Hispanic children are less likely to be diagnosed with attention deficit and hyperactivity disorder during primary care visits than white or black children are, according to a new study that looks at children's physician visits nationwide.
Primary care treatment for children's ADHD also varies regionally, according to the report in the Journal of Developmental and Behavioral Pediatrics. Children of all ethnic backgrounds who live in the South and West are more likely to be prescribed medications like Ritalin and Adderall during their primary care visits, compared with their peers in the Northeast.
Jack Stevens, Ph.D., a psychologist with Columbus Children's Hospital and an assistant professor in the Department of Pediatrics at Ohio State University and colleagues say the low rate of ADHD diagnoses among Hispanic children may be influenced by a number of factors, including language barriers and different cultural attitudes about child behavior.
For instance, Hispanic parents may not think their children's ADHD symptoms are a problem to be discussed with a doctor, according to the researchers. Previous studies indicate that Mexican-American mothers who have little experience with American culture are less likely to describe their children as having ADHD symptoms than more acculturated Latina mothers are.
These mothers may also be more wary of treating their children's behavioral problems with drugs, according to new research by Emily Arcia, Ph.D., of Mt. Sinai Medical Center and colleagues, published in the same issue of the Journal of Developmental and Behavioral Pediatrics.
Physician bias might also explain differences in ADHD diagnosis, Stevens says.
"Health care providers may more readily dismiss these [ADHD] complaints if they are mentioned by Hispanic-American parents than if they are mentioned by white-American parents," he suggests.
It is also possible that "ADHD symptoms might occur less frequently in Hispanic-American youths compared with their white-American counterparts," Stevens says, although surveys of student behavior reported by teachers do not bear this out.
The researchers found no ethnic differences in whether children were prescribed medication for the disorder once it had been diagnosed.
Regional differences in ADHD drug prescriptions are probably the result of the greater number of child psychiatrists in the Northeast, say Stevens and colleagues. In this region, children diagnosed with ADHD during primary care visits may be more likely to be referred to a psychiatrist who eventually prescribes medication.
The study included data from children's primary care visits in private practices and hospitals around the country from 1995 to 2000. The study included children ages 3 to 18, but most prescriptions for ADHD medication were given to children 8 to 12 years old.
Other researchers have uncovered ethnic differences in mental health care for adults, but "unfortunately, ethnic differences in childhood mental health have received little attention, particularly in regards to attention-deficit hyperactivity disorder," Stevens says.