A recent study published in JAMA Network Open demonstrated a disparity between the quality and frequency of the diagnosis and treatment of ADHD in children due to race. The study looked at 238,011 white, Black, Asian, and Hispanic children. Researchers found that white children were more likely to receive an ADHD diagnosis and treatment for the disorder.
Evidence of Discrimination
This study is not the first time researchers have found a disparity in ADHD treatment. In a 2016 study from The American Academy of Pediatrics of 4,297 students in fifth to tenth grade, white children were again more likely to be diagnosed and treated for ADHD than their Black and Latino counterparts. However, Black children were more likely and Latino children were just as likely to have symptoms of ADHD at each age group compared to white children. “Research evidence has revealed that Blacks, Latinos, and Asians, in particular, are far less likely to get diagnosed with ADHD as compared to whites even if their clinical presentation is quite similar,” says Dr. Rashmi Parmar, a child, adolescent, and adult psychiatrist for Community Psychiatry, California’s largest outpatient mental health organization. “ADHD can affect children and adults from all races and ethnic groups, so it is only fair to extend diagnostic services and treatment equitably to everyone. However, this is often not the case in the real world,” Parmar explains. Attention-Deficit/Hyperactivity Disorder, or ADHD, is a neurodevelopmental disorder categorized by symptoms such as fidgeting, forgetting things, and difficulty resisting temptation. Medical professionals typically diagnose it in childhood through a series of tests. However, there are many potential factors hindering diagnosis and treatment for children of color.
Economic Impact
Seeking a diagnosis and treatment for ADHD can be a costly process that is unattainable for some families. “Unlike an ear infection or strep throat which needs a quick evaluation that can be done by PCP and can be cured by a short course of antibiotics, conditions like ADHD are chronic and need extensive evaluation by experts,” says Dr. Dilip Karnik, a pediatric neurologist at Child Neurology Consultants of Austin. “Sometimes evaluations are not covered by health insurance, which means many families are unable to pay for these services.” Income in the United States varies tremendously based on race. As of 2017, the median household income for white families was $68,145. In comparison, it was $50,486 for Hispanic families and $40,258 for Black families. Along with higher salaries comes more access to resources. Karnik explains that white families may gain information from personal connections or the internet—avenues parents of color or non-English speaking parents may not have.
Cultural Impact
In families where one or more parent is not a native English speaker, children may lose the opportunity to have an adult advocate for them, and also the opportunity for evaluation. While the stigma around mental illness is still prevalent across cultures, it holds especially strong in many minority communities, some of which may also distrust the medical system for past mistreatment. Parmar explains, “Parents are often opposed or ashamed of getting their child labeled with ADHD, and may decline treatment due to fear of negative outcomes or side effects.” “ADHD symptoms are often dismissed as ‘laziness or defiant behavior’ in affected children in such households. Children are often berated and blamed in such homes for being unable to keep up with day-to-day tasks. Caregivers might not even think of these issues as problems that may need professional help; it’s often brushed under the rug as something that every family has to deal with on their own," says Parmar. Dr. Howard Pratt, a psychiatrist at Community Health of South Florida Inc., explains that many of the parents of children he works with say their own parents would never have brought them to a mental health professional. “So, these parents, and often their kids, are now well out of their comfort zone. ADHD can be a scary topic for them. So, this is a problem that can be overcome by educating parents on how ADHD is treatable depending on how early they understand, accept, and address this,” he says. ADHD is not the only mental health or behavioral disorder in which disparities occur across races. “Unfortunately, many children with ADHD and other behavioral and mental disorders do not receive timely and proper care—this is especially true for children of non-white races. More services should be made available for children from disadvantaged families,” says Karnik.
This Inequality Can Impact Children Long-term
When left untreated, ADHD can lead to a series of problems. According to Karnik and Dr. Aronica Cotton, medical director, child and adolescent psychiatry services at MedStar Montgomery Medical Center, this inequality can cause:
Inability to manage emotionsCurbed social and emotional developmentRelationship problemsRisky behaviorSubstance misuseOther mental and behavioral health disorders, such as anxiety and depressionLow self-esteemTime management issuesDifficulty holding a jobProblems with organization and efficiencyStruggles to be happy
The Work Clinicians Need To Do
Children of color face many obstacles even when they’re able to meet with a clinician about childhood ADHD. “Clinicians need to accept and be aware of their own bias while treating such children,” says Parmar. “It is important to adopt cultural sensitivity and take socioeconomic factors into account while evaluating these kids in order to provide them the care they deserve. Evaluating every symptom in detail and following established guidelines for care will make it easier to get to a correct and timely diagnosis.” Pratt concurs, “We are so comfortable with the diagnosis for ADHD for more affluent kids, but many times when it comes to kids of color that do not fall within that group, you’ll see a kid who is hyper, and as health professionals, we tend to default into thinking, ‘well, that’s a bad kid,’ and you end up with a terrible diagnosis.” When possible, Pratt recommends families consider working with a mental health professional of color. Both child and parent may feel more comfortable and the level of care and consideration provided may improve. In any case, Cotton says, “Families should be informed about: how a diagnosis is reached, the risks and benefits of treatment, as well as the possible outcomes of non-treatment. Healthcare providers should also maintain a non-judgemental approach when speaking with families and have open and honest conversations with patients, so that they feel safe to ask questions about any concerns that they may have.”
