4,297 children and parents surveyed over three waves—fifth, seventh, and tenth grades.

Results indicate that, across all waves, African-American and Latino children, compared with white children, had lower odds of having an ADHD diagnosis and of taking ADHD medication. In determining that, the researchers controlled for sociodemographics, ADHD symptoms, and other potential comorbid mental health symptoms.

Among children with an ADHD diagnosis or symptoms, African-American children had lower odds of medication use at fifth, seventh, and tenth grades, and Latino children had lower odds at fifth and tenth grades. On the other hand, for children who had neither ADHD symptoms nor ADHD diagnosis by fifth grade—and thus would not likely meet ADHD diagnostic criteria at any age—medication use did not vary by race/ethnicity in adjusted analysis.

“Racial/ethnic disparities in parent-reported medication use for ADHD are robust, persisting from fifth grade to 10th grade,” study authors conclude. “These findings suggest that disparities may be more likely related to under-diagnosis and under-treatment of African-American and Latino children as opposed to over-diagnosis or over-treatment of white children.”

A 2013 study in Pediatrics found that 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,” write the Penn State–led researchers in the earlier study.

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