What are the prevalence and risk factors associated with attention-deficit/hyperactivity disorder (ADHD) among US Black individuals?
This systematic review and meta-analysis assessing the results of 21 studies found that the pooled prevalence of ADHD among 154 818 US Black individuals was approximately 15% and suggested that the associated risk factors included sociodemographic characteristics (age, sex, race, socioeconomic status), risk behaviors, and familial and environmental factors.
The higher prevalence of ADHD observed in this study among US Black individuals highlights the need to increase assessment, accurate diagnoses, and culturally appropriate care.
As stated in the DSM-5, it is generally reported that the prevalence of attention-deficit/hyperactivity disorder (ADHD) is lower among Black individuals compared with the general population. However, Black individuals living in countries where they are considered a minority population group (eg, in Northern America and Europe) are underrepresented in studies evaluating ADHD.
To estimate the pooled prevalence of ADHD and identify associated risk factors among US Black individuals.
This systematic review and meta-analysis identified peer-reviewed studies published until October 18, 2019, using the APA PsycInfo, MEDLINE, Embase, Cochrane CENTRAL, CINAHL, ERIC, and Education Source databases.
Eligible trials were published in French or English, had empirical data on the prevalence of ADHD in samples or subsamples of Black people, and were conducted in countries with Black minority populations. All studies were assessed and passed quality evaluation.
Data Extraction and Synthesis
The PRISMA guideline was used for extracting and reporting data. Random-effects meta-analyses were generated to estimate the prevalence of ADHD among Black individuals using the metafor package in R.
Main Outcomes and Measures
Prevalence and risk factors associated with ADHD among Black individuals were identified.
A total of 24 independent samples and subsamples from 21 studies published between 1979 and 2020 (154 818 Black participants) were included in this systematic review and meta-analysis. All included studies were conducted in the US. Two studies were conducted assessing adults (aged 18 years or older), 8 assessing children (0-12 years), 1 assessing adolescents (aged 13-17 years), and 13 assessing both children and adolescents. The pooled prevalence of ADHD was 14.54% (95% CI, 10.64%-19.56%). In a narrative review of the studies in this analysis, some studies found risk factors associated with ADHD, such as sociodemographic characteristics (age, sex, race, and socioeconomic status), familial factors, environmental factors, and risk behaviors, but the data did not permit a moderation analysis to assess these findings in this study.
Conclusions and Relevance
Contrary to what is stated in the DSM-5, the results of this systematic review and meta-analysis suggest that Black individuals are at higher risk for ADHD diagnoses than the general US population. These results highlight a need to increase ADHD assessment and monitoring among Black individuals from different social backgrounds. They also higlight the importance of establishing accurate diagnoses and culturally appropriate care.
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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
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