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How are minority children with ADHD affected by diagnostic, treatment, and educational inequities—and what can we do about it?
A panel of researchers representing the American Professional Society of ADHD and Related Disorders (APSARD) Health Equity Task Force participated in an invited symposia on the effects of inequity on minority populations in relation to attention-deficit/hyperactivity disorder (ADHD) at the 2022 APSARD virtual conference on January 14.
“The task force was launched in relation to the amazing societal changes that are happening right now in front of us in association with the awareness that equity means creating fair, equitable opportunities for all of us,” explained Martin Katzman, MD, FRCP(C), APSARD board member, presentation chair, and APSARD Health Equity Task Force chair, told attendees. “We’re hoping to build connections within the APSARD community, to enhance diversity of the organization, and to reach out across boundaries as well as to partner within all of our communities to raise awareness and to increase opportunities for treatment for populations that may not get the same access to treatment.” Katzman is clinical director of the START Clinic for Mood and Anxiety Disorders.
On behalf of the task force, Amy Glasofer, DPN, RN, shared an analysis she conducted of 41 studies relating to ADHD, race, ethnicity, and disparity; Catherine Dingley, PhD, RN, FNP, FAAN, associate professor and director of the PhD program in the Nursing Department of the University of Las Vegas, Nevada, also worked on the project. According to Glasofer, a nurse scientist with Virtua, 66.7% of studies found that Black children were significantly less likely than white children to be diagnosed with ADHD, and 65% of Black children with ADHD were significantly less likely than white children to receive medication. In addition, compared to white children, she noted Black children were more likely to discontinue medication and more likely to experience gaps in treatment; less likely to receive an α-2 agonist alone; and more likely to receive significantly lower doses of stimulant. The findings suggest that, although diagnostic disparities have been reduced over time, treatment disparities still exist for minority children with ADHD.1
Napoleon Higgins, MD, discussed the school-to-prison pipeline that disproportionately affects Black children and its connection to ADHD. Higgins, CEO and president of Bay Pointe Behavioral Health Service, Inc, explained that Black students are 3.5 times more likely to be suspended or expelled, and 1 in 4 Black children with disabilities are suspended compared to 1 in 11 white children with disabilities. In addition, Black children represent 15% of all youth, but 28% of all arrests; depictions of Black individuals as violent, aggressive, dangerous, and criminal persist and result in unconscious biases and associations. Zero tolerance policies and relegation to alternative schools due to behavioral issues also effectively push children from the classroom to the prison, with punishment prioritized over education and rehabilitation.1
Higgins added that some behavioral issues may be caused by symptoms of ADHD. However, because missed diagnoses are common, the result is these children do not receive treatment, which may have lifelong detrimental consequences.Similarly, Black children with ADHD may not receive appropriate treatment due to treatment hesitancy—specifically, suspicion of the diagnosis, general mistrust of the medical community, lack of access to quality care, and the fear of mind control and potential medication-adverse events—which is common among Black families.1
To combat the school-to-prison pipeline and these treatment disparities, Higgins suggested: increased education, interventions and services, flexibility, and understanding of cultural barriers among clinicians and families; an end to zero tolerance policies; and more teachers and counselors and less law enforcement in schools. He also suggested that clinicians conduct full diagnostic interviews with Black individuals, rather than relying solely on checklists or questionnaires, to avoid missing or misidentifying symptoms of ADHD.1
J. Faye Dixon, PhD, professor in the University of California, Davis Medical Center, served as presentation cochair, and the symposia was moderated by Katzman; Brooke Molina, PhD, professor of psychiatry, psychology, and pediatrics in the University of Pittsburgh School of Medicine and director of the Youth and Family Research Program; and Roberta Waite, RN, professor and associate dean of community-centered health and wellness & academic integration at Drexel University.
1. Katzman M, Higgins N, Glasofer A, et al. Introducing the APSARD Health Equity Task Force. Presented at 2022 APSARD Conference. January 14, 2022.