Through my practicum experience at the Learning Disability Association (LDA), a non-profit learning center, I became interested in potential cross-cultural considerations when children are diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). My position at LDA provided me with the opportunity to talk to parents, teachers and assessment specialists daily, and an increasing majority of parents were seeking an ADHD diagnosis. Some of these parents enrolled in LDA classes to better understand the ADHD diagnosis and to decide if having the diagnosis would get their children the help they so desperately needed to succeed in school. Other parents had already had their children diagnosed and were looking for tutoring services from LDA.
As the parent of an African- American son, I have direct, first hand experience with schools in Minneapolis and in other parts of the country. My son has been enrolled in Minneapolis schools for the past three years. I was fortunate to spend several months volunteering in my son's classroom during our first year in Minnesota. I also have personal experience going through the ADHD assessment process for my son. His third grade teacher pulled me aside the last week of school and suggested I look into an assessment over the summer. I was shocked, confused and had a hard time seeing the symptoms in the child I knew. This was when my real research into this topic began. Obviously, these experiences have influenced my questions, focus and assumptions relating to this topic. They have also provided a foundation for the advocacy and referral work I was able to do at LDA.
The purpose of this study is to conduct exploratory research on barriers to assessment and treatment of ADHD, with a particular interest in boys of African American descent. My primary question is: Does the diagnostic process for children who are thought to have ADHD differ depending on the families’ socio-economic status, cultural heritage and/or access to adequate medical expertise?
This research was conducted in a two-fold approach by doing a literature review and a phone survey for additional qualitative data. I explored the diagnostic process used by some of the families seeking LDA services and looked to identify possible issues related to the increase within the last 10 years in boys of African American descent identified with ADHD. With all the other stereotypes surrounding African American males, I wanted to see if the prevalence of the diagnosis was related to:
different communication styles between boys and female teachers, who are predominantly well intentioned, middle class and of the dominant culture;
a means to get children the extra assistance they need in school; or,
possibly another way to identify boys for special education services.
Although hundreds of studies have been published regarding ADHD, there is very little published that discusses African American children and ADHD. Given the absence of literature on African American males and ADHD, this study attempts to look into an area which appears to be virtually unexplored, focusing on the environmental and societal factors which may influence how and why African American males are diagnosed with ADHD.
To provide a foundation on ADHD, I also address these six questions by reviewing pertinent research and reporting from a phone survey for qualitative data:
1. Is there an agreed-on set of diagnostic criteria for ADHD that reflects sufficient reliability and validity so as to delineate a clinically meaningful syndrome?
2. What is the epidemiology of ADHD, and how can the apparent disparities in prevalence in different populations be explained? (Particularly within the African American community.)
3. What is the course of the illness, and what are the adverse consequences of the illness that would justify treatment?
4. What constitutes optimal treatment for ADHD, and how do stimulants fit into it?
5. What are the adverse consequences of using stimulants, and in particular what is known about the risks of abuse and diversion?
6. Are children being appropriately assessed and treated in clinical settings to ensure that diagnostic criteria are being used appropriately; i.e., is there evidence of underdiagnosis, overdiagnosis, or misdiagnosis?
Some additional sub-questions I explore are:
Is the diagnostic process explained to parents and children prior to the assessment? Are treatment options limited by insurance coverage? What does research show about medication options?
One of my goals was to create a qualitative data collection technique that could be used for systematically gathering information about ADHD. A significant factor in assessment is having access to specialists. One hypothesis was that families of limited income and insurance coverage would have less access to options when choosing a diagnostician, their treatment plans, and less access to parent education so they could advocate for improved classroom services. Parents need to clearly understand, as best as possible before diagnosis, all the benefits and potential challenges that go along with identifying a child as having ADHD, especially in U. S. public schools.
Inequality and Stratification | Mental and Social Health
Miller, Ann W., "Exploratory Research on Barriers to Assessment and Treatment of Attention Deficit Hyperactivity Disorder (ADHD), with a particular interest in boys of African American descent." (1998). Capstone Collection. 966.