Children living in poverty more likely to be diagnosed with ADHD

Attention deficit hyperactivity disorder and other learning disabilities are more common in families locked into a cycle of poverty, a new U.S. government report suggests.

Nearly 19 percent of children living in families below the federal poverty level had a diagnosis of ADHD or a learning disability, compared with about 13 percent of families at or above the poverty level, the new report shows. A family of four with a household income of $26,200 is living at the 2020 federal poverty level.

Children with parents who have a high school education or less were also more likely to be diagnosed with ADHD or a learning disability -- 15 percent, compared with under 13 percent of those with parents who went on to higher education.

That's particularly true of white children. About 21 percent of white kids with parents who have a high school diploma or less have a diagnosis of ADHD or learning disability, compared with 16 percent of black children and 11.5 percent of Hispanic children.

"Poverty is often associated with increased adverse childhood experiences and trauma," said Dr. Victor Fornari, vice chair of child and adolescent psychiatry at Zucker Hillside Hospital and Cohen's Children's Medical Center in Glen Oaks, N.Y. "It is not about race. Early childhood trauma changes the brain and our genes, with epigenetic changes that are real." Fornari was not part of the research.

Federal researchers conducted the study to update the data surrounding ADHD, said lead author Benjamin Zablotsky, a health statistician with the U.S. National Center for Health Statistics.

The researchers pulled data from the annual National Health Interview Survey between 2016 and 2018. The survey specifically asked parents if a doctor or health professional ever told them their child has ADHD or ADD, or if a school or health professional told them their child had a learning disability.

The survey found that nearly 14 percent of children between 3 and 17 had been diagnosed with either ADHD or a learning disability, according to their parents.

However, parents can't be relied upon to accurately report such conditions, said Dr. Scott Benson, a pediatric psychiatrist with Creekside Psychiatric Center in Pensacola, Fla.

"The word is out in the community about ADHD so people are labeling themselves or getting labeled," said Benson, who reviewed the report. "They're painting it over a broad array of learning and behavior problems. It's no longer a defined condition that has some precision to it. It's kind of a loose language where people are throwing words around."

The actual number of kids with a solid diagnosis of ADHD has remained fairly stable over the years, Benson said.

"In the past, every research study that's been done where you have qualified people doing the evaluations, you come up with an incidence of maybe 7 percent or 8 percent," he said. "About 25 percent of children have some kind of trouble in school. Some of them need glasses, some of them need hearing tests, some of them need to get their teeth fixed. Some of them have severe learning problems. Then when you do careful evaluations, of the 25 percent you can sort out 7 percent to 8 percent as ADHD kids," Benson said.

He and Fornari said the stats related to poverty and education in the new study are far more compelling.

The results reminded Benson of a conversation he'd had about Florida schools, which are graded based on student performance.

"Someone pointed out, you know we have another set of data which is average family income by geographic area. If you take average family income maps and you lay them over the failing school maps, it's a perfect match," Benson said. "Children are not going to succeed at school if their family is homeless, if their family is disorganized or in disarray. These children are at extraordinarily high risk."

More effort needs to be made to accurately identify kids struggling with behavioral problems or learning disabilities and get them the proper treatment, Benson said.

"Our system is not designed to really sit with these children and try to understand exactly what is it that's making school difficult with them," Benson said. "Those are the children we need to identify and treat, because those treatments work amazingly well." The NCHS Data Brief report was released March 4.

More information

The U.S. National Institute of Mental Health has more about ADHD.

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