Mis(sed) Diagnosis: Physician Decision-Making and ADHD

• 成果类型: Article; Early Access
• 署名作者: Marquardt, Kelli
• 署名单位: Federal Reserve System - USA; Federal Reserve Bank - Chicago
• 刊物名称: JOURNAL OF POLITICAL ECONOMY
• ISSN/ISSBN: 0022-3808
• DOI: 10.1086/742421
• 发表日期: 2026
• 关键词: deficit-hyperactivity disorder; ATTENTION-DEFICIT; primary-care; deficit/hyperactivity disorder; CHILDREN; HEALTH; allocation; childhood; outcomes; text

摘要

The mechanisms driving disparities in mental health care are not well understood. This paper develops a structural model of diagnosis for attention deficit hyperactivity disorder (ADHD), highlighting how patient and physician factors can result in disparities. Using electronic health record data, I estimate model parameters and decompose the observed male & ratio;female ADHD diagnostic difference of 2.3 & ratio;1. Simulations show that only 20%-25% of this diagnostic difference can be explained by underlying symptom prevalence, with the majority driven by differences in diagnostic thresholds. I find that physicians view missed diagnosis to be costlier for their male patients, which I argue may have economic justifications.