Racial Disparities in ADHD Diagnoses
One of the most glaring factors in the differences between how ADHD is handled in white vs. non-white populations is the rate of diagnosis. According to several studies, minority children have been found to be less likely to receive an ADHD diagnosis compared to white children. This was found in African America, Hispanic, Asian, and other minority communities, with African American children generally experiencing the greatest level of disparity. In fact, one study found that the rate of diagnosis in African American children was 69% lower compared to that of white children.
In that study, a number of factors were found to influence the likelihood that a child would receive an ADHD diagnosis. Some of those factors included:
- Being a boy
- Having an older mother
- Living in an English-speaking household
- Exhibiting externalized problem behaviors
Meanwhile, the factors that decreased a children’s likelihood of ADHD diagnosis included:
- Exhibiting learning-related behaviors
- Greater academic achievement
- Lack of health insurance
Not all studies have these types of findings across racial and ethnic lines, however. There are also some studies which actually show a higher rate of diagnosis among certain minority communities. For example, a study from the National Center for Health Statistics (NCHS) found that non-Hispanic black children were more likely than non-Hispanic white children and Hispanic children to be diagnosed with ADHD or a learning disability.
It’s worth noting that the disparities in this study were less extreme than in the one cited above. NCHS researchers found the following rates of diagnoses among these groups:
- Non-Hispanic black children: 16.9%
- Non-Hispanic white children: 14.7%
- Hispanic children: 11.9%
Some of the reasons suggested for the higher rates of diagnoses among Black children include a lack of cultural competency and implicit racial bias.
Racial Disparities in ADHD Treatment
The potential barrier to diagnosis is only the beginning when it comes to the differences for minority individuals with ADHD. Getting proper treatment can also be another challenge to overcome. One study of Medicaid-enrolled children found that African American children were less likely to receive adequate follow-up care when beginning a medication treatment compared to white children. Both African American and Hispanic children were more likely to receive combined treatment involving both medication and psychotherapy versus medication alone compared to white children. Those minority groups were also more likely to discontinue medication and disengage from treatment.
Overall, white children have been found to be more likely to receive treatment for their ADHD, whether through medication, behavioral therapy, or both. This is a serious concern for minority communities as untreated ADHD can have serious mental health effects while also impacting educational and social milestones. Some of the potential outcomes of untreated ADHD include:
- Academic struggles
- Strain on family and friend relationships
- Increased risk of driving accidents among teenagers
- Higher rates of divorce and job loss among adults
Barriers to ADHD diagnosis and treatment in minority communities can arise for a number of reasons. In the Black community, for example, there is a history of mistreatment that has caused many individuals to lack trust in the medical system. Some may fear a diagnosis for reasons relating to racial biases that have contributed to the school-to-prison pipeline. In addition, some cultures have a more intense stigma surrounding ADHD, believing it to be a disciplinary problem as opposed to a legitimate mental health issue.
And while this ADHD stigma sometimes occurs within a minority group, it can also come from others who see children of certain races as more likely to develop behavioral issues. This type of stereotyping can be incredibly harmful and even potentially dangerous as others perceive certain behaviors as rebellious or defiant rather than stemming from a neurodivergent condition.
It’s important for medical professionals to recognize these factors and develop a more thorough cultural understanding of other racial and ethnic populations. The same applies to educational environments, since this is the setting in which many referrals for ADHD screening are initiated.
Lack of Representation
For many minority individuals, there’s a striking lack of representation among the ADHD community. This could be due in part to the type of stigma described above, which could cause some minority individuals to keep their diagnosis secret or avoid diagnosis altogether. In general, however, the stereotypical picture of an ADHD child is a white boy. Those who do not fit that mold according to their gender and/or race see less representation, which can also make those around them — even medical professionals — less likely to see ADHD as a possible cause for their symptoms.
Increased representation could remove some of the barriers to ADHD diagnosis and treatment. Some people in minority communities have found that, because they don’t fit the stereotypical idea of someone with ADHD, it’s harder to have their concerns taken seriously in a medical setting. Although they may be unaware of it, some practitioners have internal biases and prejudices that they need to overcome in order to provide more equal access to ADHD diagnosis and treatment.
A number of ADHD advocates in minority communities are working hard to increase representation of non-white and non-male individuals with the disorder. Some are focused on helping parents with different cultural attitudes toward ADHD better understand this disorder, especially those who may misconstrue ADHD for an intellectual disability.
One notable example of a minority ADHD advocate in the Black community is René Brooks, a social media influencer and blogger who has shared her experience with ADHD in detail. Her social media accounts and her blog “Black Girl Lost Keys” feature content designed to educate and motivate other Black women with ADHD. By putting a face to this underrepresented category, Brooks is helping to boost minority representation in the ADHD community while breaking down some of the stigma associated with the disorder.
Providing Better Access to ADHD Services
In addition to increasing representation and combating stigma surrounding ADHD, it’s important to focus on strategies to create more equal access to ADHD services among white and non-white communities. The barriers to access these services are typically higher among those belonging to a racial or ethnic minority or in low-income groups. Overcoming those challenges can help to ensure children of all races receive fair treatment every step of the way, from ADHD screening to diagnosis to treatment.
Some of the proposed strategies to improve access for minority children with ADHD include:
Increased cultural competence
When communicating with parents and children, medical professionals must exhibit greater cultural competence in understanding the differences in various minority communities. This starts with the very first step at the clinical assessment, but is also highly important if a child goes on to be diagnosed with or treated for ADHD. Various sociocultural factors come into play here, and in order to provide the best level of care, there needs to be better training to help practitioners and therapists bridge any gaps in communication. This same strategy can also be applied in schools by helping to increase cultural sensitivity and reduce racial bias among teachers, counselors, and other staff members.
Education for parents and caregivers
While medical and educational professionals may need to work on improving cultural competence, another strategy is to better inform and educate minority parents and caregivers. Like any parent, these individuals may not be familiar with ADHD symptoms and behaviors if they haven’t had firsthand experiences with the disorder. Or, they may have a stereotypical idea of ADHD in mind along with any cultural stigma that comes into play. Helping parents, caregivers, and other adults who are active in children’s lives gain a better understanding of ADHD can assist in improved recognition of symptoms and screenings that occur at an earlier age.
Establishing trust with minority communities
It’s critical to create a stronger foundation of trust with minority communities who may have a history of mistrust in the medical system. This requires working to build relationships in those communities and, perhaps most importantly, listen to and understand their concerns and fears. ADHD and mental health issues in general may be perceived differently in different cultures as well, so it’s important to recognize when individuals from minority groups may benefit from a different approach in terms of presenting screening referrals, ADHD diagnosis, and treatment options.
Although research varies on the topic, there’s no denying that there are some significant inconsistencies in the way ADHD is diagnosed and treated in different racial and ethnic groups. Furthermore, cultural backgrounds and social stigma surrounding the disorder can have a major role in how children and adults manage the disorder. Addressing these issues is critical to ensuring more equal access among every group and more successful treatment outcomes for people with ADHD regardless of their race, gender, or age.