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Attention deficit-hyperactivity disorder (ADHD) diagnoses were more common in Black people than for people of other races/ethnicities, a meta-analysis found.

In 21 U.S. studies conducted from 1979-2020, the pooled prevalence of ADHD was 14.54% for Black adults and children and 13.87% for Black children only, reported Jude Mary Cénat, PhD, of the University of Ottawa in Canada, and colleagues in

In contrast, estimates for in children and are lower in adults.

Cénat's group found that experiencing the death of a loved one or other adverse experiences, reporting risk behaviors, having a lower socioeconomic status, and things like preterm birth and in utero drug exposure were all risk factors for ADHD among Black youth.

However, the meta-analysis did not directly compare Black patients with patients of other races/ethnicities, and the authors did not measure the extent to which various risk factors influenced the elevated ADHD prevalence among Black children, which are limitations, they added.

"These results show that Black individuals face the same risk factors for ADHD diagnoses as other individuals," Cénat and co-authors wrote. "However, aspects related to the intersection of race, low [socioeconomic status], racial marginalization and discrimination, and racist microaggressions may exacerbate the symptoms of ADHD."

Historically, have been reported for African-American children.

Underdiagnosis by race might represent a lack of access more so because many studies rely on parent-reported diagnosis, commented Ami Bax, MD, of the University of Oklahoma Health Sciences Center in Oklahoma City, who was not involved in this research. Bax cited that found no difference by race in the number of children meeting ADHD criteria with the Diagnostic and Statistical Manual of Mental Disorders (DSM), but that children of color had less access to care compared with white children.

More recent CDC data aligned with the present study and found that than white children or Hispanic children (16.9% vs 14.7% and 11.9%, respectively).

Because most ADHD diagnoses are made by teacher and parent symptom rating, they could be subject to biases, Bax said.

"When you look at studies from three or four decades ago, many teachers would report higher symptoms in Black versus white children, which makes it challenging to understand whether [the discrepancy] is because of differing perceptions in the reporter, or truly a difference in the actual behaviors," Bax told 番茄社区app.

Cénat stressed the importance of developing culturally sensitive ADHD diagnostic tools for Black youth.

"We cannot continue to diagnose ADHD in Black communities with tools that are not culturally appropriate," Cénat told 番茄社区app. "We continue to give medications with known side effects, based on a biased diagnosis."

Cénat noted that high socioeconomic status was a protective factor against ADHD among white, but not Black, children, which, "may be associated with diminished returns specific to Black individuals that may be explained by racial discrimination, racism, stress, and the greater effort made by Black individuals to access social mobility."

However, in Bax's study, high socioeconomic status was protective for all children, including African-American children, she said.

On the other hand, low socioeconomic status has been documented as a risk factor for ADHD among all children. However, it is also associated with less access to ADHD diagnosis and treatment, Bax said. There is also some evidence that children with Medicaid may have better access to diagnoses and treatment than both children who are uninsured and privately insured, she added.

"We have a lot more work to do and need to continue investigating whether socioeconomic status is contributing more or less in children of different races," Bax said.

For the meta-analysis, Cénat's group included French or English language studies conducted in Canada and the U.S. that had empirical data on ADHD prevalence among Black people. The researchers did not find any published studies in countries other than the U.S. that met these criteria, perhaps due to "color-blind" research policies.

The cumulative sample size was 154,818, although this varied widely across the 21 studies included, from 36 in a to 34,411 in a Most studies measured ADHD prevalence in youth, but one study examined diagnoses among college students and another in adults. Two studies looked specifically at youth in the juvenile justice system, and one involved only economically disadvantaged families.

Overall, the prevalence of ADHD among Black patients varied widely across studies, from 3% to 58%,. As in the general population, boys were more commonly diagnosed with ADHD than girls.

Although the included studies were highly heterogeneous, Cénat and colleagues found no evidence of publication bias in the meta-analysis.

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