Clinicians working with children and adults with symptoms suggestive of ADHD should consider a spectrum of comorbid disorders, including sociodemographic, traumatic childhood experiences, and genetics. Significantly, recent research increasingly demonstrates that race and culture are not factors in ADHD. Unfortunately, unconscious bias and racial discrimination plague the diagnosis and treatment of girls, women, and minorities of any gender, potentially delaying effective treatment for many people. Ensuring a fair and accurate ADHD assessment and diagnosis process is crucial to provide appropriate care and support to individuals from all backgrounds.
ADHD affects impulse control and working memory in people whose brains have different structures, chemistry, and communication signals. The disorder often manifests in two common types: hyperactive or inattentive. The former, the more familiar type more prevalent in boys, presents as physical and external behaviors such as excessive talkativeness, aggression, and fidgeting. Girls diagnosed with ADHD tend to experience the latter type, with internal symptoms like extremely low self-esteem, verbal aggression, depression, and anxiety, as shown by assessments like (Conners 3) Conners, Third Edition.
While prenatal hormone exposure may explain some symptom variations between genders, some researchers believe that socialization plays a role in how the disorder manifests. For example, gender stereotypes about girls and women as "naturally" more talkative or inattentive than boys and men may lead to missed ADHD diagnoses. Similarly, female patients are diagnosed and referred for further testing at far lower rates than boys, possibly because the inattentive ADHD type is not as disruptive or because educators and teachers are unaware of its symptoms.
Racial and ethnic stereotyping is a recognized problem in mental and behavioral health practice, and BIPOC clients seeking diagnosis and treatment of their ADHD face significant hurdles. Despite mounting evidence showing no connection between ADHD and race or ethnicity, minorities are disproportionately diagnosed with behavioral disorders such as Oppositional Defiance Disorder and Conduct Disorder, with clinicians often disregarding the potential of ADHD explaining their symptoms. The effects of misdiagnosis can be significant, including:
Even when clinicians are aware of the problem of implicit bias and adamantly oppose its practice and effects, black children and adults are significantly more likely to receive diagnoses of CD rather than ADHD. This disparity suggests that when black children have particular trouble following directions and being attentive, these potential ADHD symptoms are evaluated as conduct problems rather than neurobiological ones. Rigorous testing situations and careful attention to potential evaluator bias are vital when evaluating children and adults with symptoms of ADHD using assessments like the Conners’ Adult ADHD Rating Scales (CAARS).
Clinicians and other stakeholders should cultivate an extensive understanding of the various types and manifestations of ADHD, in addition to co-occurring conditions and contexts. With a comprehensive knowledge of ADHD and methods for differentiating between it and similar behavioral disorders, clinicians can mitigate the problem of implicit bias in their assessments.
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018590/
https://link.springer.com/article/10.1007/s40596-019-01127-6
