title: Racial and Ethnic Disparities in ADHD Diagnosis and Treatment.
abstract: OBJECTIVE
  We examined racial/ethnic disparities in attention-deficit/hyperactivity disorder (ADHD) diagnosis and medication use and determined whether medication disparities were more likely due to underdiagnosis or undertreatment of African-American and Latino children, or overdiagnosis or overtreatment of white children.
  
  
  METHODS
  We used a population-based, multisite sample of 4297 children and parents surveyed over 3 waves (fifth, seventh, and 10th grades). Multivariate logistic regression examined disparities in parent-reported ADHD diagnosis and medication use in the following analyses: (1) using the total sample; (2) limited to children with an ADHD diagnosis or symptoms; and (3) limited to children without a diagnosis or symptoms.
  
  
  RESULTS
  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, controlling 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 10th grades, and Latino children had lower odds at fifth and 10th grades. Among 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.
  
  
  CONCLUSIONS
  Racial/ethnic disparities in parent-reported medication use for ADHD are robust, persisting from fifth grade to 10th grade. These findings suggest that disparities may be more likely related to underdiagnosis and undertreatment of African-American and Latino children as opposed to overdiagnosis or overtreatment of white children.
authors.affiliation: Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California; RAND, Santa Monica, California; tcoker@mednet.ucla.edu.
authors.forename: Tumaini R
authors.initials: TR
authors.lastname: Coker
authors.affiliation: RAND, Santa Monica, California;
authors.forename: Marc N
authors.initials: MN
authors.lastname: Elliott
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;
authors.forename: Sara L
authors.initials: SL
authors.lastname: Toomey
authors.affiliation: Departments of Psychology and.
authors.forename: David C
authors.initials: DC
authors.lastname: Schwebel
authors.affiliation: Center for Health Promotion and Prevention Research, University of Texas-Houston, School of Public Health, Houston, Texas; and.
authors.forename: Paula
authors.initials: P
authors.lastname: Cuccaro
authors.affiliation: Center for Health Promotion and Prevention Research, University of Texas-Houston, School of Public Health, Houston, Texas; and.
authors.forename: Susan
authors.initials: S
authors.lastname: Tortolero Emery
authors.affiliation: Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama;
authors.forename: Susan L
authors.initials: SL
authors.lastname: Davies
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Susanna N
authors.initials: SN
authors.lastname: Visser
authors.affiliation: RAND, Santa Monica, California; Division of General Pediatrics, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schuster
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000188:drug therapy*; D002648:Child; D015331:Cohort Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D044469:Racial Groups / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology