ADHD diagnosis and how it affects the Black community 

Hyperactivity is often underdiagnosed in the Black community.

Historically, white children have the highest percentage of diagnosis and treatment for attention deficit hyperactivity disorder, commonly referred to as ADHD. Children of color often are diagnosed with other social disorders rather than ADHD. 

Dr. Breanna Dede with Duke University School of Medicine said ADHD is often missed in minority communities. 

“It is actually pretty prevalent, but it is often missed or underdiagnosed, and so it can sometimes look like this is happening less often in Black communities,” she said. “But when we actually look at the data, it’s not happening less often. We’re just often missing it, and there’s a lot of reasons for that. One of the reasons is misdiagnosis, and so Black kids with ADHD are sometimes more likely to be diagnosed with other things like conduct disorder or oppositional defiant disorder because the disruptive behaviors are perceived more severely in communities of color.”

According to University of Buffalo researchers Noha Shalaby, Sourav Sengupta and Jamal Williams, Black children show a significantly lower formal diagnosis rate for ADHD than white children. However, recent broader studies suggest symptoms may be misattributed or diagnosed differently. 

“I think systemic racism and like just the history of psychology not always being founded in a culturally competent way contributes,” Dede said, “and so I think that really leads to a lot of our assessment tools not being tailored to Black populations, so a lot of our assessment tools for ADHD were normed on white samples, and we've done a lot of work to adapt them, and they have since been proven to be valid and able to detect in Black samples, Hispanic samples, Asian samples as well. But there’s still an implicit bias in some of these tests, and we have to think about the people filling them out.”

There is a misconception that ADHD is overdiagnosed. Dede tends to believe now they are more attentive to it, that is why diagnosis rates among all races has increased over the last decade. 

“I think before we were honestly missing a lot,” she said, “so I think it was underdiagnosed before, and there's a little bit of a correction to the mean. I do think the ADHD diagnosis is very widespread, depending on how you're looking at it.”

As a psychologist, Dede doesn’t prescribe medication but does offer what she looks for on a case-by-case basis when a child may need it. 

“What we know about ADHD treatment is one of the most efficacious combos is a combination of behavioral change done through therapeutic intervention and medication,” she said. “What I think about is there’s no evidence saying that we should start with one versus the other, or if you were to do both, you're being too hasty.

“What I think about when a kid comes into my office and I’m thinking about an ADHD diagnosis, I’m thinking about if I want you to make these behavioral changes, do you have the bandwidth and cognitive capacity to do those, or are your ADHD symptoms interfering with you even being able to pick up on some of these therapeutic things.”

Among the biggest misconceptions about ADHD are presumed laziness, it occurs in hyperactive boys only and it just isn’t real. Dede said education goes a long way in understanding its prevalence and eliminating fallacies.

“I think education on ADHD is a huge piece, especially in minority communities,” she said. “Historically, minorities are less likely to seek services at all, and they sometimes are waiting until there’s high levels of severity. So, because of distrust in the system that is founded in a lot of distrustful behaviors that have gone on throughout the medical history, I think a big piece of psychoeducation – especially in underrepresented communities – being able to go into places, community centers, schools, talking to parents and families, and normalizing this.

“I think sometimes that’s really helpful for parents to understand this isn’t just your kid making this up. We can look at the brain of a child with ADHD and without ADHD and see some significant differences. There’s a biological basis to this of why these things are difficult. It’s not just an effort situation.”

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