African-American Youngsters Inadequately Treated for ADHD

The diagnosis and treatment of attention deficit/hyperactivity disorder (ADHD) have lately come in for intense scrutiny in media and medical circles, but as is often the case with medical concerns that become public issues in the U.S., the focus has been almost exclusively on white, middle-class children.

African-American children do, of course, suffer from ADHD, but cultural issues and the need to consider unique intervention strategies make diagnosis and treatment of the disorder “challenging” in these children, according to Gail Mattox, M.D. White children displaying comparable symptoms, she noted, receive medications for ADHD at twice the rate of black children, she noted.

Speaking at the 30th anniversary conference of the Black Psychiatrists of America, which was held March 30 to April 1 in Atlanta, Mattox emphasized that a serious lack of “culturally competent providers” is one of the most distressing obstacles preventing African-American children from getting optimal care for their ADHD.

Another serious challenge stems from the fact that many of these children live in poverty. Moreover, a substantial number are in the juvenile justice or child welfare systems, where the personnel change often, and “inadequate medical care and diagnoses” are a fact of life, stated Mattox, a professor and chair of the psychiatry department at Morehouse School of Medicine.

While there are very limited research data exploring ADHD among black children, there are a number of cultural considerations of which clinicians assessing or treating these youngsters must be aware if their services are to be optimally effective, she suggested.

Among these factors are that African-American parents may be less informed about ADHD than their white counterparts and are more likely to attribute ADHD symptoms to other causes such as sugar intake, which is “a very common explanation” for the symptoms, Mattox noted.

In addition, especially in poor communities, parents often get more of their medical-related information from nonphysicians, Mattox pointed out, which has a serious impact on these parents’ knowledge of effective interventions and treatment options. Little culturally sensitive material has been developed that puts ADHD symptoms and treatments in a context that reflects unique aspects of African Americans’ lives.

A troubling corollary problem for African-American youth is that with ADHD symptoms frequently missed or incorrectly diagnosed, comorbid disorders go undetected, she said. In addition, school officials are more likely to assign them than white children to special education classes, and this class placement is “the only educational resource used” to address many black children’s ADHD-related problems. Many of the problems they display, however, could be resolved with proper treatment that would allow them to remain in their regular classes, Mattox stressed.

These special-education placements often go unchallenged by African-American parents because they may be less aware of their rights regarding school decisions and face limited access to other potentially useful services in their communities, she pointed out.

When African-American children do receive methylphenidate or other ADHD-targeted medications, physicians, school personnel, and parents need to be aware that several studies have indicated that these youngsters may not metabolize some of the drugs well and thus may need to have dosages adjusted or different medications tried, Mattox pointed out.

She urged several interventions that will make it more likely that African-American children get the care they need for ADHD, including providing the services at the point at which children enter or come to the attention of the “system,” whether it is school or elsewhere.

In addition, Mattox wants to see the development and spread of “parents-educating-parents programs” that focus on recognition and treatment of ADHD. She also favors offering parents of children with ADHD the opportunity to participate in “multifamily groups,” which can be “more powerful” than caregivers’ reminders to individual parents on the importance of adhering to the treatment regimen if symptoms are to improve.

Finally, she said that progress toward a significant increase in the number of African-American children who get treatment for ADHD hinges in large part on greater availability of culturally competent clinicians, better access to medical services, and a willingness by health care professionals to try “nontraditional approaches.” There also needs to be much more collaboration among schools, primary care providers, and service agencies such as those dealing with child welfare, Mattox stated. ▪