ADHD and Racial Disparities: What Clinicians Can Do
- October 24, 2024
- The REACH Institute
- ADHD, Assessment & screening, Child mental health, Culturally responsive

“When a parent of color raises concerns about their child’s behavior, clinicians should always stop to assess for underlying disorders,” explains child and adolescent psychiatrist Brittainy Erby, MD. “I see many children and adolescents of color who have been diagnosed with a behavior disorder, but they actually have untreated ADHD.”
The research reinforces what Dr. Erby has seen in her practice. Patients of color are less likely to receive appropriate treatment for ADHD. Black and Latino patients are also more likely to be diagnosed with a behavior disorder, such as Oppositional Defiant Disorder (ODD), rather than ADHD, compared to white peers exhibiting similar symptoms.
We asked Dr. Erby to walk us through the steps that clinicians can take to ensure children of color receive more timely ADHD diagnoses and treatment.
Barriers to ADHD Diagnosis for Children of Color
“It can be really challenging for primary care providers to sift through behavioral issues for underlying conditions,” shares Dr. Erby. This is especially true in a busy clinical setting. However, Dr. Erby advises clinicians to be aware of several factors that affect how symptoms are framed and described.
Systemic racism in the education system means children of color are more likely to be treated punitively for their behavior compared to white peers—even if the behavior in question is the same. For example, as early as preschool, Black children are twice as likely to face multiple suspensions compared to white children.
Descriptions of the problem as behavioral—as opposed to a matter of performance at school or an underlying condition—are more common from parents and caregivers of color. Dr. Erby shares that many parents of color are also less aware of the symptoms of ADHD or carry negative stigmas about the condition.
Stereotypes about ADHD can affect how parents, teachers, and others interpret and describe a child’s symptoms. For many, ADHD still conjures the image of a hyperactive, white, male child jumping on top of his desk during class, unable to sit still or pay attention. But ADHD can manifest in different ways, including aggressive behavior and inattentive type ADHD.
For children of color with ADHD, this can all add up to multiple sources—from school reports and penalization records to parent beliefs and prior diagnoses—that point to a behavior disorder rather than an appropriate ADHD diagnosis.
Simple Changes Clinicians Can Implement Today
Dr. Erby recommends several evidence-based practices that can help clinicians reduce misdiagnosis of ADHD and behavior disorders among children of color.
Use comprehensive assessment tools: Before giving a child of color a behavior disorder diagnosis, clinicians should use tools like the Vanderbilt assessment scales. This can screen children for ADHD as well as other mental health disorders, behavior disorders, and learning disorders. If there isn’t time to start the assessment during an office visit, clinicians can send the materials home with parents. Dr. Erby advises that at least two parents or caregivers and two teachers—ideally those teaching the classes with the child’s highest and lowest grades—complete the Vanderbilt assessment.
Ask about sleep and sleep hygiene: Children with ADHD often struggle with sleep and sleep hygiene, even in the absence of TV or tablets. If getting a child to sleep has always been a challenge—even in early years—this could indicate ADHD over behavior disorders.
Ask about preschool: If a child exhibited behavior issues as early as preschool, this may suggest ADHD over a behavior disorder. Ask parents if the child attended preschool and if they received any feedback about the child’s behavior or difficulty interacting with other kids or staying focused on one task or toy.
Identify settings where behavior does and does not occur: If the condition is truly a behavior disorder, like Oppositional Defiant Disorder (ODD), there will be at least one setting where the child does well, such as in school or a sport. With ADHD, however, symptoms have to be present in two or more settings. For example, home and school. Children and adolescents with ADHD may try to control their behavior but simply cannot without proper treatment. Clinicians can also observe the child for signs of ADHD at the appointment, such as interrupting the conversation, standing in the clinician’s personal space, or frequently switching toys or activities.
Look out for inattentive type ADHD: In a world of TikTok and other social platforms, it can be difficult to distinguish ADHD inattention from standard inattention. Dr. Erby has observed that “young women of color with inattentive ADHD go under the radar all the time.” Now, when she notices a girl or young woman struggling with inattention, she makes it standard practice to screen for inattentive ADHD.
Navigating Family Responses to ADHD Diagnosis and Treatment
“Even if I get a family of color in the door, the parents are often very worried and have a lot of skepticism about treatment with ADHD medications compared to white families,” shares Dr. Erby. Families’ prior experiences of racial bias within the healthcare system may only strengthen their medication hesitancy. Dr. Erby recommends patience and compassion, as it may take longer to get to the most effective treatment protocol.
RESOURCES
- For a comprehensive set of ADHD resources for clinicians, parents, and patients, check out REACH’s full ADHD Awareness Month Resource Guide.
- REACH’s recent article on navigating medication hesitancy among parents and caregivers provides actionable steps clinicians can take to mitigate medication hesitancy, especially for ADHD treatment.
- In the past several years, new and conflicting data has emerged about the prevalence and diagnosis rate of ADHD among children and adolescents of color. Interested clinicians may want to review a recap of the data and learn more about the role of unconscious bias in diagnosing disruptive behavior disorders.
- One major difference between treatment for behavior disorders vs. ADHD is the addition of medication. Appropriately diagnosing and treating ADHD can reduce problematic behaviors. A 2021 study on treating children with ADHD complicated by aggressive behavior found that, in most cases, stimulants alone at the appropriate dosage effectively managed the aggressive behavior in more than 60% of children.
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