Underdiagnosed and undertreated
By Claire Sibonney | KFF Health 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’t 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’t bottle up.
As one of the only Black kids in predominantly White schools in upper-middle-class communities–including the university enclaves of Palo Alto (Stanford University) and Chapel Hill (University of North Carolina)—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’t 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.
“Black kids at a very young age, we start dealing with race, we have a lot of racial stamina,” said Wade, who now lives outside of Durham, North Carolina. “But I didn’t understand until later on that there was probably something else going on.” At age 37, Wade learned that he had ADHD and dyslexia, two diagnoses that often overlap. He was 37.
It’s long been known that Black children are underdiagnosed for ADHD compared with White peers. A Penn State report 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–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 research suggests the prevalence of the condition is likely the same.
ADHD has been diagnosed in nearly 1 in 10 children in the United States, according to a Centers for Disease Control and Prevention study published in 2022, with rates surging nearly 70% 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.
Even before Wade’s diagnosis, he was helping similar college students in a career counseling role at North Carolina State University. Today, he’s a licensed mental health and addiction counselor and doctoral student, but he said it’s been hard to see his successes.
“To the rest of the world, this is a Black man with two master’s degrees, and he’s a PhD candidate, and he has two licenses and certifications,” he said. “But to me, I’m a brother who’s had a lot of bad luck with people and jobs I’ve gotten fired from. I’ve never been promoted, ever, in my professional life.”
Wade’s experiences of race and ADHD are intertwined. “ADHD is an accelerant to my Black experience,” he said. “I can’t separate my experiences as a Black boy and Black man from my experiences of understanding my neurodivergent identity.”
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’t recognize an underlying disability, and Black parents who are distrustful of teachers and doctors, fearing they’ll label and stigmatize their children.
“We’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,” said George DuPaul, a psychology professor at Lehigh University who studies non-medication interventions for ADHD.
Studies have shown that ADHD underdiagnosis contributes to harsher school discipline and to the “school-to-prison pipeline.” 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’s a common saying: “Black kids get cops, White kids get docs.”
This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues.