A commonly misdiagnosed disorder
Attention Deficit Hyperactivity Disorder (ADHD) is a diagnosis that often contributes to a societal stigma for those affected by it as well as family members who must confront the issue on a daily basis. While prevalent among all ethnicities, within the Black community there are several cases in which Black youth may exhibit symptoms that are often incorrectly labeled as behavioral issues. The issue has particularly adverse repercussions in terms of the classroom.
ADHD is defined as one of the most commonly diagnosed neurotypical conditions characterized by traits of inattention, impulsivity, and hyperactivity. It is important to note that there tends to be confusion amongst clinical terms such as ADD and ADHD. ADD is an outdated term often used to describe an inattentive presentation of attention-deficit hyperactivity disorder.
During the 1980’s, the Diagnostic and Statistical Manual of Mental Disorders, (i.e. DSM-5) publication by the American Psychiatric Association detailing the classification of mental disorders using common language and standard criteria. The manual first released the first official name for the condition that is now known as ADHD, as a neurodevelopmental disorder.
ADHD is characterized by difficulty paying attention, hyperactivity, impulsiveness, excessive daydreaming, fidgeting, forgetfulness, excessive talking, extreme restlessness, and difficulty taking turns. According to Children and Adults with Attention-Deficit/Hyperactivity Disorder, (CHADD), ADHD is affecting 17 million children and 10 million adults in the United States. ADHD is usually diagnosed in young and or adolescent children.
Research shows that ADHD can fall under three different categories: One being hyperactive/impulsive, another being inattentive, and the last being combined. Hyperactive/impulsive ADHD is characterized by symptoms such as problems taking turns, an inability to stay seated, frequently interrupting other people, and feelings of restlessness. Symptoms of inattentive ADHD include being easily distracted, not paying attention to details, short attention span, and forgetfulness to name a few.
It is important to know that combined ADHD contains five or more symptoms of inattention, hyperactivity, and impulsivity for six months, and recurring symptoms that cause interference with work, school, and home. Also note that a combined diagnosis doesn't mean that a diagnosis of ADHD is more severe, it is up to the practitioner to determine whether the case of ADHD is mild, moderate, or severe.
Although it is unclear what the direct causes of ADHD may be, research is being done to help provide answers. Isbell Oliva-Garcia, a licensed mental health counselor with Grow Therapy, a nationwide entity providing therapeutic services, said, “We don’t yet know the specific causes of ADHD, but there’s evidence of many factors that play a role. When these factors come together under the right circumstances and in the right combination, the chances of ADHD go up.
“Various genes, both common and rare, affect brain development and ADHD. These genetic components and specific environmental conditions increase the risk factors for ADHD. The condition often runs in families, though the genetic component remains elusive. A child diagnosed with ADHD may have a close relative, even if they’re not in the same immediate family group, who has ADHD.”
Oliva-Garcia continues, that brain chemistry also plays a contributing role. In some cases, the brain develops differently for no apparent reason. In others, identifiable events may affect brain chemistry, such as exposure to alcohol, lead, cigarette smoke, and certain pesticides.
“Epileptic disorders and traumatic brain injury can also change how the brain functions, leading to ADHD. The brain of an individual with ADHD also shows differences in volume and structure, which is still being explored. The mix of contributing factors means that ADHD isn’t preventable or curable but treatable,” she said.
Stigma and attitudes regarding ADHD within the Black community are complicated. Black Americans have historically shown mistrust of the medical system because of systemic racism that often lends itself to poor diagnosis. According to the Pew Research Center, 56% of Black people have had one of several negative experiences, namely being treated with less respect than other patients and having to advocate for themselves in medical situations.
The organization Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) has stated that the negative and inaccurate perception of ADHD is something that needs to be improved.
“Unfortunately, a high percentage of Black Americans perceive ADHD as a disciplinary problem and not as the mental health issue it is,” said Melvin Bogard, director of digital content at CHADD and the organization’s Black History Month coordinator.
There are multiple psychosocial and environmental factors, including trauma that may cause overlapping ADHD symptoms in Black youth. Not all symptoms are consistent with ADHD. Some symptoms are indicative of trauma responses and or mental health conditions or illnesses. A negative perception of psychiatric medications and conditions oftentimes may leave Black families apprehensive about trying therapy and or medication.
According to BlackHealthMatters.com, there are a lot of barriers that Black individuals face involving assistance with ADHD treatment. Some include lack of insurance, and affordability of services. The National Library of Medicine found that Black children were 30% less likely to be diagnosed. There are a limited number of Black health care professionals available making many people of color uncomfortable when attempting to find resources for their children.
Underfunded schools, low socio-economic status, and discrimination are just a few contributing factors to the lack of diagnoses. Frequently ADHD is found in children who have behavioral problems and perform poorly in school. Additionally, racial disparities, and lack of teacher training regarding identifying ADHD symptoms in students, cultural differences, and cultural behavioral expectations can also contribute to challenges diagnosing ADHD within the Black community.
According to Everyday Health, children with ADHD are at risk for poor performance and disinterest in school. Individuals with ADHD are also at risk for unnatural accidents and have more than double the risk of death. Individuals have a two-to threefold risk of being arrested, convicted, and imprisoned during their adult life.
Although a challenging diagnosis, ADHD like most things can be navigated through. OIiva-Garcia explained the challenge of the diagnosis: "The brain of someone with ADHD works differently than that of a neurotypical person. Those differences can make life a whirlwind of excitement while challenging other parts of life.” she said. “Fortunately, early intervention to manage symptoms can help build healthy relationships with family, friends, and coworkers. A combination of therapy for ADHD, medication, and lifestyle changes can work wonders for many people. ADHD can change as you age, so you may need to adapt your coping strategies as time passes."
Garcia added that the most common type of therapy is cognitive behavior therapy (CBT). “It’s the cornerstone for most disorders because of its broad connections to thoughts, emotions, and behaviors and how everything we do has those three components. It works by helping us identify how our behaviors are influencing our thoughts and actions. We work to identify that connection and how to make that connection work for the individual,” she said.
Medication and behavioral therapy in tandem are the best forms of treatment. All families are different and should evaluate what game plan will work best for them. According to Oliva-Garcia, an estimated 69.3% of children with ADHD take medication to help manage their symptoms. Of those who take medication, 70% to 80% see fewer symptoms when taking their medication.
As with any other learning, or cognitive issue, ADHD needs to be properly addressed by parents and families for children to reach their full academic potential. IEP (Individual Education Plans) are recommended for children and will allow individuals to steadily progress, take into consideration where they are in their academic journey, and offer additional learning services. Educating parents on their children's educational rights is fundamental in knowing the next steps to take, supportive family and friends are vital, as is educating those around a child with ADHD. It is important to recognize that untreated ADHD can potentially lead to substance abuse disorders in the future.
Many positive lifestyle changes can be implemented to help improve the life and success of a person with ADHD including but not limited to; a healthy diet, daily exercise and activity, goal-setting, limiting choices, getting adequate sleep, creating a daily routine, reducing distractions at home and breaking down complex tasks into simple steps. Individuals with ADHD can go on to live happy, healthy, productive lives, however, the help starts within the home.
