ADHD and Adults: A Look at Cultural Differences
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While Attention-Deficit/Hyperactivity Disorder (ADHD) occurs at the same rate across the adult population, culture and race/ethnicity can be strong determinants in whether someone receives the quality treatment and support needed for the disorder. People in minority communities tend to be under-diagnosed and undertreated for ADHD for a number of reasons, including, among other factors, cultural perceptions and access to health care. As is the case with the general population living with ADHD, a lack of treatment and support can lead to serious consequences across the lifespan for people in racial/ethnic minority communities. Untreated ADHD can create serious problems at work, in relationships and with finances. It is important that all people, regardless of race/ethnicity, understand the importance of seeking treatment and support for ADHD.
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In 2001, the U.S. Surgeon General released a special report about the roles culture, race and ethnicity play in mental health care in America, which showed that African Americans, Latinos, Asian Americans/Pacific Islanders and Native Americans/Native Alaskans faced many hurdles that made receiving treatment difficult. Some of the common impediments that the surgeon general noted in his report included:
- reduced access to quality health care because of costs and lack of insurance;
- problems with availability of services, in some cases because of language barriers;
- an under-representation of minorities in the medical community; and
- a general mistrust for the medical community.
Of course, the perceptions from people in these communities have been shaped by how they have been treated by the government and the general population. For example, memories of the Tuskegee Experiment, in which the U.S. Health Service allowed over 400 African American men to die of syphilis with no treatment or explanation of the disease that plagued them, have lasting effects on the African American community's view of health care in general and mental health care in particular. The recent treatment of immigrants in this country has shaped the views of some Latinos, while other forms of discrimination and racial prejudice continue contribute to a mistrust of the larger society that exists among many minority communities.
In 2005, the National Medical Association, the nation's largest group serving African American doctors and patients, passed a resolution acknowledging ADHD and its impact on African Americans. The resolution was a helpful step in disseminating science-based information to this population, but many people in the African American community, along with people in other cultural and racial communities, continue to go undiagnosed and untreated for the disorder. For some people in these communities, seeking help for ADHD can be hard because they are dealing with so many misconceptions among their own friends and family. That means people in minority communities living with the disorder must, in many cases, go to great lengths to dispel myths and educate their friends and family in order to develop an adequate support system as they deal with this disorder.
If you suspect that you or someone you know is living with ADHD, the following steps will help to overcome cultural and economic hurdles.
- Find a treatment professional. The first important step for any adult living with ADHD is to find a knowledgeable professional who can treat the disorder. For people who are uninsured or do not have the money to cover the cost of health care services, there are options, including public assistance and free clinics located across the country. Learn more about accessing Medicaid by visiting the website of state Medicaid programs. To locate a free clinic, visit the National Association of Free Clinics. Many of these clinics have bilingual staff and are equipped to work with people from different backgrounds. Find federally funded health centers through the Health Resources and Services Administration (HRSA). Spanish speakers can locate a health center by calling HRSA at (888) 275-4772. For a general list of mental health services, SAMHSAís National Mental Health Information Center is helpful.
- Look for a good fit with a health care professional. It's important to ask questions during a first visit with a treatment professional that will demonstrate his or her level of cultural competence. It is important to find someone who is not only knowledgeable about ADHD, but also someone who understands different cultures.
- " Inform yourself about ADHD. It is important for people in every community to arm themselves with information. But this is particularly true of people in minority populations, as they may have to use the information to combat stigma among their friends and family. The information on adults with ADHD provided in the Resource Center will shed some light on adult ADHD, but there are some other resources as well. The National Resource Center on ADHD, which is funded by the Centers for Disease Control and Prevention, provides information in Spanish on its website and has bilingual information specialists available to answer questions.
- Inform friends and family. Friends and family need to understand the disorder so that they can provide a good support system. Share information with them. The more they are exposed to accurate, science-based information the more likely they will give up any preconceived notions they might have. However, it is important to be as realistic as possible about some of the possible barriers. See the tips below on ways to change attitudes.
- Develop a support system. Regardless of whether friends and family offer support, itís vital to reach out to other people living with ADHD. There are a number of ADHD support groups available, but finding an adult group that has a significant membership reflecting a particular culture may be somewhat difficult. Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) also offers a number support groups around the country.
Sometimes, friends, family members and associates believe ADHD is over-diagnosed and that any problems are merely personality traits. These perceptions, which are present in the general population but can be more entrenched among some racial/ethnic groups, can be a barrier to seeking and receiving needed support. This section offers tips on ways to combat negative and inaccurate perceptions.
- Engage in active listening. Acknowledge that friends and family may not trust 'outsider' expert views. Even though there are reasons for mistrust, it is important to consider science-based information about ADHD and an affected individual's need for support and quality treatment.
- Share information. Share some of the information you find about the disorder with friends and family. Give them fact sheets or links to websites of reputable organizations, such as NAMI, and invite them to seek out more information about the disorder.
- Turn to your treatment professional. If you are living with ADHD and do not feel that it would violate your privacy, invite close friends and family to go with you on a visit with your treatment professional. They can ask questions that will not only help them better understand the disorder, but also help them support your own implementation of strategies.
- Extend an invitation to support group meetings. It is helpful for people who share your cultural experiences to attend these meetings, and meetings provide an opportunity for friends or family to show their support of your recovery and to address any questions they may have about ADHD.
- Ask for help from the converted. Enlist the help of someone who has been in a similar situation. If they have had any breakthroughs, perhaps the friend or family member they've won over would be willing to share their story. No one can convert like the converted!
- Reference experts. Encourage friends and family to listen to what leading experts are saying about ADHD. Experts from within your own racial/ethnic group can be most effective and respected in communicating important information. Look to the websites listed below under the references section and encourage others to visit those sites. CHADD provides videos of Rep. Sheila Jackson Lee and former Surgeon General David Satcher, both African Americans, talking about the importance of receiving treatment for the disorder. Access clips at Video CHADD. (Be sure to scroll down when you get to the site).
- Turn to others. Broaden your network of support, for example, by turning to a member at church or a family member's best friend. Anyone who is open to learning more can be a valuable supporter and would also be in a good position to talk with a family member or friend who has issues with ADHD.
- Bring up sobering examples. Remind them of the devastating impact untreated ADHD can have. Explain to them that having unscientific views about ADHD can be counterproductive for your community. Encourage them to learn and help others understand the disorder and its effects.
- Utilize local sources. Encourage friends and family to turn to groups in your area. Many state health departments have minority health commissions. These entities typically are very diverse and reflect the communities they serve. Turn to these groups for help and information.
- Keep the door open. If friends and family do not change their views about the disorder, keep the door open. Keep sharing information, and people may eventually come around.
If you are looking for treatment professionals (whether they are medical doctors, psychologists or social workers), make sure they are culturally competent and understand the issues that are unique to your community. There are many aspects of cultural competence to think about when considering a treatment professional or health center, including:
- the diversity of the staff;
- language compatibility;
- a demonstrated understanding of your communityís history, beliefs and cultural makeup;
- knowledge of the unique needs of your community;
- a sensitivity to cultural diversity;
- a diverse list of patients, including people from your community;
- a well-trained staff that is sensitive to different cultural needs;
- handouts (i.e., pamphlets, literature, etc,) in a variety of languages; and
- a demonstrated commitment to your community through outreach programs.
There are health care professionals who may not demonstrate a full commitment to making their services competent for different cultural and racial/ethnic groups. If you find yourself in a situation where your medical professional is not sensitive to your cultural or linguistic preferences, you may have to be proactive in educating that person. Any entity receiving federal funds is required to demonstrate some degree of cultural and linguistic competence. You may want to share the national standards on Culturally and Linguistically Appropriate Services with your health care professional.
Visit the Resources section for additional information and references.