More Attention Should be Paid to Immigrant Children With ADHD


Immigrant children were less likely to be diagnosed with ADHD compared to children of US born parents.

Duy Pham, BA

Duy Pham, BA

New research presented during the 2021 American Academy of Pediatrics (AAP) virtual meeting shows children born of immigrant parents are less likely to be diagnosed with attention deficit/hyperactivity disorder (ADHD), but those who are diagnosed likely to need special attention paid to their condition.

A team, led by Duy Pham, BA, Research Intern,Cohen Children's Medical Center, identified the associations between parental birth outside the US and ADHS diagnosis in children using a nationally representative sample.

There are a number of health-related challenges for children of immigrant families.

“Children of immigrants face unique challenges due to environmental, cultural, and physical factors that may adversely impact their development,” the authors wrote. “Immigration-related linguistic isolation, parental education and employment, socioeconomic status, and cultural attitudes are known to result in differing educational and health outcomes.”

Currently, the US Centers for Disease Control and Prevention (CDC) estimated 10% of US children have ADHD, although the condition is often underdiagnosed and undertreated, particularly for immigrant children.

The Study

The investigators used datasets from a combined 2016-2019 National Survey of Children’s Health (NSCH) and conducted a secondary analysis using logistic regression model.

Parental birth outside of the US was the predictor variable, while the response variables were rates of ADHD, autism spectrum disorder (ASD), diabetes, asthma, and heart conditions in pediatric patients between 3-17 years, compared to children with US-born parents.

The data was adjusted for patient’s age, race, household income, highest level of education of adults in the household, insurance coverage, and primary language spoken in the household.

The Risk of ADHD

Interestingly enough, children with ADHD were less likely to born of a household with both parents born outside the US (aOR, 0.341; P <0.001).

However, the risk of ADHD increased with either 1 parent (aOR, 0.452; P <0.001) or 2 parents (aOR, 0.452; P <0.001) born in the US.

The trends remained similar for all the other conditions examined in the study.

Conclusions Drawn

“Parental birth outside the US was found to be a strong predictor of reduced rates of ADHD diagnosis in children,” the authors wrote. “Although lower rates of diagnosis for the other studied conditions were all strongly predicted by parental birth outside the US, ADHD had the lowest likelihood of diagnosis, even after adjustment.”

However, despite the results ADHD should be a particular concern for children of immigrants because of various factors, including language and educational barriers, cultural attitudes, and access to medical resources.

There are some ways to close these gaps, including the use of rating scales to evaluate the utility, robustness, cultural relevance of diagnosing children of immigrants with ADHD.

“Pediatricians should be aware that immigration-related challenges can preclude proper diagnosis of ADHD and employ early interventions in these communities,” the authors wrote. “Proper identification and treatment of behavioral challenges in children of immigrants is needed to ensure healthy development.”

The study, “Parental Birth Outside the United States as a Predictor of ADHD Diagnosis in Children,” was published online by AAP 2021.

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