By Mary Fetzer
ADHD has been redefined throughout the years, and greater awareness among health care providers and the public has led to increased diagnoses across all population groups. Yet disparities continue in detecting ADHD among Indigenous people, Blacks, Hispanics and Asians. We examined some of the contributing factors, and what can be done to close the gap. Here’s what we found:
More Diagnoses but Still Underdiagnosed
Between 2004-2006, Black children were more likely than white children to have ADHD symptoms but were less likely to be diagnosed. In the 10 years that followed, however, the diagnosis rate for Black individuals grew three times faster than it did for white individuals.
Despite the increasing rate, however, studies indicate that ADHD continues to be less frequently diagnosed in Black, Hispanic and Asian children than in white children, regardless of socioeconomic status. These missing diagnoses present barriers to receiving help, causing racial inequalities in ADHD treatment.
Why It Matters
Without a proper diagnosis, an individual with ADHD will not have access to the accommodations and services they need to succeed in school or work. Untreated, ADHD can contribute to poor academic performance, higher rates of absenteeism, harsh punishments and an increased likelihood of dropping out. Children with ADHD also have an increased risk of being arrested, convicted or incarcerated as an adult — a statistic that is particularly troublesome for marginalized communities.
Why Disparities in ADHD Diagnoses Exist
Experts believe there are several reasons for the disparities. The primary reasons are:
Racial bias: The disparities in diagnoses across different populations do not appear to be the result of socioeconomic status. Rather, researchers suspect that racial bias may be a significant contributor.
Clinicians, using their own interpretations of a patient’s behavior to assess mental health, are more responsive to white parents seeking an ADHD diagnosis for their children than to parents of children of other racial groups. Racial expectations can cause these providers to observe identical behaviors in a white child and a Black child but interpret them differently.
For example, a white child who exhibits ADHD symptoms might be observed as having a mental health disorder, while a Black child exhibiting the same symptoms might be observed as normal but acting out because of problems at home or some other stereotypical assumption.
Cultural Mistrust: A 2020 poll found that 55% percent of Black people said they distrusted the health care system. And the Centers for Disease Control and Prevention reported that nearly one in five Hispanic people say they avoid medical care because they fear they’ll be treated poorly or discriminated against.
“This history of racism and discrimination in health care has led to a mistrust of the health care system that prevents Black and Brown people from seeking help,” says Amira Martin, a mental health therapist and an adjunct professor at Columbia University School of Social Work. Martin, a Black woman, has dedicated her career to creating therapy spaces for people of color.
Trust might be gained by the availability of more representative providers. A 2019 report from the American Psychological Association revealed that, in 2015, 86% of the psychology workforce was white. In contrast, 4% were Black, 5% were Asian and 5% were Hispanic.
Access: Access to quality health care is another factor contributing to the disparity of ADHD diagnoses. People from underrepresented groups have limited access to resources, such as educational materials and support groups, that can help lead to the proper diagnosis and treatment.
People from these groups may face language barriers or lack access to culturally competent mental health professionals. Additionally, within the U.S., rates of health insurance coverage are significantly lower among people of color than for their white counterparts.
Stigmas: “For Black and Brown people, there are cultural stigmas surrounding mental health,” says Martin. “And these can prevent individuals and families from seeking help.”
Research indicates that Black, Hispanic and Asian teens may not get mental health care because of parental stigma. While the younger generation is more open about mental health than previous generations, parents worry about the societal consequences of their already marginalized child being labeled with a mental health disorder.
How the Disparities Can Be Overcome
Martin says the healthcare system can take actions to address the underdiagnosis of ADHD within underrepresented communities. Important actions include:
- Increase awareness and education about ADHD, including its symptoms and prevalence in all populations.
- Ensure equitable access to proper evaluation and treatment from culturally competent health care providers who have been trained to recognize that ADHD symptoms may present differently in different populations.
- Reduce cultural stigmas surrounding mental health through community outreach and education.
- Encourage collaboration between health care providers and families to ensure an accurate diagnosis and appropriate treatment plan.
- Advocate for policy changes that improve access to health care and reduce health care disparities for underrepresented populations.
Ultimately, experts say, the system’s goal should be to ensure that ADHD can be diagnosed equally so that all people have the opportunity to seek treatment, manage symptoms and reach their full potential.