Question:

I teach children who come from families with a primarily African-American background. They seem to demonstrate many more ADHD like behaviors than children of other ethnic groups with which I have experience. Is ADHD more prevalent among African-Americans?

A teacher at a recent ADHD workshop

Answer:

Thank you for your excellent question. Few research studies have been conducted comparing the incidence of ADHD in various US ethnic groups. Those that have been done indicate a similar incidence of ADHD among African-Americans, Hispanic-Americans and European-Americans in the United States (Office of the U.S. Surgeon General). One exception that I found was Dr. Russell Barkley who cites research indicating that prevalence may be higher among Puerto Ricans and children of military personnel. This research does not indicate that the incidence is higher among African-Americans than among the rest of the population.

Most sources I checked agreed that African American youth are two and a half times less likely than European-American children to receive a diagnosis of ADHD. According to the CHADD Educators’ Manual, one study also found lower use of medication in non-white youth. Just five percent of African-Americans and two percent of Hispanics in contrast with eight percent of Caucasians used medication to treat ADHD.

In contrast to their under-representation in ADHD diagnoses, African-American males are diagnosed with emotional and behavioral disorders at a higher rate than white males. One interpretation of these statistics is that students who might actually have ADHD are being placed in the category of “emotionally disturbed”. African-American children are also over-represented in arrests, detentions, and incarcerations. (Office of the U.S. Surgeon General). In general, children who do not receive treatment for ADHD are at high risk for developing criminal behavior. (Barkley) The general concern is that African-American children are not receiving optimal care for the conditions that they may have, not that ADHD occurs more frequently in that population.

There are several reasons why it might seem that there is a high rate of ADHD in your students. As discussed above, some of your students who have ADHD may not have been diagnosed with the condition. Secondly, although you do not mention your own ethnicity, it is possible that your communication style differs from that of your students.

Whenever professionals work with an ethnic group different from their own, we must be culturally sensitive. This requires education and effort on our part. Enid Lee, a leader in equity education addresses this question: “How do you tap into students’ cultures if you don’t know about these cultures and if they differ from yours? You might think that my first suggestion would be to learn as much as you can about the students’ cultures. This is important, but even more crucial is knowledge and assessment about your own culture.”

Various sources list specific communication styles of specific groups. A source for this type of information, Multicultural Students with Special Language Needs is listed in the Resources. However, I would like to share some of the tips given by Ms. Lee:

• If we ourselves are members of the dominant culture we need to be aware of our tendency to think in “deficit” terms in relation to our own culture. As a first step, we need to check ourselves and ask “Is it really deficit? Or is it just different from what we consider normal?”

• Ask ourselves, “Where can I look for that culture?” in order to learn more.

• Most of us experience other cultures through the food and multicultural festivals. If we start there, we must look beneath these expressions of culture to ask “What is the meaning of these activities in the lives of the students and their families? What can they tell me about the prior experiences of this ethnic group? What does it indicate about my students’ interests and their goals?”

• We can learn about our students’ culture through respectful interactions with their families and communities through getting to know these families and attending events in the community open to the general public.

• We can continue to learn about the cultures through the literature and art of our students.

• As we educate ourselves about our students’ cultures, Ms. Lee suggests the following guidelines:

• Guard against the “deficit” lense. We risk perpetuating racism and limiting learning if we are not mindful of the ways in which the cultures of people of color are racialized and minimized.

• Watch out for categorizing whole groups of people in a single word. Cultures change over time and vary over location. Ms. Lee suggests that we will be more accurate if we qualify our observations using terms such as “with this group of Native Americans, Latinos, etc. I have noticed this cultural pattern.”

• Be open to learning from our students. They are a goldmine.

• Honor our students’ families and communities as their first teacher.

• Periodically renew our commitment to learn about the values and victories of our students and ways to incorporate these into our teaching.

• Allow the joy of learning about our students’ and our own culture to shine on.

References:

Barkley, Russell.(2006) Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, Third Edition. New York, New York: The Guilford Press

Delpit, Lisa. (1995) Other People’s Children: Cultural Conflict in the Classroom. New York, New York: The New Press.

Lee, Enid. Enid Lee Reader. Online at www.enidlee.com see “Questions to Enid Lee” and “Educating Children of African Ancestry in The United States of America, Canada, and The United Kingdom- A Select Bibliography”

Roseberry-McKibbin, C. (2002) Multicultural Students with Special Language Needs, Second Edition. Oceanside, CA: Academic Communication Associates.

Zeigler Dendy, C., Durheim, M., and Ellsion, A. (2006) CHADD Educator’s Manual on Attention-Deficit/Hyperactivity Disorder (AD/HD). Landover, MD: CHADD

Research regarding prevalence of ADHD cited here from the CHADD Educator’s Manual:

Office of the U.S. Surgeon General. (2001) Mental Health: Culture, Race. And Ethnicity, A Supplement to Mental Health: A Report of the Surgeon General. Washington, DC (author)

Rowland, A.S., Umbach, D.M, Stallone, l, Naftel, A.J. Bohlig, E.M. & Sandler, D.P. (2002) “Prevalence of Medication Treatment for Attention Deficit-Hyperactivity Disorder Among Elementary School in Children in Johnston County, North Carolina.” American Journal of Public Health, 92, 231-234.