It was stated in the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5^TM) that the prevalence of ADHD symptoms is lower among African American children and adolescents compared with White children and adolescents (American Psychiatric Association, 2013). However, a recently published meta-analysis and review suggested a higher prevalence of ADHD in Black individuals of all ages than previously reported (Cénat et al, 2021). A meta-analysis comparing the prevalence of ADHD in a broader set of races and ethnicities remains a gap in the literature. This study therefore aimed to examine the prevalence of ADHD among Black children and adolescents compared with White, Latino and Asian children and adolescents.

For this meta-analysis, research studies that investigated the prevalence of ADHD in Black, White, Latino and Asian samples were identified using seven databases. A total of 7050 articles were retrieved and 155 articles were subjected to full evaluation. Peer-reviewed articles were included if they reported prevalence of ADHD among Black children and adolescents living in a minority context and compared rates with at least one of White, Latino or Asian individuals. Subsequently, 23 studies, representing 26 independent samples, were included.

In total, 1,613,780 children and adolescents from 82 study population groups of Black (n=218,445; number of population groups [k]=26), White (n=835,505; k=25), Latino (n=493,417; k=24) and Asian (n=66,413; k=7) origin were included in this meta-analysis. The pooled prevalence rates were:

• 13.7% (95% confidence interval [CI] 11.1–16.4; Qp<0.001) across all population subgroups
• 15.9% (95% CI 11.6–20.7; Qp<0.001) among Black children and adolescents
• 16.6% (95% CI 11.6–22.2; Qp<0.001) among White children and adolescents
• 10.1% (95% CI 6.9–13.8; Qp>0.001) among Latino children and adolescents
• 12.4% (95% CI 1.4–31.8; Qp<0.001) among Asian children and adolescents.

Across all population subgroups, the pooled prevalence rate of ADHD, shown by inter-group pairwise comparisons, was not statistically significantly different between Black and White children and adolescents (Z=0.18; 95% CI −0.08 to 0.10; p=0.868). However, the differences between pooled rates were marginally statistically higher between:

• Black and Latino children and adolescents (Z=−1.70; 95% CI −0.17 to 0.01; p=0.089)
• White and Latino children and adolescents (Z=−1.86; 95 CI −0.19 to 0.00; p=0.063)
• White and Asian children and adolescents (Z=−1.73; 95% CI −0.27 to 0.02; p=0.084).

In only population-based samples, the pooled prevalence rate of ADHD, shown by inter-group pairwise comparisons, was not statistically significantly different between:

• Black and White children and adolescents (Z=−0.06; 95% CI −0.10 to 0.09; p=0.952)
• Black and Latino children and adolescents (Z=−1.64; 95% CI −0.17 to 0.02; p=0.101)
• White and Latino children and adolescents (Z=−1.58; 95% CI −0.17 to 0.02; p=0.114).

However, the differences between pooled rates were marginally statistically higher between:

• Black and Asian children and adolescents (Z=−1.83; 95% CI −0.34 to 0.01; p=0.067)
• White and Asian children and adolescents (Z=−1.80; 95% CI −0.34 to 0.01; p=0.071).

The meta-regression analysis, which was performed as a moderator analysis due to evidence for high between-study heterogeneity in prevalence estimates across ethnic groups and for all population groups, showed no moderating effects of the type of sample and the year of publication of studies. A significant publication bias was observed in the pooled prevalence rates in the combined samples across all population groups and in studies using only population-based samples. The authors noted that this publication bias suggests the presence of other moderators, which were not included in the review, but should be prospectively examined.

As well as the publication bias present in this work, the high between-study heterogeneity, which may be explained by factors such as differences in study design and informants, was noted as a limitation. There was also a lack of studies reporting the prevalence of ADHD in Black children outside the United States, and children from Middle Eastern and Indigenous communities. Furthermore, there was uncertainty around diagnostic reliability of ADHD across the studies due to differences in the diagnostic procedure.

The authors concluded that this study refutes the assertion in the DSM-5^TM that clinical identification rates are lower among Black children and adolescents compared with White children and adolescents, suggesting that there is no significant difference between the two groups. The authors hope that these findings will encourage research aimed at adapting ADHD assessments for Black children and adolescents.

Read more about the differences in prevalence rates of ADHD in young people depending on race here

Disclaimer: The views expressed here are the views of the author(s) and not those of Takeda.