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Underdiagnosed and Undertreated, Young Black Males With ADHD Get Left Behind

Underdiagnosed and Undertreated, Young Black Males With ADHD Get Left Behind

Wesley Jackson Wade is a licensed clinical mental health counselor who practices in Durham, North Carolina. Wade was diagnosed with attention-deficit/hyperactivity disorder and dyslexia in 2020, after years of grappling with the symptoms of those conditions. Now Wade counsels Black youth and adults to help identify neurological conditions. (Eamon Queeney for KFF 国产精品视频 News)

As a kid, Wesley Jackson Wade should have been set up to succeed. His father was a novelist and corporate sales director and his mother was a special education teacher. But Wade said he struggled through school even though he was an exceptional writer and communicator. He played the class clown when he wasn鈥檛 feeling challenged. He got in trouble for talking back to teachers. And, the now 40-year-old said, he often felt anger that he couldn鈥檛 bottle up.

As one of the only Black kids in predominantly white schools in upper-middle-class communities 鈥 including the university enclaves of Palo Alto, California, and Chapel Hill, North Carolina 鈥 he often got detention for chatting with his white friends during class, while they got only warnings. He chalked it up to his being Black. Ditto, he said, when he was wrongly arrested as an eighth grader for a bomb threat at his school while evacuating with his white friends. So he wasn鈥檛 surprised that his behavioral issues drew punishment, even as some of his white friends with similar symptoms instead started getting treatment for attention-deficit/hyperactivity disorder.

鈥淏lack kids at a very young age, we start dealing with race, we have a lot of racial stamina,鈥 said Wade, who now lives outside of Durham, North Carolina. 鈥淏ut I didn鈥檛 understand until later on that there was probably something else going on.鈥

After spending years grappling with self-doubt and difficult relationships 鈥 and smoking what he called 鈥淪noop Dogg volumes of weed鈥 from middle school until his 20s 鈥 he learned he had ADHD and dyslexia, two diagnoses that often overlap. He was 37.

It’s long been known that Black children are compared with white peers. A published in Psychiatry Research in September studied the extent of the gap by following more than 10,000 elementary students nationwide from kindergarten to fifth grade through student assessments and parent and teacher surveys. The researchers estimated the odds that Black students got diagnosed with the neurological condition were 40% lower than for white students, with all else being equal 鈥 including controlling for economic status, student achievement, behavior, and executive functioning.

For young Black males, the odds of being diagnosed with ADHD were especially stark: almost 60% lower than for white boys in similar circumstances, even though the prevalence of the condition is likely the same.

The racial ADHD divide isn鈥檛 merely a health concern. It鈥檚 deepening inequity for Black children, and especially Black males, said the study鈥檚 lead author, , the former director of the Center for Educational Disparities Research at Penn State. He now leads the at the University of Albany.

ADHD has been diagnosed in in the United States, according to a Centers for Disease Control and Prevention study published in 2022, with in the past two decades. It is often a lifetime condition that can be managed with treatments including therapy and medication. Untreated, children with ADHD face much greater health risks, including drug addiction, self-harm, suicidal behavior, accidents, and untimely death. By adulthood, many people with undiagnosed ADHD have spent years feeling isolated and hopeless, just as Wade did.

Even before Wade鈥檚 diagnosis, he was helping similar college students in a career counseling role at North Carolina State University. Today, he鈥檚 a licensed mental health and addiction counselor and doctoral student, but he said it鈥檚 been hard to see his successes.

鈥淭o the rest of the world, this is a Black man with two master鈥檚 degrees, and he’s a PhD candidate, and he has two licenses and certifications,鈥 he said. 鈥淏ut to me, I’m a brother who’s had a lot of bad luck with people and jobs I鈥檝e gotten fired from. I’ve never been promoted, ever, in my professional life.鈥

Wade鈥檚 experiences of race and ADHD are intertwined. 鈥淎DHD is an accelerant to my Black experience,鈥 he said. 鈥淚 can’t separate my experiences as a Black boy and Black man from my experiences of understanding my neurodivergent identity.鈥

People who study and treat ADHD cite several reasons why young Black males fall under the radar, including teachers who are racially biased or have lower expectations of Black students and don鈥檛 recognize an underlying disability, and Black parents who are distrustful of teachers and doctors, fearing they鈥檒l label and stigmatize their children.

鈥淲e’ve known for a long time that ADHD diagnoses are not made in a vacuum. They’re made in a geographic context, cultural context, racial context,鈥 said , a psychology professor at Lehigh University who studies nonmedication interventions for ADHD.

Studies have shown that ADHD underdiagnosis contributes to harsher school discipline and to the 鈥.鈥 Black kids routinely face punishment, including criminal prosecution, for problem behavior and mental health conditions such as ADHD, while white kids are more likely to be diagnosed with behavioral conditions and receive medical treatment and support. There鈥檚 a common saying: “Black kids get cops, white kids get docs.”

Wesley Jackson Wade is a licensed clinical mental health counselor who practices in Durham, North Carolina. Wade was diagnosed with attention-deficit/hyperactivity disorder and dyslexia in 2020, after years of grappling with the symptoms of those conditions. Now Wade counsels Black youth and adults to help identify neurological conditions. (Eamon Queeney for KFF 国产精品视频 News)

, a researcher and clinician at the University of Washington School of Medicine, focuses on decreasing mental health disparities in early childhood. By preschool, she said, Black children with ADHD symptoms are and less likely to receive appropriate treatment than their white peers.

Her that teachers鈥 judgments of children are heavily influenced by their opinions of the kids鈥 parents, and that often determines whether those children are evaluated for behavioral conditions and given appropriate support 鈥 or simply kicked out of class. She said the Penn State findings confirm what she鈥檚 seen in clinics and heard from parents.

Zulauf-McCurdy also pointed to research that shows Black children are as white kids to receive a diagnosis of conduct disorder compared with a diagnosis of ADHD. She said the racial bias and overdiagnosis of conditions such as , defined by symptoms of being uncooperative and hostile toward authority figures, result in more punitive consequences such as being isolated in separate classrooms.

To fix inequities in ADHD diagnosis, mental health experts see a need for increasing culturally sensitive screening and addressing Black families鈥 concerns about potential bias and racism. Ensuring access to information about symptoms and treatments for ADHD may help address obstacles to care.

Looking back, Wade said, he is grateful he got diagnosed, even if it came late. But, he said, learning about his condition earlier would have given him more confidence navigating school, work, and life. 鈥淚f I was able to get a diagnosis, I would have had a lot more support and love in my life,鈥 he said.

Behavioral tools and medication have made it easier for him to focus and to regulate his mood. The diagnosis has also helped him become more aware of how to manage his depression and anxiety.

鈥淣ow it鈥檚 an understanding of how I exist, how my brain works,鈥 Wade said. 鈥淚 don’t think that I’m just broken.鈥

Still, Wade wonders what the ADHD label would have meant for him as a child 鈥 despite his family鈥檚 privileges of money and education 鈥 before more awareness existed about the condition. Even now, he said, the remaining stigma around the diagnosis is probably worse for Black kids, who still get less benefit of the doubt than white children.

Today, Wade is helping Black and neurodivergent youth and adults identify ADHD and other conditions. It鈥檚 part of his work, but it鈥檚 also deeply personal.

鈥淚 remember how it felt to not be seen, to not be heard, and to have your needs dismissed,鈥 he said. 鈥淚t feels good to see other people getting the help that they need and know that it helps Black people as a whole and generations of those families.鈥