Attention deficit hyperactivity disorder in African American children: what can be concluded from the past ten years?

Abstract

Samuel et al. [Samuel, V. J., Curtis, S., Thornell, A., George, P., Taylor, A., Brome, D. R., et al. (1997). The unexplored void of ADHD and African-American research: A review of the literature. Journal of Attention Disorders, 1(4), 197-207.] reviewed the literature on Attention Deficit Hyperactivity Disorder (ADHD) in African Americans, and found a paucity of research. The present review of 73 articles updates this assessment of available research and presents the current understanding of ADHD symptoms, assessment, diagnosis, and treatment in African American children ages 3-18. The authors conducted a qualitative review, as well as a mini meta-analysis of 5 studies of ADHD symptoms and 5 studies of ADHD diagnosis to clarify the question of racial differences in prevalence. African American youth had more ADHD symptoms (Cohen's d=0.45, p<.001), yet were diagnosed with ADHD only two-thirds as often as Caucasian youth (OR=.66, p<.001). This pattern was not explained by teacher rating bias or by SES, but may be influenced by parent beliefs about ADHD, higher rates of risk, and lack of treatment access and utilization. Lower treatment rates may be related to high rates of classroom behavior problems among African American youth. Findings also suggest that existing assessment tools may not adequately capture ADHD manifestation in African Americans. Findings highlight the need for more investigation and awareness of relevant cultural issues to inform a culturally competent approach to assessment, diagnosis, and treatment of ADHD in African Americans.