One of the most commonly diagnosed mental health disorders in children in the United States is Attention-deficit/hyperactivity disorder or ADHD. A timely diagnosis of ADHD allows eligible children to receive adaptive, specialized educational programming in school and medication that can help control the disorder’s negative impact on behavior and learning. Yet, not all groups of children are equally likely to be diagnosed for ADHD and receive subsequent treatment and medication for the same. Despite displaying more significant ADHD symptomatology, African-American children are diagnosed with ADHD at only two-thirds the rate of white children, and therefore may have unmet medical needs.
Hypothesized treatment and mechanism for ADHD diagnosis disparities include less frequent solicitation by professionals of developmental concerns and less frequent access to service utilization and health professionals. Additional hypothesized mechanisms include a limited ability to pay for healthcare, a lower likelihood of referral by school professionals, and negative attitudes towards disability treatment and identification.
Researchers have concluded, in a synthesis of 14 already existing studies, that African-American children with ADHD are significantly less likely to treat their symptoms with medication than their White counterparts. It boils down to three main factors:
Caregiver perspectives on ADHD and ADHD-like behavior.
The belief that ADHD represents a form of social control.
Beliefs regarding the benefits and risks associated with stimulant medications.
More than 75% of White children with attention deficit hyperactivity disorder (ADHD) depend on medication for managing their symptoms, following a thorough prescription and diagnosis by a medical provider. This number is only 27.3% among African-American children, and the rate of discontinuation of medication is high. Many factors ranging from healthcare access to clinician education to systemic racism to cultural norms and beyond cause this racial disparity in ADHD treatment. Researchers have proposed three main influences in a synthesis of 14 existing studies around one such factor, caregiver medication decision making (MDM):
Fundamental caregiver perspectives on ADHD, which are influenced by exposure to ADHD information and research, the personal experience associated with people who’ve diagnosed ADHD and cultural explanations and norms for behaviors.
Caregiver concerns about effectiveness and safety of the stimulant medication.
Caregiver mistrust in the pharmaceutical industry and physicians fueled partly by the belief that ADHD treatment and diagnosis is a form of social control that is aggravated by culturally-biased ADHD screening tools.
Researchers found that cultural, structural, historical, and political factors all coalesce to form socio-cultural disparities in healthcare that disproportionately affect the African-American community and strongly impact MDM.
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Cultural norms for child behavior and fundamental perspectives of ADHD
Researchers found, in reviewing various existing studies, that African-American parents had less exposure to ADHD information, lower ADHD knowledge, and fewer interactions with individuals with ADHD than their White counterparts. It was also found that some African-American parents who are caregivers to children affected with ADHD, attributed ADHD-like behavior to origins other than biological or medical causes.
Explanations for ADHD-like behavioral symptoms included lack of attention, poor parenting, lack of discipline, or a normal development phase that would eventually be outgrown. One of the studies used in the research found African-American parents half as likely as their White caregivers to even consider ADHD a real disorder. In contrast, another study found that African-American caregivers were significantly less likely to apply a medical label on ADHD or attribute the disorder to genetic origins. This study concluded that even though there were no differences in rates of recognition of ADHD symptoms, White children were twice as likely to receive a diagnosis, evaluation, and treatment for ADHD than African-American children.
Fundamental opinions on ADHD treatment among caregivers
Studies under this research revealed that the statistical odds of an African-American parent endorsing medication as an ADHD treatment were 0.7 compared to White parents. This revealed that a significantly meager proportion of African-American parents believed that medication would be effective as a treatment for ADHD.
Additionally, caregiver concerns about addiction, weight loss, and sedative side effects led to ADHD medication being refused entirely or viewed as a last resort by African American caregivers. It was also found that parents who expressed concerns about the medication’s side effects were 2.5 times less likely to use treatment as a follow-up, thus leading to a higher rate of medication discontinuation.
Studies also revealed that African-American parents were less likely to recognize ADHD behavioral symptoms as impairing or problematic than their White counterparts because of the formerly perceived ADHD symptoms as typical childhood behavior. It means that many children have unmet medical attention needs because of differences in caregiver reports of symptoms.
Viewing ADHD as a form of social control
The participants of one study of African-American caregiver perspectives of ADHD were found to view the diagnosis of ADHD as a form of social control. Researchers suggested that a lack of trust in healthcare professionals contributes to pharmacological disparities and this outlook of ADHD. The researchers suggested that culturally-based ADHD treatment disparities should be addressed with a patient-centered approach to ADHD management. Exploring knowledge, beliefs, and misgivings about the treatment and diagnosis of ADHD can help promote shared decision-making, provide better patient education, and pursue acceptable treatment modes.