essay / research

ADHD, race and the tough questions in between

 A recent study in Pediatrics is bringing needed attention to disparities in mental health care — while skirting crucial questions about ADHD.

Tracking more than 15,000 U.S. students from kindergarten to eighth grade, the study found that non-white children are less likely to be diagnosed with ADHD than their white counterparts. They’re also less likely to be taking prescription medication even when they’ve been diagnosed with the disorder. Based on these findings, the researchers urge “pediatricians, school psychologists, teachers, and other clinicians” to be more vigilant in diagnosing and treating non-white children for ADHD.

To me, that advice is one part warranted, two parts problematic. On one hand, minority children could definitely benefit from closer attention to their mental health. There’s a long history of racial minorities and low-income communities getting the short end of the stick when it comes to mental health care. So calling attention to these disparities is a good thing when it means improving the well-being of under-served communities.

On the other hand, this paper’s recommendations imply that we currently have a solid system for understanding and treating ADHD, a system minorities just need more of. On that point, I’m less convinced. In her piece “Why French kids don’t have ADHD,” family therapist Marilyn Wedge points to France as an example of a society less prone to treat ADHD as a purely biological disorder that requires medication. Although the piece generalizes a lot (and its central claim has been challenged), I second some questions it raises: in the States, why do we so often defer to medication as the one valid intervention for mental health problems? What if we did more to address young people’s social environments and how those environments shape their behavior?

The fact is, we still don’t know enough about the long-term effects of the stimulants used to treat ADHD, especially when individuals start using these medications at a young age. And many of the risk factors for ADHD sound like candidates for social intervention. According to the Pediatrics study, children are more at risk for the symptoms associated with ADHD when they have low birth weight, low maternal education and low household income. If we put more effort into addressing the social elements of those factors, maybe we could stem the rapid increase in American children who are labeled with a neurobiological disorder and as a result get put on pills. Just because a condition manifests itself in neurobiological changes doesn’t mean that medication is the only way to treat it.

These concerns aren’t meant to undermine the experiences of young people diagnosed with ADHD, or to criticize parents whose children take stimulants. Many individuals end up with this diagnosis because their attentional or behavioral problems genuinely interfere with their lives. And parents aren’t to be blamed for seeking a solution, especially one widely endorsed by the medical community.

My point is just that before we try to bring underrepresented communities into a particular mental health care model, we should scrutinize that model to gauge whether it’s sound in the first place. I’m not the first person to question our society’s reliance on pills and our medicalization of behavior we consider to be deviant (like, say, spacing out in class). I just hope that bringing better mental health care to under-served communities won’t have to mean doling out seemingly irreversible diagnoses, and prescribing more pills.


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