586 - Parental Birth Outside the United States as a Predictor of ADHD Diagnosis in Children

Poster Number: 586
Publication Number: 586.308

Duy Q. Pham, Cohen Children's Medical Center, New York, NY, United States; Allison Lin, Cohen Children's Medical Center, Port Washington, NY, United States; Hannah E. Rosenthal, Cohen Children's Medical Center, Hauppauge, NY, United States; Ruth Milanaik, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, United States

Background: Children of immigrants face unique challenges due to environmental, cultural, and physical factors that may adversely impact their development. Immigration-related linguistic isolation, socioeconomic status, and cultural attitudes are known to result in differing health outcomes. The CDC reported that Attention-Deficit/Hyperactivity Disorder (ADHD) affects ~10% of United States (US) children, but the condition is often underdiagnosed and undertreated. The extent to which immigration-related challenges may adversely affect diagnosis/treatment of ADHD is unknown.

Objective: This study uses a nationally representative sample to examine associations between parental birth outside the US and ADHD diagnosis in children.

Design/Methods: This study used a cross-sectional analysis of a combined 2016-2019 National Survey of Children’s Health (NSCH) dataset. The NSCH uses a nationally representative population-based sample of children across the US. Caregivers report whether their child has a current diagnosis of ADHD from a medical provider. Odds ratios (OR), adjusted odds ratios (aOR), and 95% confidence intervals (95% CI) were derived from logistic regression models, with adjustment for potential sociodemographic confounders.

Results: From a sample of 82,245 children, children with one or two non-US-born parents were less likely to be diagnosed with ADHD (aOR=0.569, 95% CI: [0.431, 0.751]; aOR=0.537, 95% CI: [0.462, 0.625], respectively) (Table 1). ADHD had one of the lowest likelihoods of diagnosis in comparison to other developmental and behavioral conditions examined in this analysis. However, likelihood of a diagnosis increased as non-US-born parents spent more time in the US (Table 2). After a diagnosis, there were no substantial differences in receiving treatment for ADHD (Table 3).Conclusion(s): Parental birth outside the US was found to be a strong predictor of reduced rates of ADHD diagnosis in children. The lower likelihood of an ADHD diagnosis in children with non-US-born parents reflects an increasing need for public health education to raise awareness about ADHD among this population and the development of culturally sensitive ADHD identification methodologies that account for wide variations in perceptions of ADHD. Pediatricians should be aware that immigration-related challenges can preclude proper diagnosis of ADHD and employ early interventions in these communities.
Table 1. Likelihood of ADHD diagnosis in comparison with other developmental, behavioral, and mental health conditions, 2016-2019 National Survey of Children’s Health
Table 2. Association between ADHD Diagnosis in Children and Years that Non-US-born Parents Spent in the United States, 2016-2019 National Survey of Children’s Health