About 10 years ago, Leslie Jones (BA ’94, MA ’97) noticed that her son Coleman’s focus wasn’t always consistent. While he would sometimes struggle to stay attentive, at other times he would fixate on certain things. One year, her family traveled to Martha’s Vineyard and transported their car by ferry. “He was so fascinated with the ferry,” she says. “He would look up ferries, he knew all the different ferries at the Vineyard and if he saw a ferry on TV, he would stop and put it in a conversation, no matter the relevance.”
When a doctor suggested that she and her husband have Coleman evaluated, they were surprised to learn that Coleman possessed attention-deficit/hyperactivity disorder (ADHD), a neurodevelopmental disorder that affects the brain’s ability to process and retain information.
As an educator, Jones was familiar with ADHD. But Coleman had none of the symptoms she commonly saw associated with the disorder, such as constant fidgeting and impulsive actions. “I learned that some kids demonstrate it one way and some another,” she says.
The Jones family experience is common in many American homes, as ADHD affects nearly 10% of children between ages 3-17. People with ADHD “generally have a deficit in working memory,” says Brandi Walker (PhD ’18), a clinical psychologist and CEO of her private practice, Marie Pauline Consulting. “They may also have a deficit in processing speed or the ability to take information and act on it quickly.”
The percentage of children between 3-17 with ADHD
ADHD symptoms typically fall into two categories: some deal with inattention, such as being easily distracted, having trouble organizing tasks, an inability to pay close attention to details and a failure to follow through on instructions; others relate to hyperactivity and impulsivity, such as fidgety behavior, excessive talking, a likeliness to interrupt conversations, and having trouble waiting their turn.
Children with ADHD may have difficulty completing schoolwork, and these struggles can continue into adulthood with work-related tasks and even relationships. While an ADHD diagnosis can be difficult to navigate for any family, Black families dealing with ADHD often have a particularly challenging road. Studies have shown that Black children with symptoms of ADHD are treated more negatively by teachers and other adults, or even misdiagnosed altogether. In other cases, access to testing, treatment, and even specialists of color are hard to find, putting Black children at a disadvantage to their white peers with similar symptoms.
Getting the diagnosis right
If a parent suspects their child has ADHD, they should reach out to the child’s teacher or someone who oversees the child’s extracurricular activities to see if the child is exhibiting the same behaviors in other environments, Walker suggests. The child’s pediatrician or a mental health expert can also help the parent through the evaluation process. A medical exam will likely be conducted to exclude other causes of the symptoms, and interviews and questionnaires may be conducted with caregivers and other individuals who spend ample time with the child. A diagnosis would be based on ADHD criteria from the Diagnostic and Statistical Manual of Mental Disorders DSM-5, published by the American Psychiatric Association.
Our kids are often misdiagnosed because people look at their behaviors more punitively than they might look at the same set of behaviors in a white child or another child of color.”
Nonetheless, conducting an evaluation doesn’t guarantee that the child will be correctly diagnosed.
When Black children exhibit ADHD-typical behaviors, they are often misdiagnosed with a conduct or behavior disorder. “When you have a Black child who’s up and down out of their seat, who’s not able to focus enough to respond to the teacher in the classroom, that is often perceived as disruptive,” says psychologist Alfiee M. Breland-Noble, PhD (BA ‘91), founder and president of AAKOMA, a nonprofit dedicated to empowering Black, indigenous, people of color (BIPOC) and their families about mental health. As a result, Breland-Noble says, “our kids are often misdiagnosed because people look at their behaviors more punitively than they might look at the same set of behaviors in a white child or another child of color.”
Conversely, Walker says Black children might also be inaccurately diagnosed with ADHD. For example, if the child is living in a high-stress environment and not sleeping enough, they might exhibit symptoms easily mistaken for ADHD, Walker says. With Black families often facing systemic macroaggressions, socioeconomic injustices, and other challenges, “the mental load for our kids of color tends to be different from our ethnic counterparts,” Walker adds.
Studies even contradict on whether Black children are over- or underdiagnosed with ADHD. While a 2020 study by the Centers for Disease Control and Prevention found that Black children are more likely to be diagnosed with ADHD compared to white and Hispanic children, a study published in 2021 in JAMA Network Open found that Black, Asian, and Hispanic children were significantly less likely to be diagnosed with or treated for ADHD than white children.
Breland-Noble says we need more research that specifically scrutinizes ADHD from a cultural standpoint. “We really need Black scholars to be uplifted and funded to do this work so that we can find culturally responsive solutions that are going to benefit Black people,” she says.
Overcoming the Stigma
Another challenge Black families often face is the acceptance of the ADHD diagnosis. Melvin Bogard, marketing manager for Howard’s Center for Excellence in Teaching, Learning, and Assessment, formerly worked as a digital content director for Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), where he created content for families with ADHD with a focus on the Black community. He found that Black families sometimes don’t want to acknowledge their child’s ADHD.
“We already have so much that we have to deal with. We already have so many labels. We already have so many stigmas,” Bogard says. “Some parents say, ‘I just don’t want my child to have another label.’”
While good-intentioned, failing to help these children in the present can make their lives more difficult moving forward. “If your child broke their leg, there’s no stigma attached – you’re going to go get that leg set because you want that bone to heal so your child can have a healthy life going forward,” says Breland-Noble. “Having something like ADHD is the same thing. You want a diagnosis of the behaviors of the problem so you can find the right tools and resources to help your child in the long term.”
Deciphering the Maze of Treatment
When it comes to treatment, “there’s a fast way, a slow way, and the best way,” Breland-Noble says.
The “fast way” is medication, which can minimize the symptoms. The “slow way” is behavioral therapy, where children are provided resources to adapt to their brain function. The “best way” is a combination of the two – and includes teaching family members how they can best support the child with ADHD, Breland-Noble adds. For example, a child with ADHD may need more time to get ready for church or school.
Since many medications include side effects and some may work better for a particular child than others, parents may have to experiment with different prescriptions or dosages until they find one most effective for their child.
Having something like ADHD is the same thing. You want a diagnosis of the behaviors of the problem so you can find the right tools and resources to help your child in the long term.”
Finding healthcare providers who are culturally competent may be even more difficult. “If you think about rural areas where you might have one mental health professional for 200 families, that mental health professional more than likely is not a person of color,” Breland-Noble says. “Even when you live in areas where there are a lot of Black folks, they’re not saturated with mental health professionals who are Black because only 4% of all psychologists nationwide are Black.”
Then there are the costs. When Jones had Coleman tested, she says she and her husband had to make a $400 copayment, despite their quality insurance. “A lot of people don’t have the same level of insurance that we have so that’s a barrier to care.” After Coleman was diagnosed, they were charged another $400 copayment for medication. Though they could afford to pay, Jones thought about other families who would not be able to receive treatment because of the charges. “What if we did not have $400?” she asks rhetorically. “Do you know how many people do not have $400?”
Getting the Needed Educational Resources
Children spend much of their time in school, so the support from teachers and other staff can be critical. “We need all hands on deck to truly understand how to help a child who has ADHD,” says Mercedes E. Ebanks (MEd ’95, PhD ’05), associate professor in the School of Education.
A child with ADHD may perform better by not sitting in the back of the room where they can be easily distracted by everyone sitting in front of them, Ebanks says. Or, perhaps, a child could be permitted to sit with a bouncy ball under their feet that they can roll because a repetitive action has proven soothing to that student. “There are ways that educational settings can be set to be able to address how children can best learn,” she says. However, between overcrowded schools and burned-out teachers, concerning behaviors can easily be disregarded.
Children may also be entitled to accommodations at school that can help them to learn more effectively. For example, an Individualized Education Program (IEP) is a type of specialized instruction designed to support a child’s academic progress. A 504 Plan is a federally mandated program developed to help the educational pursuits of children with disabilities. Students may also be provided additional time to complete assignments or examinations.
For some children with ADHD, a classroom setting provides the structure they need, while others flourish when their schooling is online. Granting neurodiverse children the opportunity to explore different modes of learning can help them find what works best for them.
“It’s very important to have multiple ways to present information because every learner is not the same,” says Morris Thomas, assistant provost for Digital and Online Learning and director of the Center for Excellence in Teaching, Learning, and Assessment. Online courses often feature additional technological aids, such as video with closed captioning so students can consume the video while reading the text onscreen, or a PDF of the transcripts so students can re-read the information after class.
If a student with ADHD had difficulty focusing, that student could rewind the video and listen to that portion again. “I can have more opportunities for individualized learning by being able to pause something and run it back again as many times as I need to. I wouldn’t be able to do that in a non-online experience,” Thomas says. Online learning tools can also build in means of providing unique accommodations to students. For example, a learning platform can be programmed to give a student with ADHD more time to complete a test.
Despite the challenges, ADHD does not have to be a barrier if you receive the support needed to navigate it. Jones has witnessed it firsthand, with her son Coleman now thriving in his first year of college.
“There are plenty of people with ADHD who are super successful,” says Breland-Noble. “You have to advocate early, you have to advocate often, and you have to advocate consistently to ensure that your child’s needs are met when it comes to ADHD because it’s treatable.”
CHADD’s ADHD and Diverse Population (podcasts, articles, and videos)
Podcasts: CHADD’s ADHD and Black Culture
Article ID: 1916