REVIEW OF: Cénat JM et al, JAMA Psychiatry 2021;78(1):21–28

STUDY TYPE: Meta-analysis

In the general population, the reported prevalence of ADHD is about 10%, with estimates varying from around 5% to 15%. Black individuals are typically underrepresented in these studies, and with fewer data, it is no surprise that the estimates are less precise, with an estimated prevalence of 5% to over 20%. This study tried to improve the accuracy of prevalence measures of ADHD among Black individuals as well as identify specific risk factors for ADHD in this population.

The authors found 21 US articles published from 1979 through 2019 with 24 independent samples or subsamples of Black people. Most (13) included both children and adolescents. Eight samples included only children, one included only adolescents, and two included only adults. From these studies, the authors conducted a meta-analysis and computed a pooled ADHD prevalence of 14.5% (95% CI, 10.64%–19.56%). When only the samples of children and adolescents were included, the prevalence was 13.9%, which was not significantly different.

Older children (10–17 years) were more likely to receive an ADHD diagnosis, as were males. Males also received more prescriptions for ADHD than females. In at-risk populations like juvenile offenders, Black youth were less likely to be diagnosed with ADHD. Interestingly, Black parents were less likely to report ADHD symptoms in their children while teachers reported more symptoms. Low socioeconomic status was a risk factor for ADHD in Black individuals, but high socioeconomic status was not a protective factor against ADHD as it is in white individuals.

CCPR’S Take
This study shows that Black Americans are more likely to meet diagnostic criteria for ADHD than the general population, with a prevalence of about 14% vs about 10%. It’s not clear what drives this disparity, although an increased tendency for teachers to identify ADHD symptoms in Black children, lower socioeconomic status, as well as culturally determined biases in the ADHD construct itself might be factors. These data contradict the DSM-5, which indicates that Blacks have a lower rate of ADHD, and this should encourage us to be more vigilant in screening and treating our Black patients for this condition.