Accurate diagnosis and treatment of ADHD have significant implications for a child’s social, emotional, and educational wellbeing. Proper treatment can help a child manage her day, engage in healthy relationships, do better in school, find a satisfying career, and develop a strong sense of self-worth. Conversely, misdiagnosis and improper treatment or lack of treatment can have serious and long-lasting harmful consequences, including depression, low self-esteem, weak social functioning, drug abuse, poor overall health, risky behavior, educational failure, underemployment or unemployment, and possibly involvement in the juvenile justice system.
While Black families often believe their children are over-diagnosed with ADHD, in fact, the opposite is true: Data show that Black kids are more often undiagnosed, misdiagnosed, or under-diagnosed than White kids and therefore, are less likely to receive interventions, the lack of which can alter the trajectory of their lives negatively.
White society sees Black kids as older and less innocent and gives more negative attention to their challenging behaviors—especially those involving lack of impulse control and hyperactivity.
Without a proper diagnosis, their problematic behaviors will often be misinterpreted by school and law enforcement personnel as “defiance” and cause the child to be labeled as a “violent” or “bad” kid, face suspension or expulsion and wind up in the school-to-prison pipeline, which disproportionately impacts Black kids.
Root of the Problem
Dr. Sarah Vinson, an Atlanta-based physician specializing in pediatric mental health and psychiatry, explains that mental health researchers and practitioners are not sufficiently trained or unaware of how to serve Black families effectively.
Diagnosticians are routinely dismissive of the family’s concerns. They fail to ask appropriate developmental questions, and rely on prejudicial stereotypes to draw conclusions. They don’t appreciate that Black families routinely distrust doctors because the medical system has shown itself to be untrustworthy.
Instead of placing the blame on Black families, Vinson advises providers to understand that families’ responses are “based on the realities they’ve experienced in their society.” This includes being treated disrespectfully by the medical establishment and having inadequate access to mental health care and insurance.
Vinson’s remedy for “cultural mistrust” is for providers to “strive for cultural humility” in their encounters with Black families. She defines this as a continuing process that includes self-reflection, introspection, advocacy and co-learning. For healthcare providers as a whole, she stresses, “We need to show ourselves to be trustworthy.” She encourages White clinicians to learn about “White fragility” and address their biases.
Cultural Humility in Action
To accurately evaluate the abilities and needs of a particular Black child, Vinson urges clinicians to enter into respectful, collaborative decision-making relationships with the family and to focus on what the best treatment plan would be. She stresses that, no matter how comprehensive and data-driven a plan is, “the best treatment plan is the plan the family is able and willing to follow.”
Vinson additionally instructs providers to, “Speak with the child and make the effort to gain her trust and build a rapport.” While it’s easier to look at external “tip-of-the-iceberg” behaviors, it’s more important to learn about a child’s life and the experiences that may be driving her actions.
While Vinson encourages Black parents to understand that they are experts on their children, she advises them to appreciate that ADHD is a complex neurobiological condition for which proper treatment can be life-changing, “positioning the child to be at her best.” She counsels families to work with clinicians who are thorough, empathetic and mindful of race-specific norms, to open up about their concerns, and to fully discuss their child’s symptoms, the family’s medical history, internal resources and insurance, and any supports the primary caregiver or family unit might need.
Following are three issues Vinson advises clinicians and parents to discuss, which have customarily sparked controversy within the Black community:
- Accepting a mental health diagnosis: The stigma of mental illness is often stronger within minority and marginalized communities, whose cultures traditionally associate shame with seeking mental health treatment. Black families often feel that having a “double stigma”— being Black in a racist society and having a mental illness that triggers discrimination within their own community— would prove too socially isolating. But because an accurate diagnosis leads to helpful treatment options, it’s vital to consider having the child fully evaluated and to accept the diagnosis.
- Taking prescription medication: Substance use is disproportionately criminalized in Black communities. Because a family member may have struggled with addiction, parents are frequently concerned about their child becoming addicted and reluctant for her to try ADHD medication, especially prescription stimulants. Providers should address a family’s fears and clarify what medication can and cannot do for their child’s specific symptoms; exactly how the drugs being discussed should be taken; and that using drugs as directed will not lead to dependence.
- Following a comprehensive treatment plan: A full therapeutic plan is not just about medication management. Rather, it takes into account the “big picture” of a child’s life, addresses other potential issues, and requires buy-in from all involved. If special education or other school-based services are required, parents will need to familiarize themselves with what their child’s school offers (e.g., counselors, therapists, psycho-educational evaluations, positive behavioral supports, modifications/ accommodations), participate in school meetings, and learn the essentials of effective advocacy.
This article is based on an ADDitude Magazine’s expert webinar, Cultural Considerations When Diagnosing and Treating ADHD in African-American Children, given by Sarah Vinson, MD, a specialist in forensic psychiatry, and an Associate Clinical Professor of Psychiatry and Pediatrics at Morehouse School of Medicine. Eve Kessler, Esq., a retired criminal appellate attorney with The Legal Aid Society, NYC, is co-founder and Executive Director of the not-for-profit SPED*NET, Special Education Network of Wilton (CT) and a Contributing Editor for Smart Kids with Learning Disabilities.