Kyle Henry 10/9/13 Process Paper Dr.

Welsh Attention Deficit Hyperactivity Disorder in the Classroom: A perspective based on Race, Ethnicity and Economic Standing Section 1: ADHD: Diagnosis and Disparities As mental disorders become better and more widely understood, the diagnosis and detection have become easier, and thus have significantly increased in numbers of cases throughout the years. Among these disorders, the most prevalent seem to be ADHD. Among school-aged children, it is the disorder most commonly shown to lead to behavioral and learning issues in the classroom. Every year, more and more resources are dedicated to children of all ages to help treat ADHD, as organizations such as the centers for disease However, despite the growing prevalence, few people truly understand the nuances and symptoms that make ADHD what it is, the subtypes, and what their similarities and differences are. ADHD, or Attention Deficit Hyperactivity Disorder, is the most common neurobehavioral disorder. It is characterized by the subject displaying behaviors that are deemed impulsive acts, such as inattention, squirming or fidgeting, inability to resist carelessness or risktaking behaviors, reluctance at tasks that require long-term focus, and lack of organization. Often, it is diagnosed at a young age, and often stays with the child perpetually throughout their life. There is no singular specific test or procedure that tests for ADHD. However, many ADHD

resources ask that caretakers look for symptoms that serve as clues before referring the child to a doctor for diagnosis. By the DSM-V definition, these symptoms include:
Inattention a) often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities (b) often has difficulty sustaining attention in tasks or play activity (c) often does not seem to listen when spoken to directly (d) often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand instructions) (e) often has difficulty organizing tasks and activities (f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) (g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books or tools) (h) is often easily distracted by extraneous stimuli (i) is often forgetful in daily activities Hyperactivity (a) often fidgets with hands or feet or squirms in seat (b) often leaves seat in classroom or in other situations in which remaining seated is expected (c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) (d) often has difficulty playing or engaging in leisure activities quietly (e) is often on the go or often acts as if driven by a motor (f) often talks excessively Impulsivity (g) often blurts out answers before questions have been completed (h) often has difficulty awaiting turn (i) often interrupts or intrudes on others (e.g., butts into conversations or games)

The general rule is that the impairment caused by these symptoms should be displayed in two different settings, normally at home and at school. Afterwards, it is generally said that 6 of these symptoms should be displayed by children prior to the age of 12. Additionally, the symptoms the child may display are integral to determining what subtype of ADHD the child

may have. These subtypes are comprised of Predominantly Inattentive Type, Predominantly Hyperactive Type and Combination Type. Predominantly Inattentive Type is diagnosed when they child displays 6 or more symptoms that are described above, and less than six hyperactive symptoms. Predominantly Hyperactive Type is the polar opposite, displaying 6 or more hyperactive symptoms and less than 6 inattentive symptoms. Combination type is diagnosed when the child displays 6 or more symptoms in both the inattentive and hyperactive categories. Additionally, the symptomatic behaviors should be displayed for around 6 months prior to professional consultation to ensure accurate diagnosis. Numerous reports conclude that the number of ADHD cases in school-aged children has increased dramatically over the past decade. For example, The Centers for Disease Control reported a 22% increase of parent reported cases of ADHD between 2004 and 2007, from 7.8% to 9.5% of all school-aged children. Additionally, the CDC reported a 42% increase of diagnosis in older teens. In total, there are an estimated five million children diagnosed with ADHD. This begs the question of as to why there are such significant increases. Many would attribute the increase of ADHD cases throughout the years to ADHD diagnosis to readily available to parents who are bombarded by fear-mongering news stories and greedy doctors eager to prescribe the newest psychostimulant that pharmaceutical companies pay them to hand out, or that parents and teachers are stifling creativity and normal childhood functions by drugging children into zombified learners. Sensationalism in most, if not all cases. These increases can be attributed to information from leading researchers of ADHD becoming more and more accessible to parents, teachers, and administrators. What is lacking, however, is the ability to help every child, whether it is caused by cultural, economic, or stigmatic barriers.

Many of the reported cases of ADHD come from sources that are presumably consistently made up of white children from economically and culturally stable environments, where mental health is of a generally higher concern, and more commonly treated. However, there is little mainstream light shed on ADHD in a multicultural sense. Many sources state the claim that white children are much more likely to receive a diagnosis than a minority. Often-times, disparities in insurance coverage, resources, state laws regarding special education, language and cultural barriers, and general fear and apprehension to the aspects of having a child diagnosed with ADHD are the main culprits often blamed for the under-diagnosis of minority children. As stated before, children are usually diagnosed by the age of 12. Sources state figures in regards to this, in that by junior high school, Hispanic children were half as likely, and African-American children were two-thirds less likely to have received a diagnosis than a white child. The National Alliance on Mental Illness attributes this to three causes among minority populations; reduced available resources, lack of representation in the medical community, lack of education on mental disorders, and a general mistrust for the medical community. On a person-by-person basis, these causes usually stem from forces out of the persons control, such as how they were raised, where they live, and how the community around them approaches such situations. These often are the sole challenges that stand in the way of a child receiving proper diagnosis and treatment.

Section 2: Combatting Disparities diagnosis and treatment of ADHD in a multicultural setting The main issue in the prevention of diagnosing and providing assistance to children with ADHD is the lack of education and the demonization of mental disorders among communities of differing race, ethnicities and cultures. Unfortunately, thats easier said than done. The areas that tend to be most problematic, and serve as the main purpose of this paper, tend to be of lower income, with few readily available community resources, and even fewer related to mental health. These issues remain on the proverbial slippery slope. As mentioned, a lot of these problems stem from the overall encompassing culture of the area. Unfortunately, a lot of these problematic areas are, again, low income areas, with high rates of crime. Now, thats not to say that white is right and just because one is white doesnt mean that one automatically gets the diagnosis and services that one needs to succeed. However, the studies shown demonstrate that among all the different types of communities out there, many communities that are suffering from ADHD-related issues among their students are predominantly minority. So, to understand what issues are causing the stigma towards ADHD that leads to misdiagnosis or a complete lack of diagnosis for children whatsoever, one needs to understand the community behind these stigmas, and the driving forces behind it. Granted, this may be difficult to do without generalizing (i.e. Stereotyping) certain aspects of these populations, but is integral to addressing the issue as finding ultra-specific information pertaining to every aspect of the subject is proven difficult given the time frame. In their study on disparities on diagnoses among different races and ethnicities, Reuben and Pastor reported that there are indeed disparities between minority children and whites.

However, they did not find that these disparities were caused by any racial or ethnic factors, but rather that they were caused by socio-demographic issues more than anything. In the report, some sample findings include that 1% of Hispanic children had parents report ADHD without any type of learning disability. Comparatively, 4% of white children of white children have had a parent report ADHD without a learning disability. The same case for black children as Hispanics, in that they are 2% less likely to have a reported case of ADHD without a learning disability than a white child. Among all three races, there was a relatively equal amount parental reports of ADHD with a learning disability. In addition, minority children were reported to be on medication about 20% less than white children. Inferably, it can be said that parents are fully cognisant of learning disabilities, but it lends a lot of speculation on general attitudes towards ADHD by minority communities. Is it viewed strictly as a symptom? Is there a lack of empathy towards children with ADHD as a stand-alone disorder? Are children expected to get over it, and sit down and study? How are kids in these communities treated over accompanying behavioral issues that come along with untreated ADHD? What happens when the mistreatment of these kids gets to be too much? They lose interest, drop out, and turn to a life of crime and general delinquency. Thats the worst case scenario, but a fairly plausible one nonetheless. In an effort to understand what happens to children with ADHD in low income communities, and thus formulate ideas to counteract the ideals and stigmas that prevent could very well be holding back, further information must be obtained in that specific setting. The National Alliance on Mental Illness reports that information seems to be the prevailing issue. In low income communities, it is easy for the issues that come along with day-to-day life to overshadow the problem of having a child that seems hyperactive. As reported in desReis and Butz report, many of these parents rely on self-referral from a student, or even more commonly,

reports from the schools staff themselves to even realize that their child may even have an issue. More interestingly, their beliefs explained why they were less likely to put their child on medication that could prove beneficial. According to the study, teachers are most likely to raise the possibility of ADHD being an issue. In addition, attitudes towards drug treatment of ADHD from participating caregivers shows that many of the negative aspects medications reputably hold are of higher concern to minority, low income parents than white, middle class parents. While the child of each respective participant had been on medication for at least twelve months, many still had major misconceptions as to what the medication was fully capable of doing. 17% of the sample believed that stimulants lead to drug abuse, 22% felt too many children received ADHD medication, and 21% felt medication had bad side effects 71% were initially hesitant to use medication based on what they heard or saw in the lay press and less than half (46%) preferred medication to counseling. (Butz, dosReis, et al) These results just add fuel to the proverbial fire, in that education and misconception are the main perpetrators behind ADHD going undiagnosed and untreated in minority students. So, the answer is simple; In order to combat ADHD issues in the classroom, information must be made available to all those who have a role in the childs upbringing. That means teachers and caregivers alike. However, in practice, the answer is not so easy. There needs to be emphasis placed on what the effects of ADHD can have on a child, as well as any and all possible outcomes. Parents need to be encouraged to recognize the signs and symptoms and utilize resources that they may have. Teachers need to learn to recognize the differences between misbehavior and ADHD-related issues. There needs to be an established line of communication between teachers and parents, and both need to stay easily accessible, and responsive to each other. It extends further than just communication between the teachers and parents, however. It

comes down to resource availability, which is the main source of creating available information and resources for these communities to utilize. Section 3: Creation and Availability of Resources in all communities The common theme throughout is that many children are suffering from the misguidedness and even general ignorance in regards to ADHD by their respective guardians. So, what steps can be taken to educate parents and guardians who may not have the information needed to help their child readily presented to them? The most obvious answer would be to simply make that information available. The easiest approach would be to target those kids whom are demonstrating various ADHD symptoms, and send information on available resources around the community home with those children. However, its highly unlikely that those parents would get that information, as kids are more than likely to leave papers and other junk items that dont have any bearing on their grades in their backpack. Or worse, they could think they are in trouble for something if theyre being sent home with papers and their classmates are not. So, in those approaches, theres less of a guarantee that the information would actually make it home into someones hands. However, these outcomes would most likely be remedied by a phone call from a teacher or a school counselor. While it may prove to be difficult getting a hold of some parents, the ones that can be reached will at least be made aware that there are issues, and can be begin working with school staff on the issues their child may be experiencing. Schools can simply leave packets of information in the lobby and main office, which are areas that parents often frequent if they show up to the school, but this would not be an ideal way of getting information to them, as pamphlets on a wall often get ignored.

The other question raised, particularly for lower income communities, is what happens when resources arent really available to help treat the issues that come with ADHD? What if there are no mental health professionals in the area that can be reached by families? What if medications cannot be readily accessed by these families? How do you create solutions to combat these sorts of issues in places where a kid who seemingly will not sit down and pay attention in school serves as one of the least of a familys issues? Granted, these are not easy problems to address, but there some ideas that, with some extra time volunteered and some effort put forward, can serve as the solutions that will help out these kids and give them the education they deserve. Other ways schools can create resources to aid children with ADHD is contacting mental health professionals themselves. This opens up entirely new possibilities. Ideally, funding from school districts or even the government could bring a mental health professional to the school to work with these kids, or getting someone to volunteer their time and skill set into helping these kids. The publicity alone would boost everyones good standing with the community. Even on just a part-time basis, the impact would be immense. Kids could potentially receive an actual diagnosis, as well as the therapy and written prescriptions that could inferably go along with that diagnosis. Or even at the very least, the persuasive power of an accredited mental health professional confirming school staffs concerns, and helping to communicate those concerns with the parent would serve to only benefit all parties involved. Finally, educators and parents should do their research, and build up a network of contacts. With enough digging, one can find someone with some sort of connection that can prove beneficial to a child with ADHD. Many employers offer a limited amount of consultation sessions for their employees on an as- needed basis. Medicare and Medicaid programs do cover

therapy and prescriptions for certain medications that combat the symptoms of ADHD, particularly if school administration writes a recommendation for a child to be tested, diagnosed and treated. Community Centers, and places of worship often host support groups for various issues, and these are often presided over by a qualified counselor. Community Centers are known to increasingly offer mental health services after benefitting from various economic stimuli, and most clergy are trained in counseling. While the counselor may not be able to help themselves with a distinct, singular issue, they probably can get in touch with someone who can. Additionally, there are organizations such as Mental Health America who advocate on behalf of those who suffer from mental disorders. Their entire purpose is to ensure that mental health care is available to all those that need it, and will do everything possible to get people the care they need. They are the embodiment of the type of networking that really could benefit children who are stuck with ADHD with no treatment explicitly available. As exemplified, a child can be helped if networking through all these resources is undertaken by school staff and parents. Essentially, the problems that stem from ADHD are exacerbated by the victimization of a child through the circumstances in which they are raised. Whether it is the cultural factors, such as distrust and ignorance on the issue, or a lack of resources in regards, such as basic information, education and treatment, or some combination thereof, they are issues that, with enough effort by teachers, parents and guardians, can be tackled and remedied. It takes communication, an open-mind, and a will to see a child succeed by all the parties that are integral to a child getting an education. The exploration of these issues and solving them will serve to remedy a lot of the negative stereotypes that plague the education system in minority and/or low-income areas. For instance, the number of African American children being placed

into special education programs for behavioral issues such as poor impulse control would decrease if teachers are knowledgeable in regards to looking for signs of ADHD, as opposed to writing these kids off as bad kids who simply cant behave. Involvement with churches and other community organizations would draw parents who may be hesitant in interacting educators, such as Latino immigrants who may struggle with speaking English, or may have entered illegally. It would help by putting both parties on a proverbial neutral ground in which both would feel safe. Food and clothing drives for low-income families could also prove to be an opportunity to reach out to the parents of these children, and address those issues. Its this type of community outreach where educators can really get information out on this issue with less chance of alienating parents, combat cultural ignorance and mistrust, and foster networks of resources that would be available to any and all families of children who are dealing with ADHD in school.

Works Cited Bradley, D.. N.p.. Web. 3 Dec 2013. <http://www.nami.org/>. Elizabeth Ahmann, . N.p.. Web. 3 Dec 2013. <http://psychcentral.com/lib/adhd-among-africanamericans/00017250>. Pastor, P. N., and C. A. Reuben. "Racial and Ethnic Differences in ADHD and LD in Young School-Age Children: Parental Reports in the National Health Interview Survey." n. page. Print. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497740/pdf/16025718.pdf>. Akinbami, L., X. Liu, P. Pastor, and C. Reuben. N. Attention Deficit Hyperactivity Disorder Among Children Aged 517 Years in the United States, 19982009p.. Web. 3 Dec 2013. <http://www.cdc.gov/nchs/data/databriefs/db70.htm> dosReis, S. Butz, .Attitudes About Stimulant Medication for Attention-Deficit/Hyperactivity Disorder Among African American Families in an Inner City Community Dixon, A. Tucker, C. Low-income African American Male Youth with ADHD Symptoms in the United States: Recommendations for Clinical Mental Health Counselors