The Attention-Deficit Hyperactivity Disorder (ADHD) Among Children of Immigrants: The Implications for the ACA and CHIPRA

Background and Purpose:

Attention-Deficit Hyperactivity Disorder (ADHD) is one of the most prominent illnesses among children in the US and is associated with adverse health and academic functioning. However, little is known about ADHD diagnosis among children of immigrants, the fastest-growing population in the US. Despite significant changes made by CHIPRA and ACA, few studies have examined ADHD prevalence among children of immigrants in the context of the post-policy intervention period. Furthermore, it is unknown whether ADHD diagnosis differs by immigrant generation and family poverty, the important health determinants of children of immigrants. To this end, this study examines ADHD rates among children of immigrants in different generations compared to children of nonimmigrants and their association with family poverty in the context of the CHIPRA and ACA.

Methods:

This study uses the National Health Interview Survey (NHIS) 2010-2018 data with the 83,362 sample children aged 0-17 to reflect children’s ADHD diagnosis in the context of ACA and CHIPRA. Using multivariate logistic regression model, this study first estimates the rates of ADHD diagnosis among children of immigrants compared to children of nonimmigrants. We then separate the children sample into different immigrant generations and compare the ADHD diagnosis rates. As an additional analysis, we assess whether there are differences in ADHD diagnosis by the poverty threshold. Post hoc test is run to examine whether there are differences in the diagnosis between first- and second-generation children.

Results

This study finds that children of immigrants have lower rates of having ADHD diagnosis compared to children of nonimmigrants. We find that the odds of having ADHD were significantly lower among first-generation (OR=0.20; CI=0.14-0.27) and second-generation children (OR=0.48; CI=0.42-0.55) compared to children of US-born parents. Post hoc tests find that first-generation children had 58% reduced odds of being diagnosed with ADHD compared to second-generation children. Additional analyses disaggregated by family poverty status corroborated our results from the pooled sample.

Conclusions and Implications:

Using a nationally representative sample children, we find that a likelihood of having ADHD diagnosis decreases as the generation decreases, identifying differences in ADHD diagnosis by immigration generation. Additional analyses confirmed that the children of immigrants were more protected from ADHD conditions compared to their counterpart children of US-born parents, regardless of family SES. The findings support previous research on assimilation theory wherein a lower level of exposure to the US culture protects children from adverse health conditions. Yet, it is also possible that a lack of visits to health care providers among immigrant families could make the children appear to be healthier than they actually are. Despite CHIPRA and ACA have expanded benefits, immigrant families may still underutilize health care resources until assimilation increases familiarity with the US health care system and policy restriction is lifted with a longer duration of residency in the US. The findings indicate that promoting access to health care use for screening ADHD, raising awareness of available public health care resources, and maximizing the potential of the ACA and CHIPRA may help children of immigrants receive timely treatment.