Black individuals at higher risk for ADHD vs. general population

Black individuals appeared at higher risk for ADHD diagnoses compared with the general U.S. population, according to results of a systematic review and meta-analysis published in JAMA Psychiatry.

“Despite the paucity of primary studies and the availability of only one systematic review that used data from African American persons and found a higher prevalence of ADHD among Black children than among white youth, the DSM-5 states that the frequency of ADHD tends to be lower among Black youth than among white youth in the United States,” Jude Mary Cénat, PhD, of the School of Psychology at the University of Ottawa in Canada, and colleagues wrote. “Moreover, studies conducted on the prevalence of ADHD among Black individuals have shown a wide range of results. Whereas some studies assessing Black individuals have found a prevalence of ADHD of less than 5%, others have found a prevalence of more than 20%.”

Although several factors, including racial issues, may partially explain the variability observed in ADHD prevalence among Black individuals, there remains an overall lack of knowledge regarding the role of specific risk factors in this association. Further, the investigators noted a need for reliable data to create evidence-based and adapted programs to address this disparity.

In the current study, Cénat and colleagues sought to calculate a pooled prevalence estimate of ADHD, and determine social, familial and individual factors linked to ADHD among Black individuals. They searched seven databases for peer-reviewed studies published in English or French that included empirical data on ADHD prevalence among samples or subsamples of Black people and that were conducted in countries with Black minority populations. They included 24 independent samples and subsamples from 21 studies published between 1979 and 2020 that had data of 154,818 Black participants. Included studies were conducted in the U.S. Two assessed adults, eight assessed children, one assessed adolescents and 13 assessed both adolescents and children.

Results showed a pooled ADHD prevalence of 14.54% (95% CI, 10.64-19.56). A narrative review of the included studies revealed that certain studies showed risk factors linked to ADHD, including sociodemographic characteristics (e.g., age, race, socioeconomic status and sex), risk behaviors, familial factors and environmental factors; however, the data did not allow for a moderation analysis to assess these findings in the current study.

“Although there is still much work to be done to better understand these data and to study the barriers associated with culturally appropriate ADHD diagnoses and care for Black individuals, the present study provides important insights for both research and clinical practice,” the authors wrote. “It offers key avenues to consider the reduction of disparities associated with ADHD diagnoses among Black individuals. These considerations include research that can help to establish accurate diagnoses and culturally appropriate care for Black youth with ADHD symptoms. We believe that such efforts should be the responsibility of each researcher and clinician working with youths.”