Far too many people of color still believe that our children are over-diagnosed and over-medicated for ADHD. They believe that giving our children ADHD medication means we are not capable of disciplining them, so we use pills to control them.

At the same time, many clinicians and education professionals still perceive ADHD as a disorder of little white boys and attribute the very same behaviors in Black children as seriously problematic, with no thought that ADHD might be the issue. This mindset continues to inflict serious consequences on Black children.

[Sign Up: The Clinicians’ Guide to Differential Diagnosis of ADHD]

Welcoming Clinicians of Color

One of the most impactful and important changes of the last 25 years is that we finally have some treating professionals who look like us and sound like us; not nearly enough, but some. This makes a tremendous difference in understanding, diagnosing, and treating ADHD in our communities. We are much more likely to trust doctors and other mental health professionals who we feel at least partially understand us and can relate to our experiences. We now have African-American and other coaches of color who were not available a generation ago. Given the importance of coaching, especially for teens and adults with ADHD, this is a huge positive change.

More adults today not only acknowledge and embrace their diagnosis, but actually celebrate it through advocacy and public-facing activities. African-American and Latinx men and women have launched Facebook pages, virtual support groups, blogs, and podcasts in which they address the challenges of, and solutions to, living with ADHD. Aside from bringing ADHD “out of the closet,” these advocates help reduce the stigma around the disorder and give hope to many with ADHD who have felt isolated and alone.

In some ways, we’ve been fighting the same battle for the 30 years of my career as an ADHD advocate. But we also have made great progress around neurodivergence in communities of color.

Let’s work together to make giant strides for the next 25 years!

Advocating for Diversity in ADHD Care: Next Steps

• Download: Step Up and Speak Out About ADHD
• Watch: Scrutinizing Barriers to Health Equity, Diagnosis, & Treatment
• Read: The History of ADHD and Its Treatments
• Read: Cultural Considerations for Clinicians

Evelyn Polk Green, M.Ed., is a past president of the Attention Deficit Disorder Association (ADDA) and Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD).

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ADHD (attention deficit hyperactivity disorder) is a neurological disorder that impacts the parts of the brain that help us plan, focus on, and execute tasks.

Nearly 1 in 22 American adults have ADHD, which is characterized by a persistent pattern of inattention, hyperactivity, and/or impulsivity that interferes with and impacts work, home life, and relationships — especially if left untreated. ¹

Historically, it was considered a childhood condition, but ADHD is now recognized as a lifelong condition that persists well into adulthood. In fact, according to research published in American Journal of Psychiatry and JAMA Network Open, ADHD diagnoses among adults are growing four times faster than ADHD diagnoses among children in the U.S. (26% increase among children vs. 123% among adults from 2007 to 2016). ¹,²

However, fewer than 20% of adults with ADHD are accurately diagnosed and treated.³, ⁴

In this download, you will learn the following:

• How many adults worldwide have ADHD
• How many adults with ADHD are accurately diagnosed and treated
• How many adults diagnosed with ADHD have a comorbid condition
• The most prevalent comorbid conditions among adults with ADHD
• The ADHD diagnosis rates among adults of all races and ethnic groups
• And much more!

NOTE: This resource is for personal use only.

Sources

¹ Kessler, R.C., Adler, L., Barkley, R., Biederman, J., Conners, C.K., Demler, O., Faraone, S.V., Greenhill, L.L., Howes, M.J., Secnik, K., Spencer, T., Ustun, T.B., Walters, E.E., & Zaslavsky, A.M. (2006). The Prevalence and Correlates of Adult ADHD in the United States: Results From the National Comorbidity Survey Replication. American Journal of Psychiatry. 163(4). doi:10.1176/ajp.2006.163.4.716

² Chung, W., Jiang, S. F., Paksarian, D., Nikolaidis, A., Castellanos, F. X., Merikangas, K. R., & Milham, M. P. (2019). Trends in the Prevalence and Incidence of Attention-Deficit/Hyperactivity Disorder Among Adults and Children of Different Racial and Ethnic Groups. JAMA Network Open. 2(11), e1914344. doi:10.1001/jamanetworkopen.2019.14344

³Barkley, R.A., Brown, T.E. (2008). Unrecognized Attention-Deficit/Hyperactivity Disorder in Adults Presenting with Other Psychiatric Disorders. CNS Spectrums. 13(11):977–984. doi: 10.1017/S1092852900014036

⁴Katzman, M.A., Bilkey, T.S., Chokka, P.R., Fallu, A., & Klassen, L.J. (2017). Adult ADHD and Comorbid Disorders: Clinical Implications of a Dimensional Approach. BMC Psychiatry. doi: 10.1186/s12888-017-1463-3

ADHD is routinely under-diagnosed in African-American children due to myriad factors, including structural inequalities in medical care and schools across the U.S. But even when ADHD is diagnosed in African-American children, it often goes untreated due to the cultural misconceptions and stigma about the disorder — and a deep distrust of the medical community — by people of color.

When ADHD is untreated in children, the risk for poor outcomes in academic and social settings increases. This is why proper diagnosis and treatment is critical for children of color. It is imperative that clinicians understand the cultural differences regarding how ADHD is perceived by Black and minority families, and use effective practices that influence appropriate treatment responses and behaviors. It is equally important that minority families understand why the diagnosis and treatment of ADHD in children is so important — and how it is tied to a child’s success.

In this webinar, clinicians, educators, and caregivers will learn:

• Why the stigma and cultural misconceptions around ADHD impede proper treatment by families of color
• How to bust common ADHD myths and get to the root of the problem
• About strategies to assess and treat ADHD that align with cultural beliefs and values of minority families
• How clinicians, educators, and caregivers can apply evidence-based practices to a clinical, educational, and home environment

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

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Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Google Podcasts; Stitcher; Spotify; Amazon Music; iHeartRADIO.

More on ADHD in Families of Color

• Download: Debunking Myths About ADHD
• Read: How Children of Color Get Left Behind
• Read: “I am a Neurodivergent Black Woman — and I am Filled with Hope.”

Obtain a Certificate of Attendance

If you attended the live webinar on July 13, 2023, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker:

Cheryl Hamilton, Ed.D., LPC-S, NCC, RPT-S, ADHD-CCSP, IPT-CST, is the Executive Director of Hamilton Counseling and Consulting in Duncanville, Texas.

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In short, study after study shows that ADHD is a significant risk factor while operating a motor vehicle — and that is a serious public health issue.

The good news: Research also clearly indicates that ADHD medication greatly improves driving performance. But there’s still more to be done to understand the underlying reasons and mechanisms for risky driving, and the interventions that enhance safety. Sensitive, high-tech driving simulators, which allow us to observe behaviors behind the wheel, are proving essential for continued research in a safe environment. But they do little good if clinicians don’t communicate to patients — especially to teenagers and young adults — the risks associated with ADHD and driving,  and the importance of taking medication to improve driving safety.

ADHD and Driving: What Behaviors Increase Risk?

Driving is a multidimensional activity, involving many cognitive abilities and executive functions. The underlying impairments inherent to ADHD – including inattention, impulsivity, and difficulty concentrating and resisting distractions – are thought to interfere with driving and contribute to adverse outcomes.² But research has yet to fully answer the question of just how ADHD impairs driving, and which susceptibilities specifically lead to problems on the road.

[Get This Free Download: What Are Your Teen’s Weakest Executive Functions?]

Still, there’s no doubt that ADHD is associated with adverse driving outcomes, as shown by the following findings replicated across multiple studies:

• Compared to drivers without ADHD, significantly more drivers with ADHD
  • drive without a license
  • have a license revoked or suspended
  • have multiple crashes
  • have multiple traffic citations, especially for speeding.³
• Drivers with ADHD are more likely than drivers without ADHD to rate themselves poorly on driving habits.³
• Drivers with ADHD are more likely than drivers without ADHD to be legally at fault for traffic incidents.⁴
• Drivers with ADHD experience more severe crashes and are more likely to be killed in a car crash than drivers without ADHD.^{5 6}
• Adolescents, more than any other age group, are at a high risk for motor vehicle crashes.⁷ Within this group, teen drivers with ADHD are at a greater risk than their non-ADHD peers of crashing.^{1 8}

ADHD and Driving: Are Safety Risks Treatable?

The Road to Better Research

Research indicates that ADHD medication – stimulants in particular – may improve driving safety and mitigate risk for drivers with ADHD.

We first learned of the potential benefits of stimulant medication on drivers with ADHD from early studies involving driving simulations and self-reports.⁹ Though informative, the results of these initial studies were difficult to interpret, given limited information on the validity of the driving simulators used and the usefulness of some outcome variables chosen for these studies. It was difficult to ascertain from these studies what improvement in driving actually meant or entailed. Also unclear from these studies was the extent to which the proven clinical effects of ADHD medication would generalize to driving impairments.

A Refined Driving Simulator

In a joint effort between researchers from Massachusetts General Hospital (MGH) and Massachusetts Institute of Technology (MIT), we developed and validated a driving simulator to assess the aspects of ADHD that could account for driving impairments.¹⁰ The simulation – done in a real vehicle with a virtual roadway projected on a large, single screen – tests driving under various environments (urban, rural, highway), under differing stimulus intensity (active and monotonous), and while performing other tasks (e.g., driving while having a cellphone conversation).

[Read: Stop Distracted Driving with These Safety Tips]

Our simulator validation studies showed that drivers with ADHD were more likely than controls to crash into a surprise obstacle while driving under a monotonous, low-stimulus condition for an extended period.¹⁰ This finding supports the idea that inattention is a key moderator of impaired driving in ADHD, and that individuals with ADHD have difficulties remaining alert while driving without stimulation. Simulator studies also show, as indicated in self-assessments, that drivers with ADHD are more likely than drivers without ADHD to speed, to pass and weave through traffic, and to get into accidents.¹¹

ADHD Medication and Driving

With a validated simulator, we next assessed the effects of a stimulant (lisdexamfetamine) on driving performance in young adults with ADHD versus a placebo.¹² We tested young adults specifically because this group, as we know, is at the highest risk for driving accidents and infractions in general.

In our study, participants drove twice through a 43-mile virtual roadway of varying stimulus conditions and environments. The second simulation, unlike the first, featured five surprise events (including the appearance of cyber dogs and oncoming vehicles). Analysis showed that the medicated group reacted faster to these surprise events – 9.1% faster, on average – than did the placebo group.¹² Furthermore, during the surprise events, drivers in the medicated group were 67% less likely to have a collision than were drivers in the placebo group.¹²

What does that mean in the real world? Assuming a driving speed of 65 mph, the reaction time translates to 131 feet and 120 feet for the unmedicated and medicated group, respectively. The additional 11 feet that an unmedicated driver travels could translate to serious, even deadly consequences.

These results suggest that lisdexamfetamine, which we could extrapolate to stimulants, may be useful in clinical practice to help reduce driving risks facing young adults with ADHD. These findings – that medication improves driving performance in individuals with ADHD – have been replicated across other studies as well.⁶

Despite discernible differences in driving performance between medicated and unmedicated drivers, it is important to note that we did not see any association between clinical improvement in ADHD symptoms and driving simulation outcomes in our 2012 study. In other words, lisdexamfetamine was associated with faster reaction time and a lower likelihood of having a collision independently of the clinical effects of ADHD medication. What this means is that we cannot assume that a medication that provides benefits in ADHD symptoms will also provide benefits in driving outright. We need to specifically test the effect of ADHD medication during driving to study its potential benefits.

ADHD and Driving: Clinical Implications

Given what we know about ADHD and driving, and the benefits of medication on driving performance, it is critical for clinicians to educate patients and their families – especially if a patient is a teen or a young adult – about the importance of safe driving.

In my practice, I do not try to discourage anybody from driving. Instead, I have discussions with patients who are just beginning to drive about the seriousness of having a deadly weapon at their control, the meaning of safe driving, and the importance of being medicated – for ADHD in general and while driving. For families that stop ADHD treatment on weekends and during “downtime,” I emphasize the importance of driving only while medication is active. Patients and families must consider driving time relative to when medication is taken. A short-acting medication taken about half an hour before hitting the road may just be life-saving.

ADHD and Driving: Conclusions

From traffic citations to serious crashes, drivers with ADHD – especially if unmedicated – are more likely than drivers without ADHD to experience adverse driving outcomes. Researchers are still trying to understand the specific aspects of ADHD that contribute to unsafe driving, though it is likely that symptoms of inattention, like mind wandering and difficulty sustaining focus, are important factors. Validated simulators are useful for studying driving behaviors in this population and continue to be refined to model a realistic driving experience and improve the quality of research.

Many studies, including ours, show that stimulants reduce driving risk and improve safety for individuals with ADHD – findings that carry major public health relevance, considering the high risk of crashes associated with the condition. In practice – and as we continue to study just how medication improves driving behaviors – clinicians must educate young patients and their families about the risks, and of the importance of driving while on medication.

ADHD and Driving: Next Steps

• Read: My Brother Died in a Car Crash Because of His ADHD
• Download: Boost Your Teen’s Executive Functions
• Read: How to Steer Your Teen Toward Safe Driving
•  Read: “I’m Too Distracted When I Drive”

The content for this article was derived with permission from “The Effects of Lisdexamfetamine Dimesylate on the Driving Performance of Young Adults with ADHD,” presented by Joseph Biederman, M.D., at the APSARD 2022 Annual Conference.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Curry, A. E., Yerys, B. E., Metzger, K. B., Carey, M. E., & Power, T. J. (2019). Traffic Crashes, Violations, and Suspensions Among Young Drivers With ADHD. Pediatrics, 143(6), e20182305. https://doi.org/10.1542/peds.2018-2305

²Barkley R. A. (2004). Driving impairments in teens and adults with attention-deficit/hyperactivity disorder. The Psychiatric Clinics of North America, 27(2), 233–260. https://doi.org/10.1016/S0193-953X(03)00091-1

³ Barkley, R. A., Murphy, K. R., Dupaul, G. I., & Bush, T. (2002). Driving in young adults with attention deficit hyperactivity disorder: knowledge, performance, adverse outcomes, and the role of executive functioning. Journal of the International Neuropsychological Society : JINS, 8(5), 655–672. https://doi.org/10.1017/s1355617702801345

⁴ Aduen, P. A., Kofler, M. J., Cox, D. J., Sarver, D. E., & Lunsford, E. (2015). Motor vehicle driving in high incidence psychiatric disability: comparison of drivers with ADHD, depression, and no known psychopathology. Journal of psychiatric research, 64, 59–66. https://doi.org/10.1016/j.jpsychires.2015.03.009

⁵ Chang, Z., Lichtenstein, P., D’Onofrio, B. M., Sjölander, A., & Larsson, H. (2014). Serious transport accidents in adults with attention-deficit/hyperactivity disorder and the effect of medication: a population-based study. JAMA psychiatry, 71(3), 319–325. https://doi.org/10.1001/jamapsychiatry.2013.4174

⁶ Aduen, P. A., Cox, D. J., Fabiano, G. A., Garner, A. A., & Kofler, M. J. (2019). Expert Recommendations for Improving Driving Safety for Teens and Adult Drivers with ADHD. The ADHD report, 27(4), 8–14. https://doi.org/10.1521/adhd.2019.27.4.8

⁷ Insurance Institute for Highway Safety. (March 2021). Fatality Facts 2019 Teenagers. Retrieved February 23 from https://www.iihs.org/topics/fatality-statistics/detail/teenagers

⁸ Curry, A. E., Metzger, K. B., Pfeiffer, M. R., Elliott, M. R., Winston, F. K., & Power, T. J. (2017). Motor Vehicle Crash Risk Among Adolescents and Young Adults With Attention-Deficit/Hyperactivity Disorder. JAMA Pediatrics, 171(8), 756–763. https://doi.org/10.1001/jamapediatrics.2017.0910.

⁹ Barkley, R. A., & Cox, D. (2007). A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance. Journal of Safety Research, 38(1), 113–128. https://doi.org/10.1016/j.jsr.2006.09.004

¹⁰ Biederman, J., Fried, R., Monuteaux, M. C., Reimer, B., Coughlin, J. F., Surman, C. B., Aleardi, M., Dougherty, M., Schoenfeld, S., Spencer, T. J., & Faraone, S. V. (2007). A laboratory driving simulation for assessment of driving behavior in adults with ADHD: a controlled study. Annals of General Psychiatry, 6, 4. https://doi.org/10.1186/1744-859X-6-4

¹¹ Reimer, B., D’Ambrosio, L. A., Coughlin, J. E., Kafrissen, M. E., & Biederman, J. (2006). Using self-reported data to assess the validity of driving simulation data. Behavior Research Methods, 38(2), 314–324. https://doi.org/10.3758/bf03192783

¹² Biederman, J., Fried, R., Hammerness, P., Surman, C., Mehler, B., Petty, C. R., Faraone, S. V., Miller, C., Bourgeois, M., Meller, B., Godfrey, K. M., & Reimer, B. (2012). The effects of lisdexamfetamine dimesylate on the driving performance of young adults with ADHD: a randomized, double-blind, placebo-controlled study using a validated driving simulator paradigm. Journal of Psychiatric Research, 46(4), 484–491. https://doi.org/10.1016/j.jpsychires.2012.01.007

People with attention deficit hyperactivity disorder (ADHD or ADD) or autism spectrum disorder (ASD) face higher mortality risks than does the general population, according to a new meta-analysis published in the journal JAMA Pediatrics.¹ The study found that death in childhood or midlife from natural or unnatural causes was twice as likely for people with ADHD or autism, compared to the general population.

The systematic review and meta-analysis examined 27 studies published between 1988 and 2021, including data on more than 642,000 participants from North America and Europe. When causes of death were examined, ADHD and ASD were associated with higher mortality due to unnatural causes such as injury, poisoning, or suicide. Only people with ASD experienced reduced life expectancy due to natural causes of death.

“Most of the ADHD-related factors impacting life expectancy — impulsivity, risky behavior, and inattention, to name a few — are changeable,” says Russell Barkley, Ph.D., who lead a 2019 ADDitude webinar titled “How ADHD Shortens Life Expectancy.” “Behavioral programs designed to improve overall health will improve life expectancy as well, but only if ADHD symptoms are under control first. And that requires more accurate diagnosis and more thoughtful treatment.”²

Understanding the mechanisms of these associations may lead to targeted strategies to prevent avoidable deaths in high-risk groups of children and young people, the researchers suggest. Needed are future studies examining mortality-related health estimates in persons with ASD or ADHD that further explore distinct populations such as girls, people of color, and patients with additional comorbidities.

Sources

¹Catalá-López F, Hutton B, Page MJ, et al. (2022). Mortality in Persons with Autism Spectrum Disorder or Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis. JAMA Pediatr. https://doi.org/10.1001/jamapediatrics.2021.6401

²Barkley, R. A., & Fischer, M. (2019). Hyperactive Child Syndrome and Estimated Life Expectancy at Young Adult Follow-Up: The Role of ADHD Persistence and Other Potential Predictors. Journal of attention disorders, 23(9), 907–923. https://doi.org/10.1177/1087054718816164

Just 19% of American youth diagnosed with ADHD are receiving medication treatment, according to a review and meta-analysis published in The Journal of Attention Disorders.¹ Findings from the study suggest that, for every overtreated or improperly treated American youth, there are three more undertreated youths with ADHD.

The study rose from a debate over whether pharmacological treatment for youths with ADHD is overused or underused in the U.S. Researchers screened more than 25,000 potentially relevant studies, and retained 36 studies of 104,305 individuals. Using the 18 studies that met the main analysis criteria (that diagnosis was established using DSM criteria or validated rating scales, and not parental report), researchers identified three groups:

1. Youth with ADHD who were receiving medication treatment
2. Youth with ADHD who were not receiving medication treatment
3. Youth without ADHD who were receiving medication treatment

Across the studies, pharmacological treatment rates were 19.1 % and 0.9 % in school-age children/adolescents with and without ADHD, respectively. Essentially, more than 80% of youth diagnosed with ADHD were not being treated with medication.

In an A.D.D. Resource Center blog post on the study, David Rabiner, Ph.D. reflects that “only a minority of children and teens with ADHD receive medication treatment for the condition,” and it is,“reasonable to conclude that undertreatment is substantially more common than overtreatment. Given concerns that ADHD medication is frequently prescribed to youth without ADHD, finding that this is relatively uncommon (under 1%) is reassuring.”²

Sources

¹ Massuti et al. Assessing under-treatment and over-treatment of ADHD medications in children and adolescents across continents: A systematic review and meta-analysis. Neuroscience and Behavioral Reviews, 128, 64-73. (2021). https://www.sciencedirect.com/science/article/abs/pii/S0149763421002396

² Rabiner, David. The Over and Under Use of ADHD Medication Treatment. The A.D.D. Resource Center. (Jan. 2022). https://www.addrc.org/the-over-and-under-use-of-adhd-medication-treatment/

Most children with ADHD won’t outgrow the disorder, according to a study published this month in The American Journal of Psychiatry¹ that challenges the widely held notion that ADHD symptoms do not commonly persist into adulthood.

Findings from the study, which followed 558 children with ADHD from the Multimodal Treatment Study of ADHD (MTA) over 16 years, show that only 9.1% of subjects “recovered” from ADHD by the study endpoint, when most participants were about 25 years old.

The study also found that ADHD symptoms wax and wane over time for many individuals who continue to experience the disorder. “The results suggest that over 90% of individuals with childhood ADHD will continue to struggle with residual, although sometimes fluctuating, symptoms and impairments through at least young adulthood,” the researchers wrote.

The findings, according to the authors, depart from the historic conclusion that childhood ADHD persists into adulthood in about 50% of cases^{2 3 4}. “This conclusion is typically based on single endpoints, failing to consider longitudinal patterns of ADHD expression,” the authors wrote.

For the study, researchers examined data on ADHD symptoms, level of impairment, existing comorbidities, and treatment use from the eight assessments the participants underwent as part of the MTA. (Follow-up evaluations took place 2 to 16 years after baseline.) The authors identified participants with fully remitted, partially remitted, and persistent ADHD at each time point. Full recovery was defined as sustained remission across multiple time points until the end of the study in the absence of ADHD treatment.

About 30% of participants experienced full remission at some point in the study, but the majority (60%) experienced a recurrence of ADHD after initial remission. Only about 10% of participants demonstrated stable ADHD persistence across study time points. Overall, about 63% of participants had fluctuating periods of remission and recurrence, which may have been impacted by treatment status at the time.

The authors say that the findings support a more informed perspective on ADHD, especially its tendency to fluctuate in appearance. Clinicians, the authors suggest, can communicate to families that most adolescents and young adults with ADHD experience at least intermittent relief from their ADHD symptoms that may be modulated by treatment and personal or life circumstances.The findings also underscore the importance of continued periodic screening for recurrent symptoms and impairments in patients even after successful treatment.

Sources

¹Sibley, M., Arnold, L, Swanson, J. et.al. (13 August 2021). Variable patterns of remission from ADHD in the multimodal treatment study of ADHD. The American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.2021.21010032 

²Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2002). The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. Journal of Abnormal Psychology, 111(2), 279–289. https://doi.org/10.1037/0021-843X.111.2.279

³ Sibley, M., Mitchell, J., Becker, S. (2016). Method of adult diagnosis influences estimated persistence of childhood ADHD: A systematic review of longitudinal studies. The Lancet Psychiatry, 3(12), 1157-1165. https://doi.org/10.1016/S2215-0366(16)30190-0

⁴Sibley, M. H., Swanson, J. M., Arnold, L. E., Hechtman, L. T., Owens, E. B., Stehli, A., Abikoff, H., Hinshaw, S. P., Molina, B., Mitchell, J. T., Jensen, P. S., Howard, A. L., Lakes, K. D., Pelham, W. E., & MTA Cooperative Group (2017). Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity. Journal of child psychology and psychiatry, and allied disciplines, 58(6), 655–662. https://doi.org/10.1111/jcpp.12620

Sleep problems in children with ADHD contribute to long-term mental health challenges, including anxiety, for their mothers, according to an Australian study recently published in the Journal of Attention Disorders.¹

The year-long study asked female caregivers of 379 children with ADHD to report on their child’s sleep patterns and their own mental health at three points — at the beginning of the study, 6 months later, and during the last month of the study. The children were between 5 and 13 years old, and researchers controlled for child age, sex, ADHD symptom severity, medication use, comorbidities, caregiver age, and socioeconomic advantage in the study.

Findings show that, while child sleep problems and maternal mental health difficulties were stable across the study period, sleep problems at the 6-month point predicted overall maternal mental health difficulties and maternal anxiety at 12 months. Sleep problems at 6 months, however, did not predict maternal depression or stress at 12 months.

Given that children with ADHD experience more sleep problems than do their non-ADHD peers², the study raises awareness around related mental health difficulties for caregivers. The authors suggest that interventions to improve sleep in these children may improve maternal mental health over time.

Sources

¹Martin, C. A., Mulraney, M., Papadopoulos, N., Rinehart, N. J., & Sciberras, E. (2021). Bidirectional Associations Between Maternal Mental Health and Child Sleep Problems in Children With ADHD: A Longitudinal Study. Journal of Attention Disorders, 25(11), 1603–1604. https://doi.org/10.1177/1087054720923083

²Gruber, R., Xi, T., Frenette, S., Robert, M., Vannasinh, P., & Carrier, J. (2009). Sleep disturbances in prepubertal children with attention deficit hyperactivity disorder: a home polysomnography study. Sleep, 32(3), 343–350. https://doi.org/10.1093/sleep/32.3.343

Adults with ADHD are at greater risk than their non-ADHD counterparts for a wide range of physical health conditions, according to a recent Swedish study published in The Lancet Psychiatry ¹ that highlights the importance of assessing older patients with ADHD for the presence of liver or pulmonary disease, among other physical conditions.

The study of roughly 4.8 million patient records found that adults with ADHD exhibit elevated risk for 34 of 35 physical conditions studied, including nervous system, respiratory, musculoskeletal, metabolic, circulatory, gastrointestinal, genitourinary, and skin conditions. The only condition for which individuals with ADHD did not exhibit increased risk was rheumatoid arthritis.

The individuals in the national register, born between 1932 and 1995, formed about 3.9 million full-sibling pairs and 470,000 maternal half-sibling pairs, which researchers used to evaluate the extent to which genetic and environmental factors account for the link between physical conditions and ADHD. About 1.29% of the individuals in the register (61,960) had diagnosed ADHD.

After adjusting for sex and birth year, individuals with ADHD showed most elevated risk compared to non-ADHD adults for (but not limited to):

Gastrointestinal

• Alcohol-related liver disease (odds ratio of 4.70)
• Fatty liver disease (odds ratio of 2.94)

Nervous system

• Sleep disorders (odds ratio of 4.62)
• Epilepsy (odds ratio of 2.99)

Respiratory

• Chronic obstructive pulmonary disease (odds ratio of 3.24)

Endocrine/metabolic

• Obesity (odds ratio of 2.67)

Further analysis between ADHD and nervous system disorders showed that genetic factors explained 28% of the correlation, while shared environmental factors explained 13%. Non-shared environmental factors explained 59%. For metabolic, respiratory, and musculoskeletal disorders, genetic factors explained up to 69% of the link, and the rest was explained by non-shared environmental factors.

The study also found that full siblings of individuals with ADHD had significantly increased risk for most physical conditions compared to maternal half-siblings, suggesting that shared familial factors contribute to the co-occurrence of the disorders. These findings also suggest that ADHD and the associated physical disorders share etiological components.

The findings, according to the authors, demonstrate the importance of rigorous medical assessment and care in adult patients with ADHD. They also highlight the need to investigate possible genetic factors between physical and psychiatric conditions, given that ADHD is frequently comorbid and shares a strong genetic basis with other mental disorders. The findings are also in line with a 2019 study that found that physical diseases are more prevalent in children with ADHD than their non-ADHD counterparts.

Sources

¹Rietz, E., Brikell, I., Agnieszka, B., Leone, M. Chang, Z., Cortese, S. et.al. (July 6, 2021). Mapping phenotypic and aetiological associations between ADHD and physical conditions in adulthood in Sweden: a genetically informed register study. The Lancet Psychiatry.
DOI:https://doi.org/10.1016/S2215-0366(21)00171-1

ADHD prevalence rates are lowest among Non-Hispanic Asian boys and girls, according to a recent Journal of Attention Disorders study.¹ Prevalence of ADHD was 11.3% among non-Hispanic White children and 10.7% among non-Hispanic Black children — significantly higher than the 2.2% prevalence rate found among non-Hispanic Asian children in the study. Prevalence was also higher in male participants compared to females across all racial-ethic groups.

Data was drawn from the 2004 to 2018 National Health Interview Survey for 120,129 children aged 5 to 17.

Non-Hispanic White children had higher ADHD prevalence rates than did Hispanic and Non-Hispanic Asian children, but they had prevalence rates similar to Non-Hispanic Black and Non-Hispanic Alaskan Native/American Indian children. Females had consistently lower prevalence rates than did males — 5.86% vs. 13.26% — but racial-ethnic differences persisted across sex.

The difference in ADHD prevalence rates between Non-Hispanic White children and Non-Hispanic Black children was not as severe as reported in prior studies, which suggests that the gap in ADHD prevalence rates among White and Black youth may have diminished in recent years or contained errors in the past. Researchers concluded: “The low ADHD prevalence for Non-Hispanic Asians and the high ADHD prevalence for Non-Hispanic Alaskan Native/American Indians emphasizes the importance of including and distinguishing between multiple racial-ethnic groups, since prevalence rates vary substantially among groups that are often congregate in the ‘other’ category or neglected as a whole.”

Sources

¹ Wong AWWA, Landes SD. Expanding Understanding of Racial-Ethnic Differences in ADHD Prevalence Rates among Children to Include Asians and Alaskan Natives/American Indians. Journal of Attention Disorders. June 2021. doi:10.1177/10870547211027932

Children with ADHD who experience significant social, emotional, and executive-function impairments also demonstrate significantly higher rates of oppositional defiant disorder (ODD) and conduct disorder (CD), according to a nationwide study of Turkish children published in the Journal of Attention Disorders.¹ Impairment ratings by caregivers and educators considered the child’s relationship with his/her siblings, relationships with friends, ability to do homework, general adjustment at home, and self-esteem. In addition, the study’s nationwide representative samples demonstrated a prevalence of ADHD in Turkish children of 19.5% without impairment and 12.4% with impairment.

Researchers studied functional impairments in 5,842 students aged 8 to 10 years, who participated in a diagnostic interview, were screened with a DSM-IV-based scale for Disruptive Behavior Disorders, and had their impairments assessed by both parents and teachers.

When researchers considered the impairment criteria, the overall prevalence of ADHD was found to be 12.4%: 6.8% inattentive presentation, 0.7% hyperactive presentation, and 4.9% combined presentation. This overall prevalence of ADHD was much higher than the pooled prevalence rates of 5.29% and 7.1% reported in two extensive meta-regression-analysis studies.^2,3  This is likely because the new study applied epidemiological methodology. All presentations of ADHD were significantly higher among boys, regardless of impairment criteria. In comparing psychiatric comorbidities between ADHD groups with and without impairment, researchers found a higher prevalence of ODD and CD in the former. ODD was found in 15.1% of children with ADHD and significant impairment from symptoms, but in only 8.7% of children with ADHD and no significant impairment. CD was found in 2.2% of children with ADHD and high impairment, yet in only .2% of children with ADHD and minimal impairment.

In addition to contributing to a more accurate understanding of nationwide ADHD prevalence, these findings suggest that children with ADHD who experience more severe impairment are at a greater risk for disruptive behavior disorders. This study was limited to children attending urban schools in Turkey, which represented 71.4% of the population.

Sources

¹ Ercan ES, Unsel-Bolat G, Tufan AE, et al. Effect of Impairment on the Prevalence and Comorbidities of Attention Deficit Hyperactivity Disorder in a National Survey: Nation-Wide Prevalence and Comorbidities of ADHD. Journal of Attention Disorders. May 2021. doi:10.1177/10870547211017985

² Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., Rohde, L. A. (2007). The worldwide prevalence of ADHD: A systematic review and metaregression analysis. The American Journal of Psychiatry, 164(6), 942–948. https://doi.org/10.1176/ajp.2007.164.6.942

³ Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: A meta-analytic review. Neurotherapeutics: The Journal of the American Society for Experimental Neurotherapeutics, 9(3), 490–499. https://doi.org/10.1007/s13311-012-0135-8

Childhood attention deficit hyperactivity disorder (ADHD or ADD) is a chronic health problem that significantly impacts functioning into adulthood and increases the risk for multiple adverse long-term outcomes, according to findings from a new study published in the Journal of Attention Disorders.¹

The study, which included 232 adults with childhood ADHD and 335 adults without childhood ADHD from a 1976 to 1982 birth cohort, found that ADHD was associated with a greater likelihood for the following:

• ever having been fired (twice as likely)
• ever having a driver’s license revoked
• having a pregnancy out of wedlock
• ever being in a treatment program for alcohol, marijuana, or hard/street drugs, compared to non-ADHD referents

Notably, this new research did not compare outcomes for ADHD patients who received treatment and those who did not, however previous research on the same birth cohort found that ADHD medication use was linked to reduced rates of substance use disorder, fewer emergency room visits, and improved school function in childhood. Adults in the present study completed an extensive psychosocial questionnaire and researchers also reviewed data that was previously reported regarding the birth cohort’s learning abilities and psychiatric disorders.

• 69.4% of participants with childhood ADHD also had a learning disorder, compared to 12.5% of non-ADHD referents
• 59.5% of participants with childhood ADHD also had at least one psychiatric disorder, compared to 17.6% of non-ADHD referents

A latent class analysis was conducted to assess patterns of functional outcomes of the whole sample and a three-class solution was used to distinguish between “good,” “intermediate,” and “poor” functioning.

The “good” functioning class was characterized by having higher education, income, and rates of marriage. The “intermediate” group was characterized by a high likelihood of being fired, initiating sexual activity under the age of 18, and medium levels of income and education. The “poor” functioning class was characterized by high levels of trouble with the law, sexual initiation under the age of 18, treatment for alcohol, marijuana, or drug use, and no education beyond high school.

Participants with childhood ADHD comprised 24.9% of the study’s “good” functioning class, 53.5% of the “intermediate,” and 62.8% of the “poor” functioning class. Comorbid learning disorders were not associated with likelihood of being in the “poor” versus “intermediate” functioning classes, but the “poor” functioning class had a greater number of participants with a childhood psychiatric disorder, and co-occurring childhood ADHD with a childhood psychiatric disorder, compared to the “intermediate” functioning class.

Researchers concluded that childhood ADHD should be viewed as a serious condition that increases the risk for multiple negative long-term outcomes, and that those with childhood ADHD and psychiatric disorders might be at highest risk. They suggested that treatment for ADHD should consider the impact of ADHD on virtually all functional domains; previous research on the same birth cohort found that medicating children with ADHD was linked to reduced rates of substance use disorder, emergency room visits, and improved school function in childhood.

Sources

¹Harstad EB, Katusic S, Sideridis G, Weaver AL, Voigt RG, Barbaresi WJ. Children With ADHD Are at Risk for a Broad Array of Adverse Adult Outcomes That Cross Functional Domains: Results From a Population-Based Birth Cohort Study. Journal of Attention Disorders. October 2020. doi:10.1177/1087054720964578

Living with ADHD may cost an individual $15,664 over a lifetime, and approximately $12.76 billion annually in the United States. This finding comes from a study published in the Journal of Attention Disorders¹ that attempted to comprehensively document the social and economic costs associated with attention deficit hyperactivity disorder (ADHD or ADD) using a lifespan approach. The study calculated financial costs across multiple domains, the largest of which was lost productivity.

Researchers used a prevalence approach to estimate the costs associated with ADHD across all ages in Australia in the 2018 – 2019 financial year. They measured financial costs in the domains of healthcare, productivity, education and justice systems, and deadweight losses. Non-financial costs, or Disability Adjusted Life Years (DALYs), were also measured.

The results demonstrated that ADHD is linked to substantial societal costs across the lifespan: $15,664 per person and approximately $12.76 billion in 2019 alone (in U.S. dollars). Productivity (absenteeism, presenteeism, reduced employment) costs were 81% of the total financial costs, followed by deadweight losses (11%), and health system costs (4%). Loss in terms of wellbeing was $5.31 billion, equating to 42% of the costs attributable to ADHD.

Few international studies of the economic burden of ADHD account for its non-financial costs. Researchers conclude that these findings, presented in metrics commonly used by politicians and policy makers, are necessary to advocate for policy changes, including advancement in treatments.

Sources

¹Sciberras E, Streatfeild J, Ceccato T, et al. Social and Economic Costs of Attention-Deficit/Hyperactivity Disorder Across the Lifespan. Journal of Attention Disorders. October 2020. doi:10.1177/1087054720961828

Black Americans are more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD or ADD) than the general population, according to findings of a systematic review and meta-analysis published in JAMA Psychiatry.¹ These findings seem to contradict the DSM-5, which suggests that the prevalence of ADHD is relatively lower among Black individuals. The new meta-analysis did not determine whether the higher diagnosis rate is due to elevated risk factors for Black Americans, culturally insensitive evaluation tools, racial bias, other factors, or some combination therein.

Black individuals living in countries where they are considered a minority are underrepresented in studies evaluating ADHD. Joel Nigg, Ph.D., explains that “Most research on ADHD has studied male children of European-Caucasian ancestry in North America, Europe, and Oceana. Relatively few studies specifically examine aspects of race or cultural variation.” For the current meta-analysis, researchers reviewed 21 studies published between 1979 and 2020 that included data from 154,818 Black participants. Two studies assessed adults, 8 assessed children, 1 assessed adolescents, and 13 assessed both children and adolescents. Results showed a pooled prevalence of ADHD around 14.5% (95% CI, 10.64%-19.56%); the prevalence of ADHD is closer to 10% in the general population.

The meta-analysis did not directly compare risk factors facing Black patients and other patients. However, several of the studies used noted relatively higher diagnosis rates for ADHD and learning disabilities among Black children, and they noted that teacher ratings typically factor heavily into those evaluations. Recent research has shown that teachers are more likely to ascribe a student’s behaviors to ADHD if the student is Black.²

Several studies found significant differences in risk factors associated with ADHD — such as socioeconomic status and access to health care — among Black populations and the general population. Still, researchers did not prescribe any cause and effect for the ADHD diagnosis disparity found.

Rather, they said these findings demonstrate the need for more research with the ultimate goal of creating culturally appropriate assessment and monitoring tools to improve the accuracy of diagnoses and impact of treatment for Black individuals. Sarah Vinson, M.D., says that “to ensure more equitable health care, clinicians must recognize these issues in broader society without assuming that a universal African American experience exists; great care requires clinicians to probe and consider each individual patient’s unique experiences.”

The authors of the study concluded, “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. 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.”

Sources

¹ Cénat JM, Blais-Rochette C, Morse C, et al. Prevalence and Risk Factors Associated With Attention-Deficit/Hyperactivity Disorder Among US Black Individuals: A Systematic Review and Meta-analysis. JAMA Psychiatry. Published online September 09, 2020. doi:10.1001/jamapsychiatry.2020.2788

² Kang, Sungha, et al. “Racial Differences between Black Parents’ and White Teachers’ Perceptions of Attention-Deficit/Hyperactivity Disorder Behavior.” Journal of Abnormal Child Psychology (Dec. 2019) https://link.springer.com/article/10.1007/s10802-019-00600-y

First, terms. No term is perfect for any group that includes diverse, cross-sectional members — and who would like to choose their own term for self-description. One common term for under-represented groups is person of color (or POC); another is BIPOC (Black, Indigenous, or Person of Color). With almost no research on Black African or Caribbean immigrants to the United States, my use of the term Black generally refers to African-Americans; I use the term BIPOC to refer to other non-white groups; and the term White, for brevity.

Genetics and race.

One enduring falsehood about race is that it is biological. We have seen this ugly untruth surface lately with suggestions that extraordinarily high COVID-19 deaths among Black American and British communities relate somehow to weak genetic immunity. That is scientific nonsense. There surely is individual variation in genetic immunity (and some family lines for inherited conditions are more common in certain socially defined groups), but infectious disease variation across socially defined race groups is largely related to social factors (differential exposure, differential health care, and so on). Genetics can identify ethnic lineages, but these bear little relation to what a given society calls a race or ethnic group.

Bias in ADHD research and clinical care.

Most research on ADHD has studied male children of European-Caucasian ancestry in North America, Europe, and Oceana. Relatively few studies specifically examine aspects of race or cultural variation, although we’ve seen a slight increase as studies of ADHD have grown. My own research is no exception.

Results of simple Pub-Med search 6/8/20 for “ADHD,race” and “ADHD” from 1990-2020 show dramatic increase in total articles and corresponding percent increase in articles on race, but little change in percentage.

[Read This Next: The Children Left Behind]

In clinical care, bias in ADHD diagnoses and treatment decisions is slowly being addressed (for example, by specific training to overcome implicit bias) but still persists. The medical sectors as a whole, not just those related to ADHD, struggle to address racism, stereotyping, implicit bias, research representation, and health disparities. ADHD stigma abounds in the BIPOC community, and black individuals and families are often reluctant to participate in research due to mistrust.

The deplorable and unethical Tuskegee Study of Untreated Syphilis in the African American Male may seem like ancient history to many, but it only ended 48 years ago and it is a haunting memory within the Black community. Mistrust of research is also fueled by ongoing experiences of discrimination in research and health care settings.

Despite some progress, the fact remains that too many health-care researchers and practitioners remain inadequately aware of the best ways to serve these highly diverse communities. With the limitations on the available research in mind, here are a few things recent studies have reported specifically about race and ADHD.

How racism and stereotyping affect health and behavior.

Among American youth, concern about societal racism has risen over the last few years alongside exposure to incidents of public racism and discrimination. Recent weeks have amplified this phenomenon. Over time, exposure to discrimination and prejudice — a daily experience for many African Americans and other persons of color — is associated with a subsequent increase in symptoms of depression and ADHD, as well as a higher likelihood of trying alcohol, smoking, or marijuana. Experiencing racism or discrimination is also associated with higher blood pressure.

[Read: We Need Equity in ADHD Health Care for African American and Latinx Children]

Children are acutely aware of stereotypes about gender and race even before they start school. Youth, like adults, are sensitive to the activation of social stereotypes and how it affects their performance. The term “stereotype threat” refers to this psychological phenomenon: Sometimes, when a member of a stereotyped group is faced with a challenging situation that matters to them and that could activate the stereotype, the threat of fulfilling the stereotype interferes with performance and they do worse on the task as a result.

How trauma and social disadvantage are related to ADHD

Trauma and social disadvantage are related to ADHD. They can trigger ADHD-like symptoms. In addition, children with ADHD are more likely to be harmed when exposed to trauma as they are less resilient. Children who are BIPOC in the U.S. are exposed to more social adversities than are White children, on average. Thus, separating adversity effects from ADHD itself is a greater challenge in these populations.

Factoring in rater “bias.”

Although ADHD symptoms seem to cluster together mostly in the same way across race groups, bias is still a factor. Bias is notable in ratings of the same videotaped behavior across races of child and observer. Factors affecting ratings include role, setting, past experience of discrimination, acculturation, identity, race of rater, race of child, sex of child. (Ratings are not much affected by the rater’s prior experience of ADHD or valuing certain expressive styles).

At the same time, in rating their own children, Black parents rate their children (boys and girls) higher on ADHD symptom scales than do White parents. It is unclear whether this stems from different parent tolerance, different child behaviors, or other factors. Some standardized assessment measurements take this difference into account, but not all reflect national norms for Black children. Rater bias must be considered in an ADHD assessment.

Racial and Cultural Differences in Parenting and ADHD

Appropriate parental strategies for handling disruptive child behavior in White populations are well known and guide psychological counseling for child behavior problems accordingly. The extent to which these same methods are the right approach for Black parents and other cultural groups is less clear. In several studies, parenting styles appear to have different correlations with child outcomes depending on race and ethnicity. A more nuanced lesson from the literature appears to be that the best way of parenting to maximize for child development for ADHD may vary across race, socio-cultural context, as well as child temperament.

ADHD has the same incidence among Black and White children. Yet ADHD is less often identified and treated in Black children. We still don’t know if this means there is over-identification in the White community or under-identification in the Black community.

In addition to other barriers to care, the diagnostic process itself is complicated by race and stereotype effects, and by the aforementioned history and often by prior discrimination experienced and/or observed by Black or BIPOC individuals. A clinician must be sensitive to all of this in order to deliver an accurate and effective evaluation.

If you are in an under-represented minority group trying to understand if your child has ADHD, it is important to realize that ADHD is just as common, but harder to accurately identify, in minority groups for the reasons noted. It is therefore critical that you work with a clinician who is mindful of race-specific norms; considers the potential for implicit bias, including unconscious stereotype uses even by well-meaning educators and caregivers; understands the tendency to over-diagnose conduct disorder in African American youth with behavior problems; and also considers social dynamics and contexts such as trauma, isolation, and exposure to other important contexts.

A thorough clinician will obtain standardized ratings from multiple informants, and also consider objective evidence like grades and classwork. They look for and try to use norms for your child’s social group. They will also pay careful attention to impairment — that is, are the ADHD symptoms really interfering with the child’s development? Finally, they should know that Black youth are more likely than White to discontinue ADHD treatment or use it only intermittently for multiple reasons not well studied or understood.

On the science side, we can’t yet be sure that ADHD criteria identify children accurately across race and ethnicity. Some evidence says yes, some says not quite. Regardless, racism and stereotyping can’t be ignored if clinicians and scientists hope to accurately diagnose and truly help all children with ADHD and ADHD-like symptoms. Prejudice and bias impact our ability to get accurate evaluations of Black and BIPOC persons’ abilities and needs and, therefore, to appropriately support their growth and development. I will certainly be continuing my own efforts to learn, listen, and improve.

Additional studies that take into account race, acculturation, and identity are sorely needed. For ADHD, it is very important to continue to learn about rater effects across race groups and to evaluate the validity of different ADHD correlates, including treatment success, across populations.

ADHD-Related Research Used to Compose this Article

• Kang S, Harvey EA. Racial Differences between Black Parents’ and White Teachers’ Perceptions of Attention-Deficit/Hyperactivity Disorder Behavior. J Abnorm Child Psychol. 2020;48(5):661‐672. doi:10.1007/s10802-019-00600-y
• DuPaul GJ. Adult Ratings of Child ADHD Symptoms: Importance of Race, Role, and Context. J Abnorm Child Psychol. 2020;48(5):673‐677. doi:10.1007/s10802-019-00615-5
• DuPaul GJ, Fu Q, Anastopoulos AD, Reid R, Power TJ. ADHD Parent and Teacher Symptom Ratings: Differential Item Functioning across Gender, Age, Race, and Ethnicity. J Abnorm Child Psychol. 2020;48(5):679‐691. doi:10.1007/s10802-020-00618-7
• Scharff, D. P., Mathews, K. J., Jackson, P., Hoffsuemmer, J., Martin, E., & Edwards, D. (2010). More than Tuskegee: understanding mistrust about research participation. Journal of health care for the poor and underserved, 21(3), 879–897. doi.org/10.1353/hpu.0.0323
• Slobodin O, Masalha R. Challenges in ADHD care for ethnic minority children: A review of the current literature. Transcult Psychiatry. 2020;57(3):468‐483. doi:10.1177/1363461520902885
• Coker TR, Elliott MN, Toomey SL, et al. Racial and Ethnic Disparities in ADHD Diagnosis and Treatment. Pediatrics. 2016;138(3):e20160407. doi:10.1542/peds.2016-0407
• Miller TW, Nigg JT, Miller RL. (2009). Attention deficit hyperactivity disorder in African American children: what can be concluded from the past ten years? Clin Psychol Rev. 2009 Feb;29(1):77-86.d https://doi.org/10.1016/j.cpr.2008.10.001
• Hales CM, Kit BK, Gu Q, Ogden CL. (2018). Trends in Prescription Medication Use Among Children and Adolescents-United States, 1999-2014. JAMA. 2018 May 15;319(19):2009-2020. doi:10.1001/jama.2018.5690.
• Ji X, Druss BG, Lally C, Cummings JR. (2018) Racial-Ethnic Differences in Patterns of Discontinuous Medication Treatment Among Medicaid-Insured Youths With ADHD. Psychiatr Serv. 2018 Mar 1;69(3):322-331. doi:10.1176/appi.ps.201600469.
• Leventhal AM, Cho J, Andrabi N, Barrington-Trimis J. (2018). Association of Reported Concern About Increasing Societal Discrimination With Adverse Behavioral Health Outcomes in Late Adolescence. JAMA Pediatr. 2018 Aug 20. doi: 10.1001/jamapediatrics.2018.2022.
• Yetter G, Foutch VM. (2017). Comparison of American Indian and Non-Native BASC-2 Self-Report-Adolescent Scores. Am Indian Alsk Native Ment Health Res. 2017;24(3):14-38. doi:10.5820/aian.2403.2017.14.

Dr. Nigg is a Professor of Psychiatry at Oregon Health & Science University and a licensed clinical psychologist who has conducted federally funded research on ADHD for more than 25 years and contributed more than 200 peer-reviewed scientific articles. (The views expressed here are his own).

[Click to Read: Nine Conditions Often Linked to ADHD]

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