top of page
Brynn Legros

Stigma in Mental Healthcare: Racial Discrimination and ADHD in the United States

Written by: Brynn Legros

Edited by: Amrutha Reddy


INTRO: 

This article will discuss the diagnosis of ODD (Oppositional Defiant Disorder) and ADHD (Attention Deficit Hyperactivity Disorder) and the statistical and social differences in these diagnoses among different races of youth in the United States. This article will highlight the racial stigma in youth mental health diagnostics of these disorders and solutions to this problem. 


ADHD: ADHD is a developmental neurological disorder that includes symptoms of hyperactivity, attention deficits, and impulsivity. According to global prevalence research done in 2023, it is most commonly diagnosed in youth with a global prevalence of about 7.6% of children both boys and girls under twelve, and a 5.6% prevalence among teenagers aged twelve to eighteen (Salari, N., Ghasemi, H., Abdoli, N. et al. 2023). The process of an ADHD diagnosis involves a screening test which, if not covered by insurance or not provided by a primary physician, can be very costly. In an article written by the Guilford Press Periodicals it was stated that the cost of care for a child with an ADHD diagnosis in the U.S. is  estimated between $949 to $1220 a year (Barkley 2020).


ODD: ODD can be defined as a behavioral conduct disorder with symptoms such as emotional dysregulation and lack of age appropriate self regulation skills in youth. ODD is often stigmatized as a disruptive behavioral disorder, characterizing children as argumentative and spiteful (Psychology Today, 2022). The opinion of whether or not ODD is considered a conduct disorder or emotional dysregulation disorder is a common debate as recent research has shown deficits in emotional regulation are at the root of disordered conduct (Psychology Today, 2022) The treatment of ODD does not have as high of costs in comparison to ADHD. ODD is often not treated with medication and does not require a screening for diagnosis. The diagnostic process for ODD is actually fairly simple, using surveys and behavioral plans as treatment. However, in contrast to treatment, the prognosis is actually worse than the ADHD prognosis in most cases because of problems with conduct and behavior. 


CLAIM: Based on several perspectives and research projects, there is clear evidence that there is racial discrimination involved in distinguishing between an ADHD diagnosis and an ODD diagnosis in youths. ADHD and ODD often have similarly presenting symptoms especially in young boys. Hyperactivity and attention deficits can present as defiance to school teachers, parents and medical professionals, making the two diagnoses difficult to distinguish between. The problem presented highlights the extreme statistical difference in diagnoses based on race, showing that children of color, especially Black-American children are much more likely to be diagnosed with ODD than ADHD which has a higher diagnosis rate among white children. 


RACISM AND DIAGNOSTICS: From a sociological lens, these psychological diagnoses can be explained to show embedded racism in the mental health field. “Extensive research has shown that children of color are much more likely to be seen as "difficult" or "defiant" than white children” (Psychology Today). The stigma surrounding ODD is actively projected onto children of color in the United States. This information is backed up by the Visser et al. research study which showed, “In addition, White children are more likely to be diagnosed with ADHD alone, rather than ADHD with comorbid ODD or CD, than Black children (Visser et al.) This puts black children struggling with self regulation at a disadvantage. This racial stigma puts children of color in a position where they do not receive the same proper interventions, screening and treatment as white children. Children of color that are improperly diagnosed end up with a worse prognosis and deal with untreated symptoms which lead to detrimental dysfunction in school, work and social life. 


SOLUTIONS AND AWARENESS: This issue can be looked at through the lens of critical race theory which can be described as the idea that race can only be real if we give it power. However, it is not that easy. We as a community need to be activists. We need to call out injustices and educate the people around us about the way that racial stigmas are embedded all around us. Mental health students and professionals need to be aware of not only the impact of racial discrimination in ODD diagnosis but the stigma surrounding ODD. We can do this by educating medical professionals about how to help black families effectively. We also need to work to reduce stigma around taking medication in black communities where substance use is criminalized more than in white communities. Doctors need to work together with families to address concerns and take proper measures to ensure the safety of the family and child being treated. Another issue that needs to be addressed is the cost of ADHD screening. As mentioned before, ADHD treatment and testing is very expensive. This makes it even harder for all children struggling with mental health to get a proper diagnosis because of the cost, especially in lower income areas. 


CONCLUSION: To conclude, this article discussed the racial and economic discrimination embedded in the mental health field through the diagnoses of ADHD and ODD among different racial communities. It has shown that black children are often misdiagnosed and overdiagnosed with ODD because of racial stigmas and social stigmas surrounding the disorder. It has also shown that this issue has a detrimental impact on black children dealing with mental health issues in social, educational and occupational realms. We can work to fix this by educating students and mental health professionals how to treat all families of any race and any socioeconomic class and reduce the costs of ADHD treatment and diagnosis in order to get children the diagnosis that they need. 


References:

ADHD: Challenges for Black Kids - Smart Kids. (2020, September 8). https://www.smartkidswithld.org/getting-help/adhd/adhd-challenges-for-black-kids/

Salari, N., Ghasemi, H., Abdoli, N. et al. The global prevalence of ADHD in children and adolescents: a systematic review and meta-analysis. Ital J Pediatr 49, 48 (2023). https://doi.org/10.1186/s13052-023-01456-1

Mitchison, G.M., Liber, J.M., Hannesdottir, D.K. et al. Emotion Dysregulation, ODD and Conduct Problems in a Sample of Five and Six-Year-Old Children. Child Psychiatry Hum Dev 51, 71–79 (2020). https://doi.org/10.1007/s10578-019-00911-7

Barkley, R. A. (2020). The High Economic Costs Associated with ADHD. The ADHD Report, 28(3), 10–12. https://doi.org/10.1521/adhd.2020.28.3.10

Cavanagh M, Quinn D, Duncan D, Graham T, Balbuena L. Oppositional Defiant Disorder Is Better Conceptualized as a Disorder of Emotional Regulation. J Atten Disord. 2017 Mar;21(5):381-389. doi: 10.1177/1087054713520221. Epub 2016 Jul 28. PMID: 24481934.

Comments

bottom of page