Abstract
Lower levels of medical treatment of attention-deficit/hyperactivity disorder have been documented in ethnic minorities and in developing countries despite similar prevalence of the disorder across different cultural backgrounds. Increasing awareness of the different sociocultural factors contributing to these inequalities is fostering more culturally sensible approaches to diagnosis and treatment. To date, the existence of specific response or tolerability patterns of attention-deficit/hyper activity disorder medications across ethnic groups is unclear. The short-term efficacy of stimulants has been documented in children from various origins, and current moderator and pooled analyses have ruled out major effects of ethnicity on treatment response. Genetic variations influencing treatment response or side effects are being explored and may be promising factors in future treatment/management strategies, but the role of ethnic background is unknown and may not significantly overlap with relevant biological characteristics.
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References and Recommended Reading
US Department of Health and Human Services: Mental Health. Culture, Race and Ethnicity—A Supplement to Mental Health: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services; 2001.
Garland AF, Lau AS, Yeh M, et al.: Racial and ethnic differences in utilization of mental health services among high-risk youths. Am J Psychiatry 2005, 162:1336–1343.
Miller TW, Nigg JT, Miller RL: Attention deficit hyperactivity disorder in African American children: what can be concluded from the past ten years? Clin Psychol Rev 2009, 29:77–86.
Safer DJ, Malever M: Stimulant treatment in Maryland public schools. Pediatrics 2000, 106:533–539.
Rowland AS, Umbach DM, Stallone L, et al.: Prevalence of medication treatment for attention deficit-hyperactivity disorder among elementary school children in Johnston County, North Carolina. Am J Public Health 2002, 92:231–234.
Zito JM, Safer DJ, dosReis S, et al.: Racial disparity in psychotropic medications prescribed for youth with Medicaid insurance in Maryland. J Am Acad Child Adolesc Psychiatry 1998, 37:179–184.
Pumariega AJ, Glover S, Holzer CE 3rd, et al.: Administrative update: utilization of services. II. Utilization of mental health services in a tri-ethnic sample of adolescents. Community Ment Health J 1998, 34:145–156.
Froehlich TE, Lanphear BP, Epstein JN, et al.: Prevalence, recognition and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Arch Pediatr Adolesc Med 2007, 161:857–864.
Polanczyk G, Silva de Lima M, Horta BL, et al.: The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 2007, 164:942–948.
Arnold LE, Elliot M, Sachs L, et al.: Effects of ethnicity on treatment attendance, stimulant response/dose and 14-month outcome in ADHD. J Consult Clin Psychol 2003, 71:713–727.
Pastor PN, Reuben CA: Racial and ethnic differences in ADHD and LD in young school-age children: parental reports in the National Health Interview Study. Public Health Represent 2005, 120:383–392.
Zwirs BW, Burger H, Buitelaar JK, Schulpen TW: Ethnic differences in parental detection of externalizing disorders. Eur Child Adolesc Psychiatry 2006, 15:418–426.
Livingston R: Cultural issues in diagnosis and treatment of ADHD. J Am Acad Child Adolesc Psychiatry 1999, 38:1591–1594.
Schmitz MF, Velez M: Latino cultural difference in maternal assessments of attention deficit/hyperactivity symptoms in children. Hisp J Behav Sci 2003, 25:110–122.
Smith LC, Friedman S, Nevid J: Clinical and socio-cultural differences in African American and European American patients with panic disorder and agoraphobia. J Nerv Ment Dis 1999, 187:549–560.
Yeh M, Hough RL, McCabe K, et al.: Parental beliefs about the causes of child problems: exploring racial/ethnic patterns. J Am Acad Child Adolesc Psychiatry 2004, 43:605–612.
Bussing R, Schoenberg NE, Perwien AR: Knowledge and information about ADHD: evidence of cultural differences among African-American and white parents. Soc Sci Med 1998, 46:919–928.
Pham AV, Carlson JS, Kosciulek JF: Ethnic differences in parental beliefs of attention-deficit/hyperactivity disorder and treatment. J Atten Disord 2009 May 4 (Epub ahead of print).
Bussing R, Zima BT, Gary FA, Garvan CW: Barriers to detection, help-seeking and service use for children with ADHD symptoms. J Behav Health Serv Res 2003, 30:176–189.
DosReis S, Zito JM, Safer DJ, et al.: Parental perceptions and satisfaction with stimulant medication for attention-deficit hyperactivity disorder. J Dev Behav Pediatr 2003, 24:155–162.
Bussing R, Koro-Ljungberg ME, Williamson P, et al.: What “Dr. Mom” ordered: a community-based exploratory study of parental self-care responses to children’s ADHD symptoms. Soc Sci Med 2006, 63:871–882.
Faraone SV, Biederman J, Zimmerman B: An analysis of patient adherence to treatment during a 1-year, open-label study of OROS methylphenidate in children with ADHD. J Atten Disord 2007, 11:157–166.
Bauermeister J, Canino G, Bravo M, et al.: Stimulant and psychological treatment of ADHD in Latino/Hispanic children. J Am Acad Child Adolesc Psychiatry 2003, 42:851–855.
Polanczyk G, Rohde LA, Szobot C, et al.: ADHD treatment in Latin America and the Caribbean. J Am Acad Child Adolesc Psychiatry 2008, 47:721–722.
Bird HR, Shrout PE, Duarte CS, et al.: Longitudinal mental health service and medication use for ADHD among Puerto-Rican youth in two contexts. J Am Acad Child Adolesc Psychiatry 2008, 47:879–889.
Rue DS, Xie Y: Disparities in treating culturally diverse children and adolescents. Psychiatr Clin North Am 2009, 32:153–163.
Hervey-Jumper H, Douyon K, Falcone T, et al.: Identifying, evaluating, diagnosing and treating ADHD in minority youth. J Atten Disord 2008, 11:522–528.
Rohde LA, Szobot C, Polanczyk G, et al.: Attention-deficit/hyperactivity disorder in a diverse culture: do research and clinical findings support the notion of a cultural construct for the disorder? Biol Psychiatry 2005, 57:1436–1441.
Reid R: Assessment of ADHD with culturally different groups: the use of behavioral rating scales. School Psychol Rev 1995, 24:537–560.
Mann E, Ikeda Y, Mueller CW, et al.: Cross-cultural differences in rating hyperactive-disruptive behaviors in children. Am J Psychiatry 1992, 149:1539–1542.
Epstein JN, Willoughby M, Valencia EY, et al.: The role of children’s ethnicity in the relationship between teacher ratings of attention-deficit/hyperactivity disorder and observed classroom behavior. J Consult Clin Psychol 2005, 73:424–434.
Gingerich KJ, Turnock P, Litfin JK, et al.: Diversity and attention deficit hyperactivity disorder. J Clin Psychol 1998, 54:415–426.
Whaley AL, Geller PA: Toward a cognitive process model of ethic/racial biases in clinical judgment. Rev Gen Psychol 2007, 11:75–96.
Hillemeier MM, Foster EM, Heinrichs B, et al.: Racial differences in parental reports of attention-deficit/hyperactivity disorder behaviors. J Dev Behav Pediatr 2007, 28:353–361.
Reid R, DuPaul GJ, Power TJ, et al.: Assessing culturally different students for attention deficit hyperactivity disorder using behavior rating scales. J Abnorm Child Psychol 1998, 26:187–198.
Epstein JN, March JS, Conners CK, Jackson DL: Racial differences on the Conners’ Teacher Rating Scale. J Abnorm Child Psychol 1998, 26:109–118.
Pelham WE, Milich R, Murphy DA, Murphy HA: Normative data on the IOWA Conners’ Teacher Rating Scale. J Clin Child Psychol 1989, 18:259–262.
Conners CK, Epstein N, Angold A, Klaric J: Continuous Performance Test performance in a normative epidemiological sample. J Abnorm Child Psychol 2003, 31:555–562.
Hazel-Fernandez LA, Klorman R, Wallace JM, Cook S: Methylphenidate improves aspects of executive function in African American children with ADHD. J Atten Disord 2006, 9:582–589.
Brown RT, Sexon SB: A controlled trial of methylphenidate in black adolescents. Attentional, behavioral and physiological effects. Clin Pediatr (Phila) 1998, 27:74–81.
Szobot CM, Ketzer C, Parente MA, et al.: The acute effect of methylphenidate in Brazilian male children and adolescents with ADHD: a randomized clinical trial. J Atten Disord 2004, 8:37–44.
Lipkin PH, Cozen MA, Thompson RE, Mostofsky SH: Stimulant dosage and age, race, and insurance type in a sample of children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2005, 15:240–248.
Tamayo JM, Pumriega A, Rothe EM, et al.: Latino versus Caucasian response to atomoxetine in attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2008, 18:44–53.
Durell TM, Pumariega AJ, Rothe EM, et al.: Effects of open-label atomoxetine on African-American and Caucasian pediatric outpatients with attention-deficit/hyperactivity disorder. Ann Clin Psychiatry 2009, 21:26–37.
Stein MA, McGough JJ: The pharmacogenomic era: promise for personalizing attention deficit hyperactivity disorder therapy. Child Adolesc Psychiatr Clin N Am 2008, 17:475–490.
Winsberg BG, Comings DE: Association of the dopamine transporter gene (DAT1) with poor methylphenidate response. J Am Acad Child Adolesc Psychiatry 1999, 38:1474–1477.
Purper-Ouakil D, Wohl M, Orejarena S, et al.: Pharmacogenetics of methylphenidate response in attention deficit/hyperactivity disorder: association with the dopamine transporter gene (SLC6A3). Am J Med Genet B Neuropsychiatr Genet 2008, 147B:1425–1430.
Leddy JJ, Waxmonsky JG, Salis RJ, et al.: Dopaminerelated genotypes and the dose-response effect of methylphenidate on eating in attention-deficit/hyperactivity disorder youths. J Child Adolesc Psychopharmacol 2009, 19:127–136.
McGough J, McCracken J, Swanson J, et al.: Pharmacogenetics of methylphenidate response in preschoolers with ADHD. J Am Acad Child Adolesc Psychiatry 2006, 45:1314–1322.
Polanczyk G, Faraone SV, Bau CH, et al.: The impact of individual and methodological factors in the variability of response to methylphenidate in ADHD pharmacogenetic studies from four different countries. Am J Med Genet B Neuropsychiatr Genet 2008, 147B:1419–1424.
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Franc, N., Purper-Ouakil, D. ADHD medications and ethnicity. Curr Atten Disord Rep 1, 159–164 (2009). https://doi.org/10.1007/s12618-009-0022-3
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DOI: https://doi.org/10.1007/s12618-009-0022-3