Cultural Factors and ADHD: A Few Findings of Note James H. Johnson, Ph.D., ABPP

International Differences Prevalence rates In Canada: 9% for boys, 3.3% for girls In Chinese children, rates range from 1.3% to 13%, 3% met DSM-III criteria In Puerto Rico, rates range from 16.5% to 9.5% 6.9% probable cases in a sample of Italian 4 th graders (Gingerich et al.,1998)

International Differences Prevalence rates for ADHD varied cross- culturally when same cutoff was used on Conner’s Teacher Rating Scale 8% in Germany 15% in New Zealand 16% in Spain 12% in Italy  4.5% in Scotland  9% in Hong Kong 12% in Australia 5% in Israel (Gingerich et al.,1998)

Ethnic Groups in the U.S. Minority status has been associated with a higher prevalence of ADHD and greater severity of symptoms Differences in prevalence and severity may be due to: Variations in assessment instruments Differences in diagnostic strategies True differences in frequency of ADHD (Gingerich et al.,1998)

Ethnic Groups within the U.S. Studies in the 1970’s compared African American, Latino, and Asian American children to established White norms African American children rated as more hyperactive than expected Latino children as hyperactive as expected Asian American children less than expected (Gingerich et al.,1998)

Cultural sensitivity of diagnostic tools ADHD Rating Scale-IV School Version Assessed African American and Caucasian boys Teachers rated African American boys higher on all scales (Reid et al., 1998)

Cultural sensitivity of diagnostic tools Conner’s Abbreviated Teacher Rating Scale Compared teacher ratings of Hispanic and non- Hispanic children Children were rated similarly on subscales of ADHD symptoms Hispanic and Caucasian children were rated similarly on overall measures of behavior problems (Ramirez et al., 1998)

Knowledge about ADHD Compared the perceptions about medication treatment between White and nonwhite parents Nonwhite parents were more likely to believe that diet and sugar intake influence hyperactive behavior Nonwhite parents were more likely to believe that counseling is the best treatment for ADHD Equal proportions of White and nonwhite parents believed that medication is over prescribed for ADHD (Dosreis et al., 2003)

Knowledge about ADHD An interview study by Bussing et al. (1998) compared knowledge and information about ADHD between African-American and White parents whose child was at risk for ADHD African-American parents were less likely to attribute ADHD to genetics. They were more likely to label their child as “bad”

Knowledge about ADHD Over half of parents cited doctors as the most common source of information about ADHD Physicians ranked as the most preferred sources of information about ADHD followed by the library, then mental health professionals Lower SES parents had lower knowledge scores After controlling for SES, African American parents had significantly lower knowledge scores (Bussing et al., 1998)

What accounts for differences in knowledge about ADHD? Why are there “alternative interpretations of ADHD”? Initial medical advice comes from more informal networks Symptomatic behaviors may be perceived by African Americans as normal and not in need of professional intervention ADHD may be viewed by African Americans as a way for their children to be targeted for discriminatory practices ADHD may rank low compared to other competing needs and concerns (Bussing et al., 1998)

Perceptions of Symptomatology Ratings by parents and teachers were influenced by the ethnicity and SES of the child Teacher ratings were more stable Parent ratings were more influenced by ethnicity than SES School psychologists rated “lower class” boys as more hyperactive (Stevens, 1981)

Socioeconomic status Low SES has been associated with less utilization of health care services, lower incidence of prenatal care, and higher incidence of substance abuse Individuals from low SES background have been found to be less compliant with treatment Less compliant with medication than with psychotherapy