The potential for sociocultural factors in the diagnosis of ADHD in children.

PURPOSE: The nongenetic contributors to attention deficit/hyperactivity disorder (ADHD) remain to be identified. A previous study in eastern Wisconsin (prevalence 13.5%) suggested that male gender, white race, lower block group median household income and population density, and greater distance to the nearest park were factors predictive of ADHD diagnosis. We performed a similar study in Dane County, Wisconsin. METHODS: Cross sectional study of children age 5-17, with and without ADHD diagnosis, who received well child care in Dane County UW Family Medicine clinics (N=7954) 2007-2008. Street addresses were geocoded to 2000 Census block group. Univariate analysis was done by chi-square test or Mann-Whitney U test, multivariate analysis by logistic regression. RESULTS: ADHD diagnosis was present in 309 (3.9%) children (74.1% male; P = 0.000, compared to females) and more frequently diagnosed in black children (6.8% of black children had ADHD diagnosis) than white (4%), Native American (2.7%), Hispanic (1.6%), or Asian (1.3%) children. In contrast to eastern Wisconsin and to Milwaukee County (a subset of the eastern Wisconsin study where black rates were identical to that of Dane County), black race rather than white race was predictive of ADHD in Dane County, while median household income, population density, and distance to nearest park were not associated. The range of ADHD within school district boundaries was 2.4%-7.1% (for N > 100/district). In the group of districts with >4% ADHD diagnosis, the increased rates were largely among whites. CONCLUSION: ADHD diagnosis was much less common in this Dane County cohort than in eastern Wisconsin and was more common among blacks, but not predicted by other geo-demographic factors. Like eastern Wisconsin, ADHD diagnosis prevalence varied with apparent school district boundaries.