Attention-Deficit Hyperactivity Disorder (ADHD) is one of the most common disorders diagnosed among children in the US and is related to adverse health and academic functioning. However, little knowledge is available about ADHD prevalence among children of immigrants, the fastest-growing population in the US. Although critical changes have been made by CHIPRA and ACA, to our knowledge, ADHD prevalence among children of immigrants has not been adequately examined in the context of the post-policy intervention period. Moreover, little is unknown whether ADHD diagnosis varies by immigrant generation and family poverty, the vital health determinants of children of immigrants. This study seeks to examine ADHD diagnosis rates among children of immigrants in different generations compared to children of nonimmigrants and their association with family poverty in the context of CHIPRA and ACA.
The sample includes 83,362 children aged 0-17 from the National Health Interview Survey (NHIS) 2010-2018 data to reflect children’s ADHD diagnosis in the context of ACA and CHIPRA. Multivariate logistic regression model is used first to estimates prevalence of ADHD diagnosis among children of immigrants compared to children of nonimmigrants. We then compare ADHD diagnosis rates among children sample in different immigrant generations. As an additional analysis, we assess whether there are differences in ADHD diagnosis by the poverty threshold. Post hoc test is used to investigate whether there are differences in ADHD diagnosis between first- and second-generation children.
The odds of having ADHD diagnosis 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 nonimmigrants. Post hoc tests find that first-generation children had 58% lower odds of being diagnosed with ADHD compared to second-generation children. Likewise, additional analyses showed that children of immigrants were less likely to have ADHD diagnosis compared to children of nonimmigrants when separated by family poverty status in both adjusted and unadjusted results.
Conclusions and Implications
Using a nationally representative sample children, we find that the likelihood of having ADHD diagnosis decreases as the generation decreases, detecting differences in ADHD prevalence by immigration generation. Additional analyses supported that children of immigrants were more protected from ADHD conditions compared to their counterpart children of nonimmigrants, 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 could reduce a chance to be screened for ADHD, which makes 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. 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.