Do Māori Children Receive Equal Access to ADHD Medication Treatment in New Zealand?

What you need to know

• Māori children were more likely to be identified with ADHD concerns (2.8%) compared to non-Māori children (1.6%) during preschool health screenings.
• Among children with ADHD concerns, fewer Māori (10.8%) received medication treatment compared to non-Māori (14.9%).
• The disparity in medication access was most pronounced for Māori children living in highly deprived areas or outside major urban centers.

ADHD and Its Impact on Children

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by symptoms of hyperactivity, inattention, and impulsivity. It affects approximately 3.4% of children worldwide and is typically diagnosed in early childhood. ADHD is more common in boys than girls and has both environmental and genetic influences.

Children with ADHD are at higher risk for various adverse outcomes, including:

• Anti-social behavior and drug use
• Criminal convictions
• Mental health difficulties
• Poorer physical health
• Negative academic and occupational outcomes

Given these potential long-term effects, early identification and treatment of ADHD are crucial for improving children’s outcomes.

The B4 School Check: A Screening Tool for ADHD

In New Zealand, the Before School Check (B4SC) is a nationwide preschool health screening program offered to all children at 4 years of age. This check includes screening for social, emotional, and behavioral challenges, including ADHD symptoms.

As part of the B4SC, caregivers and early childhood teachers complete the Strengths and Difficulties Questionnaire (SDQ), a brief 25-item questionnaire designed to screen for possible emotional and behavioral difficulties in children. The hyperactivity-inattention subscale of the SDQ can indicate the severity of ADHD-like behaviors.

The Study: Investigating ADHD Treatment Disparities

Researchers conducted a study to investigate whether Māori children screened for ADHD concerns in the B4SC were as likely to receive medication treatment as non-Māori children. The study analyzed data from 414,171 children who participated in the B4SC between 2011 and 2018.

Key findings of the study include:

1. Prevalence of ADHD concerns:

   • 2.8% of Māori children were identified as having ADHD concerns
   • 1.6% of non-Māori children were identified as having ADHD concerns

2. Medication treatment rates:

   • 10.8% of Māori children with ADHD concerns received medication
   • 14.9% of non-Māori children with ADHD concerns received medication

3. Factors influencing treatment disparities:

   • The lower likelihood of medication treatment for Māori children was most significant among those living in the most deprived areas and outside of major urban centers.

Potential Factors Contributing to Treatment Disparities

Several factors may contribute to the gap in medication use between Māori and non-Māori children:

1. Impact of colonization and institutional racism:

   • Ongoing effects of colonization and institutionalized racism may contribute to a lack of trust in the healthcare system among Māori families.
   • Previous negative experiences with healthcare can influence decisions to access services in the future.

2. Lack of cultural representation in the healthcare workforce:

   • Limited representation of Māori professionals in the healthcare system can negatively impact engagement with health services.
   • Treatment compliance is often reduced when healthcare professionals and clients come from different cultural backgrounds.

3. Cultural concerns about the screening tool:

   • There have been concerns raised about the cultural appropriateness of the SDQ for Māori children.
   • Issues include the manner in which the SDQ is conducted, scoring thresholds, and whether it accurately considers behaviors in the context of Māori culture.

4. Different perspectives on health and treatment:

   • Pharmacological treatment may reflect a more Western, biologically based model of health.
   • Māori parents have reported concerns about the use of Western medicines for their children, including conflicting cultural wellbeing models and a desire for Indigenous-led approaches.

5. Access challenges:

   • The study found that disparities were most pronounced in highly deprived areas and outside major urban centers, suggesting that challenges in accessing treatment may be a key factor.

Implications and Recommendations

Addressing the inequity in timely access to ADHD treatment for Māori children is vital, as delays in treatment may have long-term effects on educational outcomes and exacerbate existing socio-economic inequities. Key strategies to improve access include:

1. Reducing financial barriers:

   • Lower costs associated with ADHD assessments and prescription fills.

2. Incorporating Māori models of health:

   • Integrate traditional Māori health concepts into treatment strategies.

3. Improving cultural competence in healthcare:

   • Invest in workforce development for culturally safe care.
   • Increase representation of Māori among mental health specialists.

4. Enhancing awareness and access:

   • Ensure Māori families are aware of and have access to all treatment options for ADHD.
   • Develop culturally appropriate information resources about ADHD and its treatment.

5. Addressing geographical disparities:

   • Implement targeted interventions to improve access to ADHD treatment in non-urban areas and highly deprived neighborhoods.

Conclusions

• Māori children identified with ADHD concerns were less likely to receive medication treatment compared to non-Māori children.
• The disparity in treatment access was most significant for Māori children living in highly deprived areas or outside major urban centers.
• Addressing barriers to healthcare access is crucial for reducing inequities in ADHD treatment between Māori and non-Māori children.
• Further research is needed to understand whether treatment disparities extend to non-pharmacological interventions and to identify specific barriers to accessing treatment for Māori families.