A white boy who lives in the city and has an older teacher is more likely to be diagnosed with attention deficit hyperactivity disorder than a black girl who lives in the South and has a white teacher, according to a study of thousands of elementary school students that was published in the April issue of Pediatrics, the journal of the American Academy of Pediatrics.
In addition, children are more likely to be diagnosed with ADHD, a condition characterized by inattentiveness or impulsivity, in states with strong state-level school accountability laws, the study adds.
The study developed a scale of four measures of accountability: state school report cards, school ratings, rewards for schools based on test scores, and sanctions based on scores. A child in a state with one such accountability measure was 1.32 times more likely to be diagnosed with ADHD than a child in a state with none, and the likelihood increased as accountability measures were added.
“Who Receives a Diagnosis of Attention-Deficit/ Hyperactivity Disorder in the United States Elementary School Population?” is posted by the journal Pediatrics.
Such a correlation was expected, said Helen Schneider, a visiting professor of economics at the University of Texas at Austin, and one of the study’s co-authors. But “it was a little bit surprising how significant it was,” she said.
Ms. Schneider and Daniel Eisenberg, an assistant professor of health management and policy at the University of Michigan in Ann Arbor, gathered their data from the Early Childhood Longitudinal Study, a U.S. Department of Education-funded data-collection effort on thousands of children across the country. The data are made available to researchers for a variety of studies.
The authors studied a cohort of children who started kindergarten in fall 1998, and the same children in spring 2002. Most of the students were in 3rd grade, unless they skipped or repeated one or more grades. The sample size ranged from 5,998 children to 9,278 children, depending on what variables were being measured.
By the time the children had reached 3rd grade, about 5.4 percent of them had a diagnosis of ADHD, according to the study. Several factors were found to give children a significantly higher chance of receiving that diagnosis, including being male, white, living in an urban location, or being born to parents from the United States.
Greater Vigilance?
Accountability standards played a role, the researchers suggested, because teachers and schools in those states with tougher standards could have an extra incentive to recommend evaluation if it led to treatment that improved academics and reduced problematic behavior.
The researchers also found a correlation between being born in the summer, possibly because those children are younger than others in the same grade and therefore appear to be more impulsive and immature than their older classmates, Ms. Schneider said.
George A. Giuliani, the co-director of the National Association of Special Education Teachers, in Washington, said such research will prompt more conversation about accountability standards and their role in schools and ADHD evaluations.
“It’s good we’re taking notice, because this is definitely an issue that teachers are facing,” said Mr. Giuliani, who is an education professor at Hofstra University in Hempstead, N.Y.
Dr. Andrew Adesman, an adviser to Children and Adults with Attention Deficit/Hyperactivity Disorder, a Landover, Md., group, said the study found some interesting correlations. The research could be suggesting that in states with strict accountability standards, “there might be greater vigilance or a lower threshold for diagnosis,” he said.
But it is no surprise that a variety of factors play a role in the diagnosis of ADHD. “You could probably show this for anything,” said Dr. Adesman, the chief of developmental and behavioral pediatrics at Schneider Children’s Hospital in New Hyde Park, N.Y.
Diagnosed asthma, for example, is not randomly distributed throughout the population, he said. Just as with ADHD, some of the variability in reported frequency of that condition is related to differences in rates of diagnosis and availability of treatment, he said.
