ADHD in Black and Hispanic adults: what research shows about underdiagnosis

ADHD occurs across every racial and ethnic group, and the diagnostic criteria are the same for everyone. Yet in the United States, Black and Hispanic adults are diagnosed less often than white adults. Whether that gap means ADHD is less common, or that it is less often recognized, is an important question for anyone wondering whether their own struggles deserve a closer look. This page summarizes what peer-reviewed research shows, where the evidence is limited, and what to expect from an evaluation.

A note on language: studies use different group labels (for example Black or African American, Hispanic or Latino). This page uses the terms each study used. People within each group are diverse, and none of the findings below describe any individual.

What the numbers show

Adults

The largest adult study is from Kaiser Permanente Northern California, published in JAMA Network Open in 2019. It covered more than 5.2 million adult members from 2007 to 2016. Adult ADHD diagnoses rose in every racial and ethnic group over that period, but white adults consistently had the highest rates.

These are diagnosis rates in one health plan's records, not true prevalence, and they are far below survey estimates of how many adults have ADHD. The authors concluded the data showed substantially lower rates of detection among minority racial and ethnic groups. The same study found that adults with depression, anxiety, bipolar disorder or an eating disorder had higher odds of an ADHD diagnosis, a reminder that ADHD often travels with other conditions and an evaluation needs to look at all of them.

The CDC's national survey of US adults in late 2023 gives another view. Among adults with a current ADHD diagnosis, 70.4% were white, 16.6% Hispanic or Latino, 7.4% Black and 5.6% another group. That describes who makes up the diagnosed group, not the rate within each group.

Adolescents and young adults

A 2024 study in Psychiatric Services used claims for more than 4.2 million commercially insured young people from 2014 to 2019. In every age band from 12 to 25, Asian, Black and Hispanic youth were less likely than white youth to have visits with a recorded ADHD diagnosis. Among those who were diagnosed, differences in treatment were small. Everyone in the study had commercial insurance, so the gap appeared even among insured young people.

Underdiagnosis or lower prevalence?

Lower diagnosis rates could mean ADHD is less common in a group, or that it is missed. Several studies help separate the two, though most of them involve children:

• Accounting for symptoms. A 2016 study in Pediatrics followed 4,297 children through fifth, seventh and tenth grades. After controlling for ADHD symptoms and other mental health symptoms, Black and Latino children had lower odds of an ADHD diagnosis and of taking ADHD medication than white children. Among children with neither symptoms nor a diagnosis, medication use did not differ by race or ethnicity. The authors concluded the disparities were more likely related to underdiagnosis and undertreatment of Black and Latino children than to overdiagnosis of white children.
• A national birth cohort. A 2021 study of 238,011 insured children found that, after adjusting for sex, region and household income, Black children had about a 17% lower rate of ADHD diagnosis and Hispanic children about a 23% lower rate than white children.
• Pooled prevalence. A 2021 meta-analysis in JAMA Psychiatry pooled 21 US studies with more than 150,000 Black participants and estimated ADHD prevalence at 14.54%. The authors wrote that, contrary to the statement in DSM-5 that prevalence is lower among Black individuals, their results suggest Black individuals are at higher risk for ADHD diagnoses than the general US population. Only two of the included studies assessed adults, and the estimate was imprecise (95% confidence interval 10.64% to 19.56%).

Taken together, the research points toward underrecognition rather than a lower true rate, at least in childhood. For adults, the direct evidence is thinner. Researchers in these studies say more work is needed to understand why the gaps exist; the studies above were not designed to identify a cause, so this page does not guess at one. A 2022 review of adult ADHD treatment noted that most research on ADHD has used predominantly white samples, which limits what is known about how ADHD and its treatment play out in other groups.

Why a missed childhood diagnosis matters in adulthood

An adult ADHD diagnosis requires several symptoms before age 12. NIMH notes that diagnosing adults is complicated by this requirement and that it relies heavily on past reports of behavior. If ADHD was never considered when you were a child, there may be no paper trail: no school evaluation, no pediatric records. That does not rule out a diagnosis, and adult diagnosis is common: in the CDC survey, 55.9% of adults with a current ADHD diagnosis received it at 18 or older. Report card comments, family memories and your own account of school all count. The New York guide explains how evaluation works without childhood records, and the symptoms guide has advice on asking family about childhood symptoms.

Getting a careful evaluation

• Describe impairment in your own terms. Concrete examples from work, school, money and relationships help more than labels.
• Mention earlier diagnoses. If you were told you had a behavior problem, a learning problem, anxiety or depression, say so. An evaluation considers whether those fit, overlap with ADHD, or explain the symptoms instead.
• Ask about language. If you would be more comfortable in Spanish or another language, ask any office before booking whether that is possible, and whether a family member can join to describe your childhood.
• Ask about cost up front. For public coverage, see New York Medicaid and adult ADHD, NJ FamilyCare and adult ADHD, and lower-cost ADHD care in New York.

You are entitled to ask any clinician how they reached a conclusion, and to get a second opinion if something does not fit.

When to talk to a clinician

It is worth talking to a clinician if focus, organization, restlessness or impulsivity have caused problems since childhood and still affect your work, studies or relationships, whether or not anyone raised ADHD when you were young. The adult ADHD self-test can help you organize what you notice, but it cannot diagnose ADHD or rule it out.

Dr. Shershow is a psychiatrist who focuses on adult ADHD and sees adults located in New York or New Jersey. His evaluation covers current symptoms, childhood, school and work history, health (medical history, medications, sleep, substances) and other explanations such as anxiety, depression or stress, and ends with what it found and the treatment options that fit. See ADHD testing in NYC or ADHD testing in New Jersey, or call the office.