Cite
Ghoshal, Malini. “How Race and Culture Can Impact an ADHD Diagnosis.” MedCentral, March 9, 2022. https://www.medcentral.com/behavioral-mental/adhd/adhd-and-culture-a-complex-dynamic-influences-diagnosis-and-treatment-in-bipoc-patients.
Jeremy
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FirstAuthor:: Ghoshal, Malini
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Title:: How Race and Culture Can Impact an ADHD Diagnosis
Year:: 2022
Citekey:: ghoshalHowRaceCulture2022
itemType:: webpage
LINK
Abstract
Strategies and sensitivities to be aware of when discussing an ADHD diagnosis with a patient, parent, or caregiver. .
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Imported: 2025-02-28 2:02 am
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Studies show that race and culture impact perceptions regarding ADHD behavior symptomatology.⁵ These perceptions are significant because clinicians rely on subjective behavior ratings from educators, family, patients, and other caregivers to make their final assessments. Subjective behavioral interpretations can lead to bias in cumulative reports, w
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For example, a study by Lawton and colleagues examined parental locus of control (PLOC) among Latino parents. They found two aspects of cultural values (fate/chance and parental efficacy) to be linked to beliefs that ADHD-related behavior would resolve on its own.¹⁰
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Research indicates that untreated childhood ADHD increases the long-term risks for substance use disorder (SUD), depression, and other comorbid behavioral health disorders. Undertreatment also has wider implications, including affecting families and individuals’ quality of life, health, and well-being later in life.¹⁷
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Undertreatment of ADHD may occur based on the four-stage ADHD Help Seeking Behavior Model (HSBM), developed by researchers to explain the potential rationale for disparities in diagnosis and treatment among minority children.¹⁸ The four stages include problem recognition, outreach for help, selection of services, and utilization of services.
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Paradoxically, studies have also shown that community-level factors, such as teacher bias in school-based subjective behavior ratings, may lead to disparities in ADHD referrals. A 2020 study by Kang et al showed that White teachers rated Black boys’ ADHD behavior levels and the probability of having ADHD greater than their parents.¹⁹ Subjective behavior assessments by teachers are inherently influenced by race, ethnicity, and culture of both teachers and students.
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- Interesting that the outside influence thinks differently than someone of the same culture.
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Research shows that Black students have higher rates of discipline referrals than other minority students, which has negative consequences on education and life outcomes.²³ Bias, stereotypes, and discrimination in school can also lead to student disengagement and negative academic persistence.²⁴ These traits are also often misidentified to be symptoms of ADHD, which in many cases, leads to the student not getting the proper classroom attention or accommodations they need.
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In school-based student-parent interactions, Dr. Mihalas noted, “What is of critical importance is explaining some of the particular concerns that the student/patient is having in the environment in question and how you, as a professional, may be able to help.” She added, “If a student may be fidgeting excessively and this is impacting how other peers are able to relate to the student, explain this openly and honestly. Many parents would want their child to connect with other peers. However, if you talk about the abnormal nature of movement, some cultures may disagree with this, and immediately the line in the sand is drawn. If a clinician is not aware of the cultural interpretation of ADHD, and the model of the family’s culture is not matched appropriately, the likelihood of getting support to the family will be pushed to the wayside.”
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- Relates to the article by Darrell Bock in what we say and how we say it matters. People are not the enemy.
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The significance of ethnocultural context that leads to disparities in treatment cannot be understated.
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