Many parents lament over their children not following directions, lack of focus or inability to sit still. These actions are often seen “out of control” and “bad” behavior. However, it may be a sign of ADHD. According to a recent study by Getahun and colleagues published in JAMA Pediatrics, ADHD diagnoses are increasing among youth.
What is ADHD?
Attention-deficit/hyperactivity-disorder is the most common child disorder, which affects about 4.6 million American (eight percent) school aged children. ADHD is ‘a persistent pattern of inattention and/or hyperactivity-impulsivity.” These symptoms should have begun before age seven, must be present for at least six months and cause problems in everyday functioning in at least two settings (e.g., school vs. home).
A recent study by Getahun and colleagues found a 70 percent increase in the number of ADHD diagnoses among African-American children, with a 90 percent increase among African-American girls. This is compared to smaller increases in other groups — 60 percent among Hispanic youth and 30 percent among white youth. Dr. Richard Gallagher of the Institute for Attention Deficit Hyperactivity and Behavior Disorders at NYU Child Study Center cautions to not be alarmed that there has been a huge jump in the use of the diagnosis of ADHD. In fact, several studies show youth of color have previously been under-diagnosed for ADHD.
How does ADHD affect children?
Children with untreated ADHD are more likely to have problems in school because they are easily distracted and have difficulty learning. Untreated ADHD also impacts social relationships because children with ADHD often don’t get along well with others. An additional consequence of untreated ADHD is an increase in physical injuries due to hyperactivity and disruptive outbursts.
The Getahun study was conducted using medical records from almost 850,000 children ages 5 to 11 years. It was the first of its kind to sample such a large number of children using very strict criteria. But the study wasn’t able to examine why the increase in ADHD diagnoses are occurring. There are several possible explanations for the increase.
Gallagher finds that “African-American parents are obtaining more knowledge of the symptoms of ADHD and are encountering practitioners that are being more careful in discussing the symptoms and the treatments with them.” This encourages more parents to get ADHD evaluations for their children.
Gallagher also mentions that the tools used to test for ADHD have become better at identifying different types of ADHD, which might explain the increase.
However, some experts, like Dr. Elissa Brown, Executive Director of the Child HELP Partnership, have noticed that many children who have experienced trauma — violence, physical abuse and the like — are initially misdiagnosed as having ADHD. In these cases, PTSD symptoms can be misperceived as ADHD symptoms, Brown says.
Unfortunately there is much debate but very little is known about the reasons for the increase in ADHD diagnoses.
What is known is that increases in ADHD diagnoses among African-American youth without treatment could have consequences for those communities.
Consequences of untreated ADHD among African American children
Youth with untreated ADHD are more likely to drop out of school, abuse drugs and become engaged in delinquent activity, which may lead to incarceration. African-American youth are already at higher risk for these problems, thus those with ADHD are at an increased risk for the negative consequences of those behaviors.
ADHD is usually more prevalent among boys compared to girls, 11 percent compared to 5 percent. However, the Getahun study shows that this gender gap is closing for African-American children.
Researchers that have looked at gender differences found that girls with untreated ADHD are often more likely than boys to have low self-esteem, forget things easily, be disorganized and become involved with promiscuity or acting out sexually.
Many youth with untreated ADHD continue to have symptoms as adults where they are less likely to manage jobs and household responsibilities, have challenges parenting and experience high levels of stress that may place them at risk for physical health problems.
These concerns taken together highlight the severe consequences of not properly identifying and treating ADHD for individuals and within the African-American community at large.
What needs to be done about ADHD among African-American children?
Experts are not certain of the cause of ADHD in general. So what can be done?
Screening children for ADHD is an important step in addressing the problem. Dr. Deidre Anglin, licensed clinical psychologist recommends: “get a comprehensive psychological evaluation if ADHD is suspected to rule out other competing explanations for your child’s behavior such as anxiety, or other learning disorders.”
If the child is diagnosed, there are very effective treatments to help parents and children deal with the challenges they experience from ADHD. These treatments include: teaching behavior strategies to help deal with symptoms of ADHD, providing approaches for parents and children to structure the home and school environment, as well as prescribing medication.
It’s important for parents, school personnel and community leaders not to dismiss a child’s behavior as simply “troublesome” or “something they will grow out of.”
Here are some steps for getting help if you are concerned a child has ADHD:
- Begin taking notes about the behaviors of concern. Identify when you noticed the behaviors starting and how long they have been occurring.
- Talk to a trusted health provider about your concerns about the child’s behavior.
- Utilize the web for available resources, like the Children and Adults with Attention Deficit/Hyperactivity Disorder organization, to learn more about the symptoms and treatment options for ADHD.
- Dealing with a child who has ADHD can be stressful. It’s important to get support from others, including other families with children who have ADHD.
Dr. Scyatta A. Wallace is an award winning Psychologist/Teen Expert, Associate Professor of Psychology and Founder of Janisaw Company. Dr. Wallace’s work focuses on health issues impacting youth and families.