N E W RE S E A R C H PO S T E R S
5.19 — 5.21
5.19 A LITERATURE REVIEW: RACIAL AND
ETHNIC DISPARITIES IN THE DIAGNOSIS AND
TREATMENT OF ADHD
Ravipreet Gosal, MD, Johns Hopkins University,
rgosal1@jh.edu; Bushra Rizwan, MD, Hal Kronsberg, MD
Objectives: ADHD is a neurodevelopmental disorder characterized by
symptoms of inattention, hyperactivity, and impulsivity. ADHD has a preva-
lence rate of approximately 5% in children and responds well to therapeutic
interventions. If untreated, ADHD can cause impairment in academic and
social functioning. This review aims to study the current literature to identify
disparities in diagnoses and treatment among non-Hispanic White and ethnic
and racial minority patients.
Methods: A literature review was conducted among studies from the last 10
years from PubMed and PsycINFO. The search terms used in PsycINFO were
“treat/intervention or diagnosis/assess or clinical decision” and “ADHD and
racial bias/racial or ethnic differences.” The search terms used in PubMed
were “ADHD,” “ADHD and racial disparity,” and “ADHD, treatment and racial
disparities.” Combined, 36 studies were imported for screening from 2
sources with 9 duplicates, leaving 27 studies. Of these, 5 were considered
irrelevant by authors. A full-text review was done for 22 studies.
Results: Nearly all studies showed that ethnic and racial minority children,
mainly African Americans and Latinx, were less likely to be diagnosed with
ADHD when compared to the non-Hispanic White youth. These disparities
remained even after various environmental and sociocultural confounding
factors were statistically controlled for by logistic regression. Furthermore,
minority children were also less likely to receive care and were at risk of early
discontinuation of treatment. Two recent studies have shown increasing rates
of diagnosis and treatment of ADHD in Black children; however, the disparity
remains.
Conclusions: Although ethnic and racial minority children exhibit the same
severity of ADHD symptoms when compared to non-Hispanic White youth,
they are less likely to be diagnosed with ADHD and have decreased odds of
receiving appropriate psychopharmacologic and other treatment modalities.
Barriers to care included minority status, less parental education, and lack of
insurance, which decreased the chances of getting a comprehensive evalua-
tion and which also decreased the odds of identifying comorbidities associ-
ated with ADHD. When ethnic minority children receive less comprehensive
evaluations, there may be more opportunities for unconscious bias to impact
diagnosis and treatment.
ADHD, DEI, PPC
https://doi.org/10.1016/j.jaac.2021.09.067
5.20 CLINICAL AND NEUROPSYCHOLOGICAL
CHARACTERISTICS OF CHILD AND ADOLESCENT
OFFSPRING OF PATIENTS WITH
SCHIZOPHRENIA: THE ROLE OF ADHD
Elena De la Serna, PhD, Centro de Investigaci
on Biom
edica
en Red de Salud Mental (CIBERSAM), eserna@clinic.cat;
Patricia Camprodon-Boadas, MBA, Gisela Sugranyes,
Daniel Ilzarbe, MD, Inmaculada Baeza, MD,
Dolores Moreno, MD, Nuria Martin, Covadonga Diaz-
Caneja, PhD, Miriam Ayora, Maria Dolores Picouto, MD,
Josefina Castro-Fornieles, PhD
Objectives: The present study is part of the Bipolar and Schizophrenia Young
Offspring Study (BASYS). In the current study, we analyze the clinical and
cognitive characteristics of a sample of child and adolescent offspring of
patients with schizophrenia (SZoff) diagnosed with ADHD (SZoff-ADHD)
compared to a sample of children with ADHD without a family history of
psychotic disorders and a sample of healthy controls (HCs).
Methods: A sample consisted of 22 SZoff-ADHD children, 15 children with
ADHD with no familial history of psychotic disorders, and 40 HCs between 6
and 17 years old. All subjects completed clinical and neuropsychological as-
sessments. The clinical assessment included: the K-SADS, the Structured
Interview for Prodromal Symptoms and the Scale of Prodromal Symptoms
(SIPS/SOPS), and the Global Assessment Functioning (GAF). The
S156 www.jaacap.org
neuropsychological assessment included the following areas: intelligence,
working memory, processing speed, verbal memory, and executive functions.
Results: Significant differences between groups were found in socioeconomic
status, which was lower in the SZoff-ADHD group than in the other 2 groups (F
¼ 15.886; p < 0.001). Moreover, the SZoff-ADHD group also showed a higher
percentage of males (90.9%) compared with the ADHD group (62.5%) and the
HCs (45%) (F ¼ 12.647; p ¼ 0.002). Regarding clinical assessments, the SZoff-
ADHD group obtained higher scores than the HC group on all SIPS/SOPS
subscales and lower scores in the GAF. The ADHD group obtained signifi-
cantly higher scores than the HC group in disorganized and total symptoms of
the SOPS and lower scores on the GAF. Significant differences were detected
between the SZoff-ADHD and ADHD groups in the positive, disorganized,
and total subscales of the SOPS, whereas the SZoff-ADHD group obtained
higher scores than the ADHD group. Regarding cognition, the SZoff-ADHD
group scored lower than the HC group in intelligence, working memory,
processing speed, and verbal memory, while the ADHD group only obtained
lower scores than the HC group in verbal memory. The SZoff-ADHD group
scored lower than the ADHD group in intelligence and working memory.
Conclusions: Compared with the HC group, the SZoff-ADHD group displayed
more subclinical psychotic symptoms and worse psychosocial functioning.
The ADHD group showed an intermediate pattern between the SZoff-ADHD
and HC groups.
ADHD, SZ, BRD
Supported by Instituto de Salud Carlos III Grants PI18/00696 and
PI17/00741, and Catalonia Government Grant 2017SGR881
https://doi.org/10.1016/j.jaac.2021.09.068
5.21 ASSOCIATION OF VITAMIN D DEFICIENCY
AND ADHD: EVIDENCE FROM A NATIONAL
INPATIENT SAMPLE IN THE UNITED STATES
Chintan Trivedi, MD, MPH, Texas Tech University Health
Science Center, docchintantrivedi@gmail.com;
Kaushal Shah, MD, MPH, Griffin Memorial Hospital/
Oklahoma Department of Mental Health and Substance
Abuse Services, kpshahmd@gmail.com;
Zeeshan Mansuri, MD, MPH, Mounica Thootkur, MD,
Ramu Vadukapuram, MD, Abhishek Reddy, MD
Objectives: ADHD is the most common neurodevelopmental childhood dis-
order. Hyperactivity and inattentivity at home and school are important features
of ADHD. Even though 6.1 million (9.4%) children in the United States have
ADHD, 23% of them do not receive any form of treatment. Because previous
studies have found a relationship between ADHD and vitamin D (VitD) defi-
ciency, we aim to explore their association using large sample size data.
Methods: We used the 2016-2018 National Inpatient Sample (NIS) datasets to
identify 2 groups of subjects through the ICD-10 diagnostic code: Group 1
patients with VitD deficiency and Group 2 with normal VitD levels. Groups
were compared for ADHD prevalence and demographic characteristics. OR
and 95% CI were used to evaluate ADHD and VitD deficiency associations.
Results: A total of 32,365 discharge records were identified for patients with
the VitD deficiency. The control group (without VitD deficiency) was
composed of 1,632,199 patients. The age distribution (mean age 14.9 years)
was similar between the 2 groups. More females had VitD deficiency (62.4% vs
58.5%). ADHD was prevalent in 14% of patients with VitD deficiency compared
to 11.7% of patients with normal VitD levels (OR ¼ 1.22; 95% CI, 1.09-1.37).
After controlling for age, gender, race, and median household income, VitD
deficiency was associated with 31% higher odds of having ADHD (OR ¼ 1.31;
95% CI, 1.17-1.46). Including other conduct disorders along with ADHD as an
outcome, the odds of having ADHD and conduct disorders were 1.34 times in
patients with VitD deficiency (OR ¼ 1.34; 95% CI, 1.18-1.52).
Conclusions: Findings reveal a strong association between VitD deficiency
and ADHD. Early screening for VitD deficiency and treatment might help to
prevent or alleviate ADHD symptoms. We recommend large-scale well-
designed clinical trials and longitudinal studies to further establish an
association.
ADHD, ADOL, OTH
https://doi.org/10.1016/j.jaac.2021.09.069
Journal of the American Academy of Child & Adolescent Psychiatry
Volume 60 / Number 10S / October 2021