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Background:
Child psychiatric treatment facilities vary greatly worldwide and are virtually non-existent in many low-income countries. One of the most common psychiatric disorders in childhood is ADHD, with an estimated prevalence of 3-5% in Sweden. Previous studies have shown a similar prevalence of ADHD in minority and majority children in Swede...
Contexts in source publication
Context 1
... total of 14,405 individ- uals were excluded, leaving 1,385,397 Swedish born- children in the final study population. Table 1 describes the immigrant categories in the study, based on the parental country of birth obtained from the Swedish Register of Total Population. Children having two Swedish parents were recorded as having Swedish background. ...
Context 2
... a sensitivity analyses that had an ADHD diagnosis in specialised care as the outcome, the multiple logistic regression gave similar results as the medication out- come (Additional file 1: Table S1). Compared to children with native parents, children in the European middle- income category had the lowest odds of receiving an ADHD diagnosis (OR [95%CI] the prescriptions by practitioners who do not report to the Swedish Patient Register. ...
Citations
... Studies examining cross-cultural differences in the US reveal that compared to their non-minority peers, children from ethnic minorities are evaluated and treated for attention deficit hyperactivity disorder (ADHD) symptoms considerably less frequently (Morgan et al., 2013;Ray et al., 2006). European studies (Arat et al., 2018;Knopf et al., 2012;Schlack et al., 2007;Wittkampf et al., 2010) similarly found that compared to non-immigrant children, immigrant children had lower rates of ADHD diagnosis and therapy. Studies show that minority children are overdiagnosed with neurological disorders and disabilities and are disproportionately placed in special education despite growing concerns about the misdiagnosis and harmful health effects of ADHD within some minority communities (Coker et al., 2016). ...
According to recent data, many communities worldwide are multicultural nowadays. Culture is believed to significantly impact the creation of therapy materials, practice models, assessment instruments, and client collaboration. Also, recent works address the interaction between a therapist and a client and the need to understand a child's social needs. Even with significant advancements in the development and delivery of efficient treatments for children with ADHD, ethnic minority youths and teens continue to lag behind their non-minority peers in terms of diagnosis and treatment rates. Various learning and behavioral obstacles are linked to this disorder because of cognitive and metacognitive functioning difficulties. Individuals can only fully integrate into society if these functions have been acquired. Children can acquire alternate strategies to manage their cognitive deficits and adapt to different circumstances by using internal attention to build self-awareness, self-regulation, and self-control. The quick progress of research has led to the development of several medicinal and psychological strategies for treating ADHD, which significantly help with symptom management. The goal of the current study is to gain an understanding of the various therapeutic approaches used to help children from racial and ethnic minorities who are suffering from ADHD. These approaches include games using augmented reality (AR) environments.
... Crosscultural studies in the United States show that ethnic minority children are assessed and treated for attention deficit hyperactivity disorder (ADHD) symptoms far less frequently than their non-minority counterparts [2][3]. According to European Intercultural Education and ADHD: Τhe Use of Virtual Reality as a Means of Intervention and Assessment research [4][5][6][7], immigrant children also had lower rates of ADHD diagnosis and therapy compared to non-immigrant children. Despite increasing concerns about the misdiagnosis and detrimental health impacts of ADHD within certain minority communities, several studies indicate that minority children are being overdiagnosed with neurological disorders and disabilities, and are disproportionately placed in special education [8]. ...
People are looking to the digital world for solutions to the challenges they face in their every-day lives, as technology continues to advance rapidly. People with impairments now have equal access to learning opportunities due to technological advancements. ADHD (attention deficit hyperactivity disorder) has become more prevalent among children and teenagers from ethnic minorities in recent years. Due to challenges with cognitive and metacognitive func-tioning, this condition is associated with various learning and behavioral difficulties. People can only assimilate into the social environment once they have developed these functions. Children can learn alternative techniques to manage their cognitive deficiencies and adapt to various contexts by developing self-awareness, self-regulation, and self-control through inter-nal attention. With the rapid advancement of research, numerous medical and psychological approaches have been developed for the treatment of ADHD, significantly assisting in the management of symptoms. The current study examines different therapeutic strategies aimed at improving the quality of life for children from racial and ethnic minorities who are affected by ADHD. These strategies include video games with virtual reality (VR) environments.
... Therapies which appear to be promising for ADHD includes music therapy and physical therapy. Chess games have also been reported to show benefit in a few smaller studies [2,3]. ...
... Ethnic minority children are evaluated and treated for ADHD symptoms considerably less frequently than their nonminority peers, according to cross-cultural research conducted in the United States [2][3]. Also, compared to non-immigrant children, immigrant children have lower rates of ADHD diagnosis as well as therapy, according to studies conducted in Europe [4][5][6][7]. Other studies indicate that minority children are over-diagnosed with neurological conditions and impairments and are disproportionately represented in special education [8], despite growing concerns about the misdiagnosis and negative health outcomes of ADHD among some minority populations [9][10]. ...
... More specifically, many cultures have varied approaches to treating ADHD symptoms, and behaviors that are considered harmful in one culture may not be in another [4][5][6][7]. A cross-cultural study carried out in the United States has shown that ethnic minority children are assessed and treated for ADHD symptoms far less frequently than their nonminority counterparts [2][3]. ...
There is proof that kids and teens from ethnic minorities get less health care than their non-minority peers, despite the fact that Attention Deficit Hyperactivity Disorder (ADHD) is more common in these populations. Minority children might not receive timely, adequate ADHD intervention because of the low socioeconomic position of minority parents, their lack of awareness regarding ADHD, and the available remedial techniques. People are looking to the digital world for answers to challenges in their daily lives as the number of mobile applications grows. People with impairments now have equal access to learning opportunities because to technological advancements. The majority of their time is now spent on mobile devices by kids. As a result, using mobile applications to solve their problems would be quite successful. Mobile learning, also known as e-learning programs that utilize mobile devices, can be employed as a form of therapy to enhance both executive functioning and general well-being. Also, by practicing cognitive and metacognitive task abilities more frequently, they increase motivation in kids and teenagers. Also, the understanding and retention of the presented information might be aided by the audiovisual stimuli offered through smartphone applications. They may therefore serve as crucial learning aids for kids with ADHD. The current study examines the function and efficacy of mobile applications in enhancing the quality of life of children from ethnic minorities who have Attention Deficit Hyperactivity Disorder (ADHD), as well as the barriers that may impede or delay their access to treatment services.
... While the two studies cannot be compared directly, both of them suggested a lower initiation of ADHD medication within the immigrant population. Immigrants in general might be prone to underutilizing psychiatric health care (41)(42)(43)(44), but other factors such as cultural beliefs and attitudes toward behavioral symptoms and medication of ADHD (45,46), health literacy (47), language problems, or occupation might also contribute to less frequent medication initiation. A study among children, who were born between 1995 and 2004 in Sweden, found that children who had only foreignborn parents were less likely to use medication compared with children who had at least one Swedish-born parent, suggesting that ADHD medication use might be influenced by cultural factors (46). ...
... Immigrants in general might be prone to underutilizing psychiatric health care (41)(42)(43)(44), but other factors such as cultural beliefs and attitudes toward behavioral symptoms and medication of ADHD (45,46), health literacy (47), language problems, or occupation might also contribute to less frequent medication initiation. A study among children, who were born between 1995 and 2004 in Sweden, found that children who had only foreignborn parents were less likely to use medication compared with children who had at least one Swedish-born parent, suggesting that ADHD medication use might be influenced by cultural factors (46). Similar to our findings among adults, mental comorbidities were associated with a lower likelihood of ADHD treatment initiation among youth (24) and children (29). ...
Introduction
Long-term medication use is a recommended treatment for attention-deficit/hyperactivity disorder (ADHD), however, discontinuation is common. Non-medical factors which might influence initiation and discontinuation are understudied. Therefore, we investigated how different sociodemographic factors and comorbidities were associated with the initiation and discontinuation of ADHD medication use among young adults.
Methods and results
We conducted a population-based prospective cohort study using individually linked administrative register data, in which we included all individuals residing in Sweden, between the age of 19 and 29 who were first diagnosed with ADHD between January 2006 and December 2016 (n = 59224). ADHD medication initiation was defined as the first prescription of ADHD medication in the period from 3 months before to 6 months after the cohort entry date. Those who initiated ADHD medication were followed up for medication use until discontinuation, death/emigration, or until 2019. Logistic and Cox regression models were used to investigate the associations between sociodemographics, health-related predictors and initiation, as well as discontinuation. Overall, 48.7% of the 41399 individuals initiated ADHD medication, most often methylphenidate (87%). Among the initiators, 15462 (77%) discontinued medication use during the follow-up (median time: 150 days). After mutually adjusting all other predictors, initiation was positively associated with older age, male sex, higher level of education, and negatively associated with living at home with parents, immigrant status, being unemployed during the year before inclusion, being on disability pension, having autism, substance use, schizophrenia-spectrum disorders, other mental disability/developmental disorders, cardiovascular diseases or previous accidents. Discontinuation was positively associated with being born abroad, living in big cities, being unemployed during the year before inclusion, having cancer, and negatively associated with a higher educational level, having depression, anxiety or stress-related disorder, autism spectrum disorder or diabetes.
Conclusion
Besides medical factors, sociodemographics, such as educational attainment and immigrant status might also play a role in the initiation and discontinuation of ADHD medication use among young adults newly diagnosed with ADHD.
... Children with an immigrant background had lower odds of being diagnosed with ADHD than children with Norwegian-born parents, in contrast to studies from Finland, where children of immigrants were more likely than others to be diagnosed with ADHD [13]. In Sweden, children with parents from low-and middle-income countries have been found to have lower levels of ADHD medication than children with two Swedish born parents, whereas children of parents from high-income countries, or with one immigrant and one Swedish-born parent, had the same level of ADHD medication as children with two Swedish-born parents [21]. Environmental factors most consistently associated with ADHD are pre-and perinatal factors, such as severe early deprivation and psychological stress during pregnancy, low birth weight, and prematurity. ...
Background
Risk of being diagnosed with different developmental disorders is found to vary with immigrant background. Knowledge about such differences in Norway are a starting point for equity in health services quality, and for early identification and prevention. Our objective was to assess the risk of receiving diagnoses of developmental disorders among children born in Norway (2006–2017) to two or one immigrant parent compared to children with two Norwegian-born parents.
Methods
Information on developmental disorders was from the Norwegian Patient Register (NPR) and information on immigrant background, parental country of origin, parental education, and household income from Statistics Norway. We estimated hazard ratios (HR) with Cox proportional hazard regressions. With children with Norwegian background as reference category, we estimated HRs for immigration background and region of origin. All analyses were adjusted for sex, year of birth, parental education, and household income.
Results
Children with two immigrant parents had a lower risk of receiving any developmental disorder diagnosis [HR 0.80 (95% CI 0.77, 0.82)] than children with Norwegian background, and lower risk of being diagnosed with attention deficit hyperactivity disorder (ADHD) diagnosis [HR 0.24 (95% CI 0.22, 0.27)], learning difficulties diagnosis [HR 0.39 (95% CI 0.33, 0.47)], and behavioral and emotional disorders [HR 0.52 (95% CI 0.49, 0.55)]. Children with immigrant parents had higher hazard than Norwegian background children of autism spectrum disorder (ASD) [HR 2.21 (95% CI 2.04, 2.39)], mental retardation [HR 1.84 (95% CI 1.64, 2.07)], language disorders [HR 1.30 (95% CI 1.20, 1.40)], and unspecified developmental disorders [HR 1.22 (95% CI 1.17, 1.28)]. Children with only one immigrant parent had lower risk of diagnoses than children of two immigrants.
Conclusion
Risk of receiving a diagnosis of various developmental disorders varied substantially by immigrant background. Understanding the underlying mechanisms of these differences is warranted to ensure equity in health services and timely intervention.
... Previous studies show problematic trends in terms of utilization of mental health services among migrant children and youth within the Scandinavian universal health care system. While findings indicate an under-utilization of outpatient specialist psychiatric care among migrant children, emergency psychiatric and inpatient care have been found higher among refugee children compared to their majority peers [8][9][10], suggesting that refugee children access care at a higher severity of symptoms [11] and that migrant children overall face barriers to out-patient services. A systematic review of migrant children's health care utilization confirmed this picture; while migrant children had reduced use of most types of health services, including mental health care, migrant children's use of emergency and hospital services was higher than native populations' use of such services [12]. ...
... Thus, examining utilization among migrant children of all ages allows for a more complete understanding of service utilization, including the youngest age-groups whose utilization up to date has not been well examined [6,9,10]. Moreover, several studies show that migrant children are significantly less likely to be prescribed ADHD-medication or to be diagnosed with high functioning autism spectrum disorder (ASD) compared to majority individual [8,25,26]-despite a lack of evidence that the prevalence of such disorders are lower among migrants.. Therefore, a possible under-diagnosis of these conditions may be at play [27], although some studies suggest a higher risk of being diagnosed with ADHD among descendent children to immigrant parents, and an increased likelihood to be diagnosed as parental time in the new country increases [9,28]. Nonetheless, given that disparities in diagnosis and treatment of neurodevelopmental disorders have been demonstrated among ethnic and migrant groups [29,30], it is fruitful to investigate whether the under-utilization of psychiatric care among migrants that has been observed could in part be explained by the lower utilization of care related to neurodevelopmental conditions. ...
... Our results regarding neurodevelopmental disorders substantiates the previous findings of lower utilization of ADHD-medication among children with an immigrant background [8,25] and could partially explain the overall lower use of mental health services, evident especially for nonrefugee migrants across all age-groups. Although research on the mental health of non-refugee migrants have yielded inconclusive results [7,39,40], the previous research suggests that neurodevelopmental disorders are in fact underdiagnosed among migrant children [27]. ...
Purpose
Migrant children underutilize mental health services (MHS), but differences according to age, reason for migration, type of problem, and time have not been thoroughly analyzed. We aimed to explore utilization of MHS among migrant children and youth and to study if the hypothesized lower utilization could be explained by fewer neurodevelopmental assessments.
Methods
A cohort of the population aged 0–24 years in Stockholm, comprising 472,129 individuals were followed for maximum 10 years, between January 1, 2006 and December 31, 2015. We categorized individuals as accompanied refugee migrants, unaccompanied refugee migrants and non-refugee migrants, or Swedish-born. We used survival and logistic analyses to estimate rates of utilization of MHS.
Results
Migrant children and youth utilized less MHS than the majority population, with hazard ratios ranging from 0.62 (95% CI: 0.57; 0.67) to 0.72 (95% CI: 0.69; 0.76). Refugee and non-refugee children utilized less mental health care than their Swedish peers, apart from the youngest refugees (0–10 years) who had similar utilization as Swedish-born. The lower rates were partly explained by all migrant youths’ lower risk of being diagnosed with a neurodevelopmental condition. Time in Sweden had a major impact, such that unaccompanied refugee minors had a higher utilization in their first 2 years in Sweden (OR: 3.39, 95% CI: 2.96; 3.85).
Conclusion
Migrant youth use less MHS compared with native-born peers, and this is partly explained by fewer neurodevelopmental diagnoses. Strengthening the awareness about unmet needs, and the referring capacity by professionals in contact with migrant children could help reduce barriers to care.
... ADHD was defined as either NPR ADHD diagnosis and/or ADHD medication in the PDR. In Sweden, these medications can only be prescribed by a specialist in psychiatry or child and adolescent psychiatry thus being a good proxy for ADHD diagnosis [30]. ...
... We defined healthy controls as individuals without any child and adolescent psychiatry contact. Families with immigrant background are less likely to seek help from specialist psychiatric services [30]. It is therefore possible that some participants in need of child psychiatry or exposed to CM were misclassified as healthy controls. ...
Childhood maltreatment is considered a risk factor for substance use disorders (SUD), but this is largely based on retrospective self-reports that are subject to recall bias, designs that do not control for familial confounding, or both. The specific contribution of childhood maltreatment to SUD risk thus remains unclear. Here, we evaluated this contribution in a prospective cohort with objectively recorded childhood maltreatment, using a design that allows controlling for familial confounding. We used medical records and registers to study 525 young adults (20–37 years) with prospectively and objectively documented severe maltreatment exposure, 1979 clinical controls (unexposed former child and adolescent psychiatry patients), 1388 matched healthy controls; and their siblings and cousins. We examined the association between maltreatment and SUD using Cox regression models in the population, as well as stratified within siblings in the same family. SUD risk was significantly increased with childhood maltreatment exposure (crude HR: 6.61, 95% CI: 5.81–7.53; HR adjusted for sex, birthyear, externalizing problems, parents’ SUD and socioeconomic factors: 3.50, 95% CI 2.95, 4.16). An approximately threefold elevated SUD risk remained when comparing exposed individuals with their unexposed siblings (adjusted HR: 3.12, 95% CI 2.21, 4.42). We provide estimates of the association between childhood maltreatment and SUD accounting for possible confounds of both recall bias and familial factors. When familial confounding is controlled for, SUD risk attributable to severe childhood maltreatment is decreased, but nevertheless considerable. These findings establish a specific contribution of childhood maltreatment to SUD, underscoring the need for SUD prevention in young people exposed to maltreatment.
... This suggests that current efforts may still be insufficient to address disparities in access to neurodevelopmental care for immigrant families in France. When considering ADHD care, studies have consistently shown lower use of ADHD medication in children of immigrants (114). For example, a study on Dutch ADHD patients aged <19 years found that higher proportions of patients with Turkish or Moroccan backgrounds reported never having used ADHD medication compared to nonimmigrant Dutch patients. ...
Children of immigrants may have higher neurodevelopmental risks than those of non-immigrant populations. Yet, some evidence suggests that this group may receive late diagnosis, and therefore miss beneficial early interventions. Clinicians may misattribute symptoms of disorders to other social, behavioral or language problems. Likewise, there might be cultural differences in parents' likelihood of perceiving or reporting first developmental concerns to clinicians. Population-based standardized screening may play an important role in addressing ethnic inequalities in the age at diagnosis, although further research focusing on cross-cultural use is necessary. Once children are diagnosed, clinicians may rely on culturally sensitive procedures (translation services, cultural mediators) to increase the accessibility of interventions and improve adherence among immigrant families. In this brief review, we provide an overview about what is currently known about the epidemiology and risk factors of neurodevelopmental disorders, paying special attention to autism spectrum disorder (ASD), in children of immigrants and suggest the necessity of population-based screening and culturally sensitive care.
... a Except Sweden and Finland b Small sample size immigrants. The authors found that having parents in low-income or non-European countries is associated with a lower uptake of ADHD medication [41] (used as a proxy of ADHD), which is in agreement with our findings. The risk of ADHD among the immigrant children and adolescents in our study did not entirely match that of the general population in their countries or regions of origin as reported by estimates from the Global Burden of Disease [20]. ...
... All residents in Sweden receive free healthcare services from birth through the age of 18 years and, from Jan 1st 2016, prescribed medications to this age group is also free of charge. However, during the follow-up period in our study, ADHD medication was not free for children [41]. This may especially affect immigrants that have poorer economic resources than natives. ...
Background
Studies on the incidence of Attention Deficit Hyperactivity Disorder (ADHD) among immigrant children and adolescents is limited and results are mixed. The aim of this study was to compare the ADHD risk between first- and second-generation immigrants aged 4–16 years and their native peers in Sweden.
Methods
This was an open nationwide retrospective cohort study. We included 1,902,526 native and 805,450 children and adolescents with an immigrant background, born 1987–2010, and aged 4–16 years at baseline. We identified participants using national population data and participants were observed until they received an ADHD diagnosis in the National Patient Register, turned 18 years, migrated, died, or until the end of the study, whichever came first. ADHD risks were adjusted for birth year and age and maternal income at baseline.
Results
For both males and females, the ADHD risk was lower among most immigrant groups. However, the combination of a Swedish-born mother and foreign-born father was associated with an increased risk of ADHD. The ADHD risk varied substantially between immigrants from different regions of the world. For example, immigrants from other Scandinavian countries, North America, and Latin America and the Caribbean had higher rates of ADHD compared with natives.
Conclusions
Future research should examine the underlying factors behind the differences in ADHD risks between certain immigrant subgroups and natives, such as family structure, cultural and language barriers and potential differences in health care utilization among immigrant families.
