Skip to main content

“Us Against Them”: Schools, Families, and the Diagnosis of ADHD Among Black Children

Abstract

Prior research indicates that attention-deficit/hyperactivity disorder (ADHD) is underdiagnosed, or less likely to be diagnosed, among Black children relative to White children and children in other non-Black racial categories. Scholars have suggested that this may be a result of cultural biases or misconceptions that affect the ways classroom behavior is interpreted. The purpose of this pilot study was to engage a larger theoretical framework that explores the relationships between parents and teachers and to examine some of the ways in which common cultural misconceptions can lead to flawed behavioral ascriptions in the classroom, producing negative social outcomes for Black children. Findings from ethnography and interviews reveal that the most common barriers in this low-income neighborhood school setting included poor parent-teacher rapport, a general lack of basic understanding for how ADHD can affect classroom behavior, and faulty procedures in the school setting based on cultural stereotypes. These findings suggest that school officials’ disinclination to recommend ADHD testing for Black children may be largely a result of the aforementioned obstacles. A larger study based on these results may produce more robust findings about the barriers that contribute to racial disparities in ADHD diagnoses.

This is a preview of subscription content, access via your institution.

References

  1. Castellanos FX, Sonuga-Barke EJS, Milham MP, Tannock R. Characterizing cognition in adhd: beyond executive dysfunction. Trends Cogn Sci. 2006;10:117–23.

    Article  PubMed  Google Scholar 

  2. Sonuga-Barke EJ, Sergeant JA, Nigg J, Willcutt E. Executive dysfunction and delay aversion in adhd: nosologic and diagnostic implications. Child Adol Psych Cl. 2008;17:367–84.

    Article  Google Scholar 

  3. Nigg JT. Attention-deficit/hyperactivity disorder: endophenotypes, structure, and etiological pathways. Curr Dir in Psychol Sc. 2010;19:24–9.

    Article  Google Scholar 

  4. Visser SN, Danielson ML, Bitkso RH, Holbrook JR, Kogan MD, Ghandour RM, Perou R, Blumberg SJ. Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011. J Am Acad Child Psy. 2014;53:34–46.

    Article  Google Scholar 

  5. Hagaman JL, Casey KJ. Understanding and supporting the academic needs of students with adhd. Special Education. 2016;1(34). Doi:10.21277/se.v1i34.248.

  6. Castellanos XF, Tannock R. Neuroscience of attention-deficit/hyperactivity disorder: the search for endophenotypes. Nat Rev Neurosci. 2002;3:617–28.

    Article  CAS  PubMed  Google Scholar 

  7. Litner B. Teens with adhd: the challenge of high school. Child Youth Care For. 2003;32:137–58.

    Article  Google Scholar 

  8. Barkley RA, Fischer M, Smallish L, Fletcher K. Young adult follow up of hyperactivity children: antisocial activities and drug use. J Child Psychol Psyc. 2004;34:195–211.

    Article  Google Scholar 

  9. Birchwood J, Daley D. Brief report: the impact of attention-deficit/hyperactivity disorder (adhd) symptoms on academic performance in an adolescent community sample. J Adolescence. 2012;35:225–31.

    Article  Google Scholar 

  10. Barkley RA. Attention-deficit/hyperactivity disorder: a handbook for diagnosis and treatment. 4th ed. New York: Guilford Press; 2015.

    Google Scholar 

  11. Morgan P, Staff J, Hillemeier M, Farkas G, Maczuga S. Racial and ethnic disparities in adhd diagnosis from kindergarten to eighth grade. Pediatrics. 2013;132:85–93.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Morgan P, Hillemeier M, Farkas G, Maczuga S. Racial/ethnic disparities in adhd diagnosis by kindergarten entry. Journal of Psychological Psychiatry. 2014;55:905–13.

    Article  Google Scholar 

  13. Kochman T. Black and white styles in conflict. Chicago: University of Chicago Press; 1983.

    Google Scholar 

  14. Davidson JC, Ford DY. Perceptions of attention-deficit/hyperactivity disorder in one african-american community. J Negro Educ. 2001;70:264–73.

    Article  Google Scholar 

  15. McCabe SE, Morales M, Cranford J, Delva J, McPherson MD, Boyd CJ. Race/ethnicity and gender differences in drug use and abuse among college students. J Ethn Subst Abus. 2007;6:75–95.

    Article  Google Scholar 

  16. Downey DB, Pribesh S. When race matters: teachers’ evaluations of students’ classroom behavior. Sociol Educ. 2004;77:267–82.

    Article  Google Scholar 

  17. Rudd T. Racial disproportionality in school discipline: implicit bias is heavily indicated. Kirwan Institute Brief, Kirwan Institute for the Study of Race and Ethnicity at The Ohio State University. 2014.

  18. Crenshaw K, Ocen P, Nanda J. Black girls matter: pushed out, overpoliced and underprotected. African American Policy Forum, Center for Intersectionality and Social Policy Studies at Columbia University. 2015.

  19. Smith EJ, Harper SR. Disproportionate impact of K-12 school suspension and expulsion on black students in southern states. Philadelphia: University of Pennsylvania, Center for the Study of Race and Equity in Education; 2015.

    Google Scholar 

  20. Bussing R, Schoenberg NE, Perwien AR. Knowledge and information about adhd: evidence of cultural differences among African-American and white parents. Soc Sci Med. 1998;46:919–28.

    Article  CAS  PubMed  Google Scholar 

  21. Horn IB, Joseph JG, Cheng TL. Nonabusive physical punishment and child behavior among african-american children: a systematic review. J of the Natl Med Assoc. 2004;96:1162–8.

    Google Scholar 

  22. Ahmann E. Adhd among African-Americans. Psych Central. 2013. http://psychcentral.com/lib/adhd-among-african-americans/00017250.

  23. National Institutes of Health Consensus Development Conference Statement. Diagnosis and treatment of attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2000;39:182–93.

    Article  Google Scholar 

  24. Centers for Disease Control and Prevention. 2014. http://www.cdc.gov/nchs/fastats/adhd.htm.

  25. Mehta S, Nagar S, Aparasu R. Unmet prescription medication need in U.S. children. J Am Pharm Assoc. 2009;49:796–76.

    Article  Google Scholar 

  26. Bailey RK, Owens DL. Overcoming challenges in the diagnosis and treatment of attention-deficit/hyperactivity disorder in african americans. J Natl Med Assoc. 2005;97(10 Suppl):5S–10S.

    PubMed  PubMed Central  Google Scholar 

  27. Bailey RK, Jaquez-Gutierrez MC, Madhoo M. Sociocultural issues in african american and hispanic minorities seeking care for attention-deficit/hyperactivity disorder. Prim Care Companion CNS Disord. 2014;16. Doi:10.4088/PCC.14r01627.

  28. Mueller AK, Fuermaier ABM, Koerts J, Tucha L. Stigma in attention-deficit/hyperactivity disorder. Atten Def Hyp Disod. 2012;4:101–14.

    Article  Google Scholar 

  29. Schneider H, Eisenberg D. Who receives a diagnosis of attention-deficit/hyperactivity disorder in the United States elementary school population? Pediatrics. 2006;117:601–9.

    Article  Google Scholar 

  30. Kendall J, Hatton D. Racism as a source of health disparity in families with children with attention-deficit/hyperactivity disorder. Adv Nurs Sci. 2002;25:22–39.

    Article  Google Scholar 

  31. Washington H. Medical apartheid. New York: Random House, Inc; 2006.

    Google Scholar 

  32. Ayalon L, Alvidrez J. The experience of black consumers in the mental health system—identifying barriers to and facilitators of mental health treatment using the consumers’ perspective. Issues Ment Health Nurs. 2007;28:1323–40.

    Article  PubMed  Google Scholar 

  33. Musa D, Schulz R, Harris R, Silverman M, Thomas SB. Trust in the health care system and the use of preventive health services by older black and white adults. Am J Public Health. 2009;99:1293–9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Richardson A, Allen JA, Xiao H, Vallone D. Effects of race/ethnicity and socioeconomic status on health information-seeking, confidence, and trust. J Health Care Poor and Underserved. 2012;23:1477–93.

    Article  Google Scholar 

  35. Herman JL, Yeh JP. Some effects of parent involvement in schools. Urban Review. 1983;15:11–7.

    Article  Google Scholar 

  36. Wentzel KR. Social relationships and motivation in middle school: the role of parents, teachers, and peers. J Educ Psychol. 1998;90:202–9.

    Article  Google Scholar 

  37. Adams KS, Christenson SL. Trust and the family—school relationship examination of parent-teacher differences in elementary and secondary grades. J School Psychol. 2000;38:447–97.

    Article  Google Scholar 

  38. Irvine JJ. Black students and school failure: policies, practices, and prescriptions. Westport: Greenwood Press; 1991.

    Google Scholar 

  39. Saft EW, Pianta RC. Teachers’ perceptions of their relationships with students: effects of child age, gender, and ethnicity of teachers and children. School Psychol Quart. 2001;16:125–41.

    Article  Google Scholar 

  40. Meehan BT, Hughes JN, Cavell TA. Teacher-student relationships as compensatory resources for aggressive children. Child Dev. 2003;74:1145–57.

    Article  PubMed  Google Scholar 

  41. Ladison-Billings G. Like lightning in a bottle: attempting to capture the pedagogical excellence of successful teachers of black students. Int J Qual Stud Educ. 1990;3:335–44.

    Article  Google Scholar 

  42. Gregory A, Cornell D, Fan X. The relationship of school structure and support to suspension rates for black and white high school students. Am Educ Res J. 2011;48:904–34.

    Article  Google Scholar 

  43. Hughes J, Kwok O. Influence of student-teacher and parent-teacher relationships on lower achieving readers’ engagement and achievement in the primary grades. J Educ Psychol. 2007;99:39–51.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Hughes JN, Gleason KA, Zhang D. Relationship influences on teachers’ perceptions of academic competence in academically at-risk minority and majority first grade students. J Sch Psychol. 2005;43:303–20.

    Article  PubMed  PubMed Central  Google Scholar 

  45. U.S. Bureau of Labor Statistics. Memphis area economic summary. 2016. http://www.bls.gov/regions/southeast/summary/blssummary_memphis.pdf. Accessed 7 Oct 2016.

  46. Hesse-Biber SL, Leavy PL. The practice of qualitative research. Thousand Oaks: SAGE Publications; 2010.

    Google Scholar 

  47. Braun V, Clarke V. Successful qualitative research: a practical guide for beginners. Los Angeles: SAGE Publications, Inc; 2013.

    Google Scholar 

Download references

Acknowledgments

The author would like to acknowledge Zandria Robinson, Anna Mueller, Wesley James, and Courtney Thomas for their advisement during this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Myles D. Moody.

Ethics declarations

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moody, M.D. “Us Against Them”: Schools, Families, and the Diagnosis of ADHD Among Black Children. J. Racial and Ethnic Health Disparities 4, 949–956 (2017). https://doi.org/10.1007/s40615-016-0298-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-016-0298-9

Keywords