Are troublesome ADHD symptoms going untreated in African-American youth even after they are diagnosed?
According to a recent study published in Pediatrics, the answer is yes. Researchers found that African-American youth with ADHD are more likely to go off of their medication and less likely to have adequate follow-up than their white counterparts.
But, while the study focused mainly on the medication aspect of treatment, some parents are simply managing their children’s ADHD in other ways.
LaTonia Taylor, of Corona, Calif., struggled for years to find the right regimen for her two daughters with ADHD. Both tried different medications before stopping them altogether in their teens.
“Each time we adjusted the medications, it would cause problems with sleep patterns, eating patterns and mood swings. We decided to manage it with alternative methods,” Taylor explains.
If parents don’t see an immediate benefit or they notice side effects, they are more likely to stop their child’s medication, says Dr. Erikka Dzirasa, a board-certified child and adolescent psychiatrist and medical director of Veritas Collaborative in Durham, North Carolina.
“We need to communicate potential adverse effects so families can be prepared if their child experiences [these] effects,” Dzirasa says.
Melisa Alaba, a licensed professional counselor who practiced for 15 years in Marietta, Georgia, followed the alternative methods route with her daughter Olayemi as well.
“I never started my daughter on medication,” Alaba says. “I taught Yemi to meditate very young and to use movement to help her focus in school. When she was three years old we enrolled her in karate. She has learned that movement calms her down and helps her to focus.”
Dzirasa says this is not uncommon.
“In my experience, families of color are more likely to prefer non-medication approaches before initiating medication,” Dzirasa states.
Along the same lines, in the Pediatrics study, Janet Cummings, PhD, and her team actually found that African-American youth with ADHD were more likely to receive psychotherapy services than white youth with ADHD.
“These findings are consistent with other research indicating that African-American parents may have a stronger preference for psychosocial treatments over medication for ADHD,” says Cummings.
Taylor encourages other parents to do their research.
“Find what’s best for your child,” she says. “There is no cookie-cutter method across the board. If you are going to allow your child to skip medications, be prepared to deal with the effects of the decision. Research other ways to modify behavior from a holistic approach.”
Some parents choose alternative approaches because they are aware of its positive benefits. Some parents stop medications to give their children a break from the side effects. But, there are some who avoid medication out of fear and misinformation.
“There is absolutely a stigma around ADHD, and actually all mental illness, within the black community,” says Dzirasa. “I can’t tell you how many times I’ve heard parents say, ‘You all just want to turn my kid into a zombie’ or make assumptions that doctors just want to drug African-American youth.”
Black youth – diagnosed way too much or too little?
Tameka Esannason of Woodbridge, Va., whose 9-year-old son DJ has ADHD, says the reaction she’s gotten from others in the black community has been a mixed of mistrust and disbelief about his diagnosis.
“Most believe children are just ‘bad,’ that doctors are over-diagnosing, and behaviors can be modified with spankings or punishments [instead],” Esannason says.
However, in a 2013 study, researchers who followed more than 17,000 children from kindergarten to eighth grade found that minority children were actually underdiagnosed with ADHD when compared to otherwise identical white children.
Taylor says she has lived through it with her daughters, and ADHD was definitely not on the school’s radar.
“What I found in my experience is that African-American children with ADHD were looked at more from a defiant, out-of-control perspective versus a child with a disorder that needs to be managed,” Taylor says. “When compared to white children, mine were labeled as disruptive and sent out of class.”
Dzirasa agrees: “African-American youth are often misdiagnosed with conduct disorder, oppositional defiant disorder or psychotic disorders [instead of ADHD].” Even in Cummings’ study, an abundance of the children in the study also had diagnoses related to conduct and defiance in addition to their ADHD diagnoses.
The Faces of ADHD
ADHD, which affects 6.4 million, or roughly 1 in 10 children, is characterized by symptoms of inattention – such as trouble focusing for long periods of time, careless mistakes, not following through on schoolwork or chores, trouble organizing, losing things frequently – and symptoms of hyperactivity such as fidgeting, restlessness, excessively running around, always on the go, talking excessively or interrupting others. However, in reality, the symptoms of ADHD can vary depending on the child.
“Not every ADHD case looks like the child that’s bouncing off the wall,” Esannason says. “For DJ, it’s his mind racing in a million different directions – which is why he is so good at video games.”
Similarly, which treatments will be effective also varies from child to child. Common medications include stimulants such as Ritalin and Adderall, as well as non-stimulants such as Strattera, Intuniv and clonidine. It may take a few tries to find the right regimen.
But, even if a patient decides medication is not for them, Dzirasa says, it is still important for them to stay in therapy.
“The therapist can monitor them closely and can quickly refer them to a psychiatric provider if they decline or develop any other concerning symptoms,” she explains.
“Children who have ADHD have difficulties that are real… so please commit to some type of treatment to help your child long-term,” Alaba pleads. “Medication provides temporary relief, but having a behavior modification plan, mentors and support will allow your child to be successful as they grow.”
And her daughter Olayemi is doing just that.
“Yemi is now a star student, vice president of her sophomore class and an honors student,” Alaba boasts. “When I think of all the hard work she has put in to get to this point it literally brings tears to my eyes. She fought to learn and identify how to stay focused among distractions.”