2023-11-18 20:51:50
As a child, Wesley Jackson Wade should have been ready to succeed. His father was a novelist and corporate sales manager and his mother was a special education teacher. But Wade said he struggled in school even though he was an exceptional writer and communicator. He played the role of class clown when he didn’t feel challenged. He got in trouble for talking back to teachers. And, the now 40-year-old said, he often felt anger he couldn’t contain.
As one of the only black children attending predominantly white schools in upper-middle-class communities – including the college enclaves of Palo Alto, California, and Chapel Hill, North Carolina – he often was arrested for chatting with his white friends during class, while they only received warnings. He attributed this to the fact that he was black. Ditto, he said when he was wrongly arrested when he was in eighth grade for a bomb threat at his school while he was being evacuated with his white friends. So he wasn’t surprised that his behavioral problems were punished, even though some of his white friends with similar symptoms began receiving treatment for attention-deficit/hyperactivity disorder.
“Black kids, from a very young age, start to deal with race, we have a lot of racial stamina,” said Wade, who now lives outside Durham, North Carolina. “But I only realized later that there was probably something else going on. »
After spending years grappling with self-doubt and difficult relationships — and after smoking what he called “volumes of Snoop Dogg weed” from middle school through his twenties — he learned he suffered from ADHD and dyslexia, two diagnoses that often overlap. He was 37 years old.
It has long been known that black children are underdiagnosed for ADHD compared to their white peers. A Penn State report published in Psychiatry Research in September studied the extent of the gap by tracking more than 10,000 elementary students nationwide from kindergarten through fifth grade through student assessments and surveys of parents and teachers. Researchers estimated that the odds of black students being diagnosed with a neurological disease were 40 percent lower than those of white students, all else being equal, including taking into account economic status, student achievement, behavior and their executive functions.
For young black men, the odds of being diagnosed with ADHD were particularly high: nearly 60 percent lower than those of white boys living in similar circumstances, even though research suggests the prevalence of the condition is likely the same.
The racial divide in ADHD isn’t just a health issue. This worsens inequities for black children, and particularly for black males, said the study’s lead author, Paul Morgan, former director of the Center for Educational Disparities Research at Penn State. He now directs the Institute for Social and Health Equity at the University at Albany.
ADHD has been diagnosed in nearly one in ten children in the United States, according to a Centers for Disease Control and Prevention study released in 2022, with rates increasing by nearly 70% over the past two decades. It is often a lifelong condition that can be managed with treatments including therapy and medication. Untreated, children with ADHD face far greater health risks, including substance abuse, self-harm, suicidal behavior, accidents and premature death. As adults, many people with undiagnosed ADHD have spent years feeling isolated and hopeless, just like Wade.
Even before Wade’s diagnosis, he was helping similar students in a career counseling role at North Carolina State University. Today, he’s a licensed mental health and substance abuse counselor and doctoral student, but he says it’s been difficult to see his successes.
“To the rest of the world, he’s a black man with two master’s degrees, a doctorate and two licenses and certifications,” he said. “But for me, I’m a brother who’s had a lot of bad luck with people and jobs he’s been fired from. I have never been promoted in my professional life.
Wade’s experiences with race and ADHD are intertwined. “ADHD accelerates my black experience,” he said. “I cannot separate my experiences as a black boy and black man from my experiences understanding my neurodivergent identity.”
People who study and treat ADHD cite several reasons why young black men go unnoticed, including teachers who are racially biased or have lower expectations of black students and fail to recognize an underlying disability , and black parents who distrust teachers and doctors. , fearing labeling and stigmatizing their children.
“We have long known that ADHD diagnoses are not made in isolation. They’re developed in a geographic, cultural, racial context,” said George DuPaul, a psychology professor at Lehigh University who studies non-drug interventions for ADHD.
Studies have shown that underdiagnosis of ADHD contributes to harsher school discipline and the “school-to-prison pipeline.” Black children routinely face punishment, including criminal prosecution, for behavioral problems and mental health issues such as ADHD, while white children are more likely to be diagnosed with behavioral problems and receive treatment and medical support. There’s a common saying: “Black kids have cops, white kids have doctors.” »
Courtney Zulauf-McCurdy, a researcher and clinician at the University of Washington School of Medicine, focuses on decreasing mental health disparities in early childhood. At preschool age, she said, black children with ADHD symptoms are more likely to be expelled and less likely to receive appropriate treatment than their white peers.
His research found that teachers’ judgments of children are heavily influenced by their opinions of the children’s parents, which often determines whether those children are evaluated for their behavior problems and given appropriate support – or simply kicked out of class. . She said the Penn State results confirmed what she saw in clinics and heard from parents.
Zulauf-McCurdy also pointed to research that shows black children are 2.4 times more likely than white children to receive a conduct disorder diagnosis compared to an ADHD diagnosis. She said racial bias and overdiagnosis of conditions such as oppositional defiant disorder, defined by symptoms of lack of cooperation and hostility toward authority figures, lead to more punitive consequences, such as isolation in separate classrooms.
To correct inequities in ADHD diagnosis, mental health experts see the need to increase culturally sensitive screening and address Black families’ concerns about potential bias and racism. Ensuring access to information about ADHD symptoms and treatments can help overcome barriers to care.
Looking back, Wade said he is grateful to have received a diagnosis, even if it came late. But, he said, having learned of his condition earlier would have given him more confidence to navigate school, work and life. “If I could have gotten a diagnosis, I would have had a lot more support and love in my life,” he said.
Behavioral tools and medications made it easier for him to concentrate and regulate his mood. The diagnosis also helped him become more aware of how to manage his depression and anxiety.
“Now it’s about understanding how I exist, how my brain works,” Wade said. “I don’t think I’m just broken. »
Still, Wade wonders what the ADHD label would have meant to him as a child — despite his family’s privileges in money and education — before the condition gained more attention. Even today, he says, the stigma that remains around diagnosis is probably worse for black children, who still receive less benefit of the doubt than white children.
Today, Wade helps Black and neurodivergent youth and adults identify ADHD and other conditions. It’s part of his job, but it’s also deeply personal.
“I remember what it was like to not be seen, not to be heard and to have your needs ignored,” he said. “It feels good to see other people getting the help they need and to know that it’s helping Black people as a whole and generations of these families.” »
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