Awareness about and diagnosis of attention deficit hyperactivity disorder (ADHD) in minority populations in the United States has increased over the past decade. The higher numbers diagnosed likely are the result of more widespread attention to signs, symptoms, and diagnosis.
As a result, ADHD has been increasingly recognized among African-Americans.
As recognition of ADHD grows in the African-American community, access to accurate and culturally relevant information about ADHD in this population is important for individuals, families, and practitioners alike. In particular, the following six issues deserve attention:
- Prevalence of ADHD among African-Americans
- How race affects ADHD
- Research on differences in treatment among racial groups
- The impact of cultural beliefs
In 2010, the U.S. National Center for Health Statistics published an analysis of data (PDF) related to the prevalence of ADHD in various racial groups. The data was obtained from the National Health Interview Study over the ten-year period from 1998 to 2007.
This research found an increase in numbers of children diagnosed with ADD over the study years, particularly among white and black, non-Hispanic, children.
While the data showed that ADHD prevalence varied by race and ethnicity, differences between groups narrowed over the study period. By 2007–2009 ADHD prevalence was similar among Caucasian, African-American, and Puerto Rican children.
Since prevalence estimates in this report were based on parental report of a child ever receiving a diagnosis, results could be affected by the accuracy of parental memory, by differential access to health care between groups, or by parental willingness to report an ADHD diagnosis.
It was not possible in the study to discern whether the growing prevalence rates indicate a true change in prevalence or, instead, increased detection and diagnosis of ADHD.
In a Washington Post interview, Lara Akinbami, MD, the primary researcher for the study, was asked directly, “How does race play a factor in ADHD?”
Here’s her answer:
This is a great, and perhaps thorny question. For many health conditions, race and ethnicity has been recognized to be associated with prevalence and outcome…. There are many other related factors, such as income level, place of residence, culture, health habits, etc. that are related both to race and to health. What we do know about ADHD is that prevalence has increased greatly among some groups of minority children….
This study did not address the very important question of differential treatment of ADHD among children in various racial and ethnic groups. Yet, research suggests a number of factors affect treatment for racial and ethnic minorities in the U.S., including lack of health care providers who understand different cultures, inability to pay for care, and lack of knowledge regarding effective treatments.
According to Melvin Oatis, MD, writing for the American Professional Society of ADHD and Related Disorders (PDF):
Seeking and receiving treatment for a mental health disorder like ADHD can be a complex process that is influenced by a combination of access barriers and individual, cultural, and societal factors. For ethnic minorities, these factors include attitudes and perceptions about mental health care, language barriers, parental knowledge about ADHD, general access to treatment, and cost of treatment.
Two interesting articles published in 2005 examine the impact of cultural beliefs on seeking treatment for ADHD among African-Americans. Although these articles are now each several years old, they highlight beliefs about ADHD and help-seeking that are important in any discussion of eliminating racial disparities in treatment.
A study published in The Journal of the National Medical Association suggests that many African-American parents may be unfamiliar with ADHD:
“Although … 69 percent of African American parents have heard of ADHD, only 36 percent … [had] information about ADHD. African Americans may [also] have false beliefs about the cause of ADHD … [for example,] merely 10 percent of African American parents [knew] that ADHD is not caused by “too much sugar.”
Additionally, in an article in the National Resource Center on AD/HD’s Attention magazine, Gary and Bussing point out that help-seeking behaviors among African-American parents may be affected by a history of institutional racism:
“African American parents …. want the best teachers and health professionals for their children, yet, they also remember that numerous generations of African American parents have had bad experiences and reasons to distrust these systems.”