Ashleigh Pigusch. CSL 489- Psychopathology. Dr. Rodrigo Sebastian Torres. ADHD in African American Children

Transcription

1 Ashleigh Pigusch CSL 489- Psychopathology Dr. Rodrigo Sebastian Torres ADHD in African American Children

2 RUNNINGHEAD:ADHDINAFRICANAMERICANCHILDREN 2 School counselors know that they will come across numerous students who have been diagnosed with Attention Deficit Hypertension Disorder (ADHD). After all, ADHD is the most frequently occurring behavioral disorder that occurs in childhood (Wright et al., 2009). As school counselors one will also come across students who need to be diagnosed with ADHD and have yet to be. ADHD might be the most common thing students are going to need to overcome in their academic career. However, there is a lack of knowledge about where ADHD comes from and there is even more confusion about ADHD when it comes to the African American race. ADHD in African Americans can appear very different in comparison to other ethnic groups. At times ADHD can be extremely over diagnosed in African Americans as well. According to Hosterman, DuPaul and Jitendra, African American and Hispanic students are disproportionately diagnosed and placed into categories of special education in the United States (2008). Being diagnosed with ADHD can have severe implications in the family, academics, and their use of mental health services and should be treated as such. To precede it is important to understand what criteria is needed to be diagnosed with ADHD. There are two main classes of ADHD, which are inattention and hyperactivity/impulsivity. According to the DSM-IV-TR, to be diagnosed with ADHD- inattentive type you must exhibit six or more inattention symptoms, which are: does not give close attention to details or makes careless mistakes in schoolwork, often has trouble keeping attention on tasks or play activities, does not seem to listen when spoken to directly, does not follow instructions and fails to finish schoolwork, has trouble organizing activities, avoids/dislikes/doesn t want to do things that take a lot of mental effort, looses things needed for tasks and activities, easily distracted, and is often forgetful in daily activities (2000). According to the DSM- IV-TR, to be diagnosed with ADHD-hyperactive type you must exhibit six or more hyperactivity or impulsivity symptoms, which are: often fidgets with hands/feet or squirms in seat, gets up from seat when remaining seated is expected, runs about or climbs when and where it is not appropriate, has

3 RUNNINGHEAD:ADHDINAFRICANAMERICANCHILDREN 3 trouble playing or enjoying leisure activities quietly, on the go or often acts as if driven by a motor, talks excessively, blurts out answers before questions have been finished, trouble waiting ones turn, and interrupts or intrudes on others (2000). It is important to note that if a child exhibits symptoms across both types the child can be diagnosed with ADHD-combined type and all symptoms need to be present for the past six months. When treating a child with ADHD it is very important to keep in mind the family dynamic as well as the culture in which the family resides. Research has shown that African American families would rather manage their child s ADHD within the family instead of utilizing professional help in the school or outside of it (dosreis et al., 2006). This is a hurdle that teachers, counselors, and other school personnel need to figure out how to overcome. Obviously, the African American families of children that suffer from ADHD would rather deal with the issue in a smaller more familiar community aspect. This could be as simple as really involving the parent or parents in the child s therapeutic interventions. Typically, a student will have greater success if a parent is involved in their therapeutic interventions and would practice those interventions at home such as, organization skills, study skills, and staying focused. This would give the child a consistent treatment across all realms of life. However, it has been reported that African American parents are less likely to include school interventions as part of their treatment plans for their children (Bussing et al., 2007). This is where the school counselor, teacher and case manager s roles would be very important. They would be key in communicating with the child s parent in explaining how important everyone s roles are in giving the child the most success possible with their ADHD diagnosis. Another important aspect to remember when working with African American families is that the parents personal beliefs about the behavioral problem will greatly influence a decision to seek medical care (Hervey-Jumper et. al, 2006). This can stem from a lack of trust within the mental health and

4 RUNNINGHEAD:ADHDINAFRICANAMERICANCHILDREN 4 healthcare system as they may have not received proper treatment and do not want to impose that same experience on their children. Parents may fear that their children will be diagnosed and treated solely on their ethnic or racial backgrounds and will be labeled with that diagnosis for their rest of their lives (Hervey-Jumper et. al, 2006). As a counselor of any kind, understanding where the parents have come from with their own experiences could greatly impact the parent to test their child for ADHD. This may also come down to something as simple as psycho-education as only one in three African-American parents knew something about ADHD (Hervey-Jumper et. al, 2006). If a parent does not know much of anything about ADHD it might be rather difficult to get them to allow their child to go through treatment. The child s future will be at risk if parents are not better educated around issues of mental health including behavioral disorders. There must be an effort to build trust between child, parent, teacher and counselor to make an impact on the belief system of the parent surrounding mental health as well as utilizing school interventions. Finally, African American families have larger concerns surrounding medication for ADHD treatment. According to dosrios et al., they are less likely to believe that psychotropic medications are efficacious, more likely to be concerned with side effects, and less likely to give it to children than Whites (2006). Again, our role as counselors in this circumstance is to educate parents on all aspects of medication where we can. As a part of ADHD treatment medication is essential that parents, no matter of their racial background, need to understand the larger picture of how medication, psychotherapy, and school interventions work together to give their child the best outcome possible. Teachers, counselors, and other school personnel need to figure out ways to incorporate the African American culture into learning about ADHD, medication, and the potential therapies. One way to possibly do this is by utilizing services that are available in their community. One example would be the use of the library. Most communities have public libraries that have free and unlimited access to information (books,

5 RUNNINGHEAD:ADHDINAFRICANAMERICANCHILDREN 5 videos, internet, etc.) about ADHD and could prove to be a very worthwhile source for parents and children of African American background (Bussing et al., 2007). This would give parents the opportunity to be proactive and educate themselves on the aspect of ADHD medication, the possible side effects, and would allow them to have some background knowledge when talking to their child s doctor about what they are going to prescribe. This would also give these parents the power to be involved in their child s psychotherapy and school interventions at home, which as stated earlier, is key with children with ADHD. Having a child with ADHD also has implications with their school. As much as ADHD management starts with the family it really relies on the school systems to accurately identify children with ADHD and initiate proper interventions that best suit the child. This needs to start with assessment and the screening tools used to identify children with ADHD. There are many issues surrounding accurate assessment and diagnosis for African-Americans, cultural differences in perceptions of behavior, and possible bias and discrimination (Tucker & Dixon, 2009). Some tools and instruments may not be culturally sensitive to the African American community and therefore may not be the correct tool to use. For example, one of the most used tools is the Conners Ratting Scale-Revised (CRS-R) and has been well validated through research. However, in the process to validate the CRS-R African- Americans are always under represented in the samples used and do not do a great job in diagnosing African-American children with ADHD (Flowers & McDougle, 2010). This may account for why there is such over diagnosis in this particular population of children. Teachers, counselors, and other professionals who come into contact with children who may have ADHD need to make sure they maintain being culturally sensitive and not choose a testing tool that is biased toward any population of people. One tool that has been found to be culturally sensitive when it comes to diagnosing for various disorders including ADHD has been the Terry. According to Flowers and McDougle, the Terry is an

6 RUNNINGHEAD:ADHDINAFRICANAMERICANCHILDREN 6 African-American version of the Dominic-R and involves pictorial representations of symptoms that are congruent to DSM-IV diagnostic criteria (2010). Again teachers, counselors and other professionals need to make sure they stay informed on various tools used to assess for ADHD as to not misdiagnose the child or use a tool that is biased towards the child s background. This is where schools can start having a positive assessment experience for the children in their schools and may also help influence family outlook on mental health in the African-American community. School can be a very challenging atmosphere for children with ADHD no matter of ethnic background. Classes may be hard to sit through, tests may be hard to focus on, homework is hard to complete on time, and grades will suffer because of it. Schools need to do a better job of supplying appropriate classroom experiences to children with ADHD, as well as get information out to families with children who suffer from ADHD about the types of programs and support that the school offers. In a study conducted by Bussing et al., they had found that more then two thirds of parents said they had never heard of Individualized Education Programs (IEP) services and less then half of the parents said that their child ever received an IEP even if their child was receiving special education services (2007). Schools are failing to get the information out to parents that really would benefit their child s educational success. Students with ADHD are at risk for many things in a school setting including academic underachievement, having antisocial behavior, and dropping out of school (Efron et al., 2008). All of the students ADHD symptoms can really affect learning and their academic success. This is why having quality support in school that is readily available to the family and the child to utilize is extremely important. Efron et al., states during pediatric consultations a significant proportion of parents have reported feelings of frustration regarding their child s school and their knowledge and attitudes toward ADHD (2008). As mentioned earlier, it is already extremely difficult for parents of African-American

7 RUNNINGHEAD:ADHDINAFRICANAMERICANCHILDREN 7 background to utilize the support and expertise available to them at their child s school and if the school does not put forth the necessary effort to stay abreast on ADHD research, treatment information, as well as possible interventions it will only feed their belief and distrust of the school not knowing what they are doing. It is a vicious circle and needs to become a quality support system for the well being of the students in the school. Parents will then start to feel at ease about utilizing the support and also maintain those same interventions at home with their child. In looking at just the child, without a quality support system in place during school for their ADHD we are really limiting the child s success and hindering positive outcomes of their future. It is also important to note here that parents from African-American backgrounds may have experienced their own personal academic failures and this may attribute to their lack of wanting to be involved in their children s school in any way (Jurbergs et al., 2010). These parents may feel that they cannot interact with their child s teachers, counselors, or school administrators because of their lack of success in education and may not feel respected or welcomed in that atmosphere. In allowing for the most success of these children their teachers, counselors and administrators need to keep in mind that they need to incorporate the parents as much as possible and rid the stigma that they are not smart enough to be able to be a large part of their child s ADHD interventions and future success. One of the biggest obstacles to overcome when dealing with African-American students with ADHD is the fact that they are found more likely to be referred to mental health agencies at far younger of ages then any of their peers but are the least likely to utilize outpatient therapy (Tucker, & Dixon, 2009). This can be due to many reasons some of which have been mentioned before; lack of knowledge about ADHD, distrust in the mental health system, and a lack of faith in the school system their child attends.

8 RUNNINGHEAD:ADHDINAFRICANAMERICANCHILDREN 8 There are historically more boys then girls being diagnosed with ADHD between the ages of eight and fifteen years of age at a prevalence rate of two to one (Flowers, & McDougle. 2010; Tucker, & Dixon, 2009). As stated previously, this holds true in the African-American population, as they are the most often diagnosed of all groups. Through research there is no clear explanation of why gender has such a large impact on diagnosis and future research should be heading in this direction. Having more males diagnosed with ADHD then females as well as having more minority males being diagnosed with ADHD then those who are white has a large impact on seeking treatment. It is known that females seek treatment at a greater rate then males and in the case of African-American males they are less likely to receive any type of mental health intervention services or continue outpatient treatment plans after initial diagnosis (Tucker, & Dixon, 2009). There is no other group in greater need of treatment then minority males that are being diagnosed with ADHD. As stated previously, the risk factors of being African- American, male and having a diagnosis of ADHD greatly increases the risks of academic failure and punishment for being a disruptive student. When African-American males do receive mental health treatment it is more on an emergency basis. The current state of the federal state budget surrounding mental health services makes this look even bleaker. If African-American males are more likely to utilize emergency services which are provided directly from the federal state budgets and those continue to be decreased each year then this population is at greater risk of not receiving any mental health services at all. The information around African-American s with ADHD receiving treatment is unsettling to say the least. The treatment around ADHD needs to be further developed to suit the needs of this population and this can start with the student s counselor. According to Kutscher, there are four rules for treating ADHD (2008). The first is to keep it positive with the child and to remember that it is important to celebrate the things that the child does well. The counselor may be the only positive person in the

9 RUNNINGHEAD:ADHDINAFRICANAMERICANCHILDREN 9 child s life. The second rule is to keep it calm as students that suffer from ADHD may find it difficult to have any form of impulse control. Nothing good will be accomplished from anyone who is out of control and this could include the student, teacher, parent, and even the counselor. The third rule is to keep it organized as one of the largest obstacles for students suffering from ADHD are the fact that they are disorganized. Five of the nine criteria to diagnose ADHD could be seen as organizational matters and could be solved by simply having an assignment book, planner, folder, or binder (Kutscher, 2008). The fourth rule is keeping it going and is simply to just continue any interventions from rules one through three. These rules may seem simple enough, however, there are even further things to keep in mind when treating students of African-American decent. Counselors should take extra care in developing counseling relationships with these students (Tucker & Dixon, 2009). As mentioned previously, this community has had a history of negative experiences from mental health services. This would work to help negate these experiences as long as the counselor is willing to have a positive professional relationship with the student. This could be incorporated into all if Kutscher s rules of treating ADHD. Another very important issue to remember about working with African-American s with ADHD is to fine ways to involve the parents in the treatment process as something other then consent-givers (Tucker & Dixon, 2009). As counselors, invite the parents of these children to participate in the interventions that are happening in the school to help their child as well as keep the parents informed about the options of assistance available in the school. This important point is key to working with this population. Including the parent would be beneficial to all four rules and would be most beneficial in keeping the interventions going especially when at home.

10 RUNNINGHEAD:ADHDINAFRICANAMERICANCHILDREN 10 If a student is in need of further assistance outside of the school it is important for counselors to remember a very basic aspect of their job with this population and that is to simply be an advocate for the student and the family (Tucker & Dixon, 2009). Here it would be very important to not only understand the community that the family resides but to also understand their mistrust with the mental health system. According to PelhamandFabiano,treatmentthatneedstobegivenonanongoing basisshouldbeinexpensive,simple,andbasedontheneedsofthestudent(2008).one would need to advocate for reasonable and cheap treatment options as well as something that might be shorter in duration to be able to make further treatment easily accessible to this population. There is further research that is needed to better understand ADHD in the African-American population. Further information is needed on the causes of the disorder as well as how gender plays a role. Obviously, more boys are being diagnosed then girls but this could be due to counselors, teachers and other professional s biases of what ADHD looks like in each student. If more research were done on the impact of gender this question would start to be answered. Further research must be done on proper assessment tools in diagnosing ADHD in minority populations. As mentioned previously, the current assessment tools may be biased to any other populations other then the white-middle class. Again, minorities are being diagnosed at an overwhelming number when compared to their white peers as this could be because of the assessment tools being used to decide if a child does have ADHD. Using a tool that is not culturally sensitive to the child s own background will be very damaging to their own lives, academic success, and will only feed the parents mistrust in the mental health system. Because there are so many minority students that are being diagnosed with ADHD more should be done to create a proper assessment tool that is not only culturally sensitive but also holds validity in the field.

11 RUNNINGHEAD:ADHDINAFRICANAMERICANCHILDREN 11 Treatment options also need to be accessible and readily available to all populations no matter of ethnic background or cultural group. If the state mental health budgets continue to decrease year after year treatment options continue to also decrease for the African-American population as well as other minority groups. Counselors and other mental health professionals need to advocate for the well being of their clients as well as their future clients. In knowing that African-American males are at such a greater risk to develop ADHD or any other learning disability, not as likely to receive on going outpatient therapy, and use emergency services for treatment more research needs to be done to fight for the states mental health budget. ADHD in African-Americans is very fascinating at is it frequently diagnosed but hardly treated appropriately. Being diagnosed with ADHD do not only effect the child but also it has large implications for the family, academic success, and the type of mental health services they choose to seek out or is available for them. Counselors can work to minimize the stigma around ADHD with the help of parents, teacher, and other professionals. Working with the family is extremely important and my combat the parents own negative thoughts about mental health services that are available to them and will allow their child the largest success.

12 RUNNINGHEAD:ADHDINAFRICANAMERICANCHILDREN 12 References American Psychiatric Association Press. (2000). Diagnostic and Statistical Manual of Mental Disorders: Text Revision (4 th ed.). Washington, DC: Author. Bussing, R., Gary, F. A., Mills, T. L., & Garvan, C. (2007). Cultural Variations in Parental Health Beliefs, Knowledge, and Information Sources Related to Attention-Deficit/Hyperactivity Disorder. Journal Of Family Issues, 28(3), Retrieved from EBSCOhost. dosreis, S., Butz, A., Lipkin, P. H., Anixt, J. S., Weiner, C. L., & Chernoff, R. (2006). Attitudes about stimulant medication for attention-deficit/hyperactivity disorder among African American families in an inner city community. The Journal Of Behavioral Health Services & Research, 33(4), Retrieved from EBSCOhost. Efron, D., Sciberras, E., & Hassell, P. (2008). Are Schools Meeting the Needs of Students with ADHD? Australasian Journal Of Special Education, 32(2), Retrieved from EBSCOhost. Flowers, A., & McDougle, L. (2102). In Search of an ADHD Screening Tool for African American Children. Journal of the National Medical Association, 102(5), Retrieved from EBSCOhost. Hervey-Jumper, H., Douyon, K., & Franco, K.N. (2006). Deficits in Diagnosis, Treatment and Continuity of Care in African-American Children and Adolescents with ADHD. Journal of the National Medical Association, 98(2), Retrieved from EBSCOhost. Hosterman, S. J., DuPaul, G. J., & Jitendra, A. K. (2008). Teacher Ratings of ADHD Symptoms in Ethnic Minority Students: Bias or Behavioral Difference? School Psychology Quarterly, 23(3), Retrieved from EBSCOhost. Jurbergs, N., Palcic, J. L., & Kelley, M. L. (2010). Daily Behavior Report Cards with and without Home-Based Consequences: Improving Classroom Behavior in Low Income, African American Children with ADHD. Child & Family Behavior Therapy, 32(3), Retrieved from EBSCOhost. Kutscher, M. L. (2008). ADHD: Misconceptions and the Four Rules of Treatment. Exceptional Parent, 38(9), Retrieved from EBSCOhost. Mychailyszyn, M. P., dosreis, S., & Myers, M. (2008). African American caretakers' views of ADHD and use of outpatient mental health care services for children. Families, Systems, & Health, 26(4), Retrieved from EBSCOhost. Pelham, W. r., & Fabiano, G. A. (2008). Evidence-Based Psychosocial Treatments for Attention- Deficit/Hyperactivity Disorder. Journal Of Clinical Child And Adolescent Psychology, 37(1), Retrieved from EBSCOhost. Tucker, C., & Dixon, A. L. (2009). Low-income African American male youth with ADHD symptoms in the United States: Recommendations for clinical mental health counselors. Journal Of Mental Health Counseling, 31(4), Retrieved from EBSCOhost.

13 RUNNINGHEAD:ADHDINAFRICANAMERICANCHILDREN 13 Wright, C., Shelton, D., & Wright, M. (2009). A Contemporary Review of the Assessment, Diagnosis and Treatment of ADHD. Australian Journal Of Learning Difficulties, 14(2), Retrieved from EBSCOhost.