Is attention deficit hyperactivity disorder (ADHD) underdiagnosed among African American children?
The answer may hold implications for the well-being of thousands of African American and other minority youths. Just as importantly, the reasons behind the faulty diagnoses can reveal root problems that may stand between clinicians and accurate assessments.
ADHD is a brain disorder with a high rate of heritability, estimated through studies of twins to be around 70-80 percent. A child of a parent with ADHD has greater than a 50 percent chance of having it. The rate of diagnosis is more than twice as great for boys than it is for girls.
ADHD has three hallmark traits: inattention, hyperactivity, and impulsivity. Some people are predominantly inattentive while others tend to be more hyper and impulsive. Some have both types. In classrooms, common ADHD symptoms like not following instructions and being disruptive may be confused with other conditions, such as learning disabilities or vision or hearing problems.
A Growing Disorder
ADHD is one of the most common mental disorders in children and adolescents. In 2011, more than 5.3 million, or 8.8 percent of, students ages 4 to 17 had a current ADHD diagnosis. And about 2 million more children had received a diagnosis for ADHD than in 2003.
Part of the reason for the spike may be due to improved access to healthcare and better recognition of ADHD symptoms, particularly among lower-income families. But it’s unclear how much racial disparities exist in diagnoses if only because we don’t know what the true prevalence rate is supposed to be for African Americans and other minorities.
According to 2011 data from the comprehensive National Survey of Children’s Health, white children were slightly more likely to have ever been diagnosed with ADHD than African American children (12.2 percent vs. 11.9 percent). They were also more likely to currently have the condition (9.8 percent vs. 9.5 percent). Both groups were nearly twice as likely to be diagnosed than Latino children.
The racial gap between white and African American children is more pronounced regarding treatments. Among whites, 7.1 percent had a current ADHD diagnosis and were on medication, compared to 5.7 percent for African American youths. In a paper in the journal Pediatrics, a group of researchers concluded that the imbalance more likely stems from minority children being underdiagnosed and under-medicated than from white students being over-diagnosed.
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Causes of Misdiagnoses
Researchers say a mix of cultural, economic, educational, and other factors can hamper correct diagnoses in African American children:
- Absence of objective test to diagnose ADHD
- Lack of knowledge among African American parents about symptoms, causes, and treatments
- Parents’ unease about using medications even though drugs and counseling are standard treatments for ADHD
- Lack of health insurance
- Fear of stigma of ADHD
- Bias from clinicians, such as perceiving African American students as more hyperactive
Dr. Althea Stephens-Spencer , an expert in child psychology who works with adolescents with mental illnesses and behavioral issues, said the lack of minority doctors and psychiatrists gives African American parents even more reasons to get educated about the disorder.
Being informed, Stephens-Spencer says, will allow parents to engage more actively in their children’s care.
For instance, they can question a doctor who says a child has ADHD by asking about the reasons for the diagnosis, she says. Or they can say, “You’re telling me my child needs medication. What else can I do?”
Ensuring Right Diagnoses
Children with ADHD can respond well to evidence-based interventions in school and at home, according to Anil Chacko, a professor for Counseling@NYU, which offers an online master's in school counseling from NYU Steinhardt.
But first, Chacko cautions, the diagnosis must be correct. “It’s important to remember that many students with ADHD also have a learning disability or learning issues,” Chacko said. “School counselors, teachers and parents should appreciate that the challenges these children face may be more than just ‘ADHD.’”
Like all mental disorders, ADHD can’t be confirmed with a laboratory test. But educators and parents can take steps to help confirm the condition in minority children.
Tips for teachers and counselors:
- Rule out other issues, such as difficulties at home or even hunger, as a reason for behavioral problems in the classroom. Be alert to biases or stereotypes, like assuming that black children are normally more active than children of other races
- Use assessment tools that take into account any cultural differences, to ensure they measure characteristics accurately
- Learn to recognize the symptoms of ADHD
- Don’t dismiss behavioral problems as something the child will grow out of
- Reject any stigma against ADHD and seek professional help
- Communicate with teachers and counselors about your child’s learning or behavioral problems
Alexis Anderson is a digital PR coordinator covering K-12 education at 2U, Inc. Alexis supports outreach for their school counseling, teaching, mental health, and occupational therapy programs.
