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ADHD: Health, Education, and Wealth: A Racial Justice Approach

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  • Brandi Walker, PhD, clinical psychologist/clinical and organizational consultant at Marie Pauline Consulting, LLC
  • Dawn-Elissa Fischer, PhD, professor of anthropology, California State University, San Francisco.
  • Rick Webster, founder and CEO of Renafi, Inc.

A panel discussion on the intersectionalities of ADHD and racial disparities was held during ADHD2023 in Baltimore, Maryland. The following excerpt was condensed and edited for clarity.

What happens when judgment of the hyperactivity and impulsiveness of ADHD meets with racial bias in disciplinary actions in the classroom? How does the combination of color and ADHD contribute to placement into the school-to-prison pipeline? What impact does racial bias have on ADHD diagnosis? What are the likely outcomes?

According to Russell Barkley (2008), sixty-one percent of individuals who have ADHD experience significant and recurring financial problems. How do racial disparities contribute to negative outcomes for people of color? In this segment on education, our speakers discuss how ADHD and implicit bias affect educational outcomes and future life opportunities for students of color.

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School Experience from Childhood Through Adolescence and Adulthood for People of Color, Compounded with ADHD Symptomology

  • Difference in classroom side & teacher-student ratio
  • Difference in course content, class materials, extracurriculars
  • Difference in accommodations and execution thereof (IEPs/504s)
  • Macroaggressions, microaggressions, implicit bias, prejudice & stereotypes
  • School environment & safety concerns
  • Pivotal/formative experiences with rejection, acceptance & belonging
  • Trajectory for falling behind, knowledge gaps, perception of behavioral problems
  • Ineffective coping and unhealthy avoidance

Dawn-Elissa Fischer:
Hello, and welcome. I'm so glad you are joining us as we discuss racial justice approaches to ADHD, health, and wealth, intersectionality about racism and neurodiversity throughout popular culture, and so some of that will come up today. So again, [I am here with] Dr. Dawn-Elissa Fischer, Dr. Brandy Walker, and Rick Webster.

Brandi Walker:
Alright, so we're talking about ADHD, health, education, and wealth, and we're talking about a racial or social justice approach.

Education. Yes. So, this is one of Dawn's favorite topics; also, one of mine. I’ve got a story, but do you want to get into the topic first before I can give all of you my story? Okay, we'll talk about my story just a little bit.

So, back in the day, I had a patient, a client that I'm seeing. My client disclosed to me—he's probably around 26 to 27, unemployed, looking for work, living in substandard conditions. I'm trying to figure out, how did how did you end up there? Where's your school education?

“I got a high school diploma,” he says, “but not, you know, they kind of gave it to me. So, we talk. This person talks about how they grew up in Baltimore, went through the Baltimore school system, and when they were in grammar school, they had straight As, a 4.0 GPA.

From grammar school, they go into middle school. And in grammar school they have some of the advanced classes, middle school, same thing, right? All of these advanced classes. But in this middle school—80% black, 20% white students—and, the 20% that's white are all in the advanced classes.

So, what does that mean? That means the 80% that are black are in regular classes. While he's in regular classes, he's with his friends and everything is not too bad. He's applying himself as needed, but he has this high intellectual level. And so at some point, they say, Okay, we probably should put you in some advanced classes because you really are overachieving. [They] put him in advanced classes and in that environment, he's exposed to racism, discrimination, implicit bias. It's only him and two other black people. This student recognizes that, “Hey, some of these people don't belong here. I know people in my regular classes that are way smarter than them. They're in this space and they're protected, and they have this privilege and at the same time, not just them, but my teachers are treating me differently.”

So, what happened? The student starts going to class, but now he puts his head down. He doesn't speak up, doesn't get involved. He'll fight if he needs to, because he's always going to stand up for himself. The other two black people that are in this class, he may speak up for them because they're getting into problems. He may intercede on their behalf when he sees that they're being shamed or ridiculed but, otherwise, [he keeps his] head down—until he decides to stop coming to school.

And in high school, doesn't even apply himself. Stops going. But they passed them anyway. Now, how successful is that individual going to be?

These [kinds of] experiences that our students have in these classroom environments are absolutely critical. When you take a classroom environment that is not respectful or appreciative, or a teacher who doesn't see you and your worth, when you start experiencing these negative experiences, it feels traumatic, and it changes your mindset about even applying yourself. This is the trajectory that we see where all of these people end up in prison.

How does that look for someone who has ADHD who's having these experiences?

This happened maybe about eight to seven years ago. All of this stuff is recent in the educational system—oh my gosh—this is where kids either love school or hate it. But we all know that education is probably one of the number one predictors of a higher quality of life. Over to you, Dawn.

Rick Webster:
Before you go with that, there's a book called Coaching for Equity, which I think should be required reading for every teacher, because a lot of this is implicit. The teachers aren't evil. They just don't know. They don't know what they're doing. It’s an element of white privilege. You get to walk around not knowing that you don't know.

Dawn-Elissa Fischer:
The book was called coaching for?

Rick Webster:
Coaching for Equity: Conversations That Change Practice.

Dawn-Elissa Fischer:
For those of you who have our handout, we have a list of peer-reviewed resources at the end. You don't have to read educational research journals if you don't want to—something we like to do. I definitely have to read academic articles and publications and so forth. There's also a number of books in this outline that have accessible terms and audio books, so that people can get access to the information that they need.

At this point I want to shout out to Dr. Zoe Smith, who just won an award from at this conference—who is doing research—I see you, Zoe! I just think it's important for us to keep learning and doing this together.

I know we need to switch on to our last hot topic, that gets to the wealth and inheritance and so forth. But it's important to understand that, out of the gate or from the beginning, that healthcare is a necessity, but it’s not always an option. It has costs and takes a lot of persistence and advocacy.

Then we talk about education, in which many people are excluded, whether they know it or not, and sent messages that they don't belong. That somewhere else is a place for them. Yet what a mixed message from society, because it’s not true. Because we don't just go to school for knowledge and education, right? We can get that in multiple places. We're there for our networks, our friendships, our future advocates—people who might be able to refer us to people to help us get help.

And if you're cut out from all of that, or there's some obstacle and barrier to getting access to that, then that, again, can have lifelong impacts, factors that take many of us decades to finally connect to the resources that we offer here in this room, to find community.

But, I can say that I've witnessed radical change, on individual levels and then on policy levels. And I'm dealing with large systems, public education, given the state that I worked in for the past 20 years, but even prior to that, in Florida, Illinois, Missouri, and even in other countries. Change is possible, but it takes us understanding this and practice talking about it. I think I'll try to bring it back up later.

There's a story that some of us grow up with about Charles Drew.
I didn't expect to tell this story about the heart surgeon who died outside of the hospital that was a segregated hospital. I’m going to try to make this leap to education for a moment.

As educators, coaches, clinicians and medical professionals, we need to recognize that our attention and our continued education are critical. It's life and death for many people—and that might not just be in a hospital or in a therapy session or in a coaching session, but it might also be taking place in a classroom or any related office. All of our work matters.

Brandi Walker:
Yeah, and just to add a little bit more continuity to the idea of education, we've talked a lot about the school-to-prison pipeline. Nobody goes to school and says, “You know what? I think I want to go to jail when I leave here.”

But that happens, particularly when executive functioning is impaired or compromised. We know with the diagnosis of ADHD, the aspect of us being able to think things through and make good decisions, in spite of distractions or for immediate gratification, is impaired. When that's happening in our brain, as a kid, it matters.

But when that's not addressed, it just shows up in adulthood for adult-type situations. So now: You couldn't get me to do my homework. And yeah, I didn't feel like doing my chores. But guess what? I can't get a job. Or if I can get a job, I don't know really how to cope with my symptoms. I mean, I might smoke a joint or two, or three or four, every day and this is how I cope, right? I can’t get enough money to get enough—I don't know—marijuana or whatever. Because that's light compared to some of the other things that people are dabbling in. Those become the coping strategies. We open ourselves up to a lot of accidental-type conditions, whether it's driving-type accidents with fatal results, or maybe it's just being in the wrong place at the wrong time, hanging with the wrong people. But this whole pipeline, where we end up with these negative trajectories that end up in the law, it's just a matter of time before things kind of cross the legal line, too many speeding tickets.

Now, I went to Howard University, and I will tell you parking is crazy. I have a photo album of parking tickets and red light violations. I was at court like every other day—but wait. They were like, “Have you put on lip gloss? Is this you?” Sure, that's me.

I don't have a diagnosis of ADHD. I just work very closely with the population. And my research is here and I have strong relationships and collaborations here because I feel like we can make a tremendous difference. But in my work, what I see is that, even in the military population, is this trajectory we're not intentional and not getting the resources and the connections that we need. For the individual who is dealing with these challenges in an educational environment as a youngster, we have got to get them the resources they need. If only we can get them 504 plans and IEPs that absolutely are executed by school systems.—and that execution needs to happen. [In] middle school, high school, college, even in an advanced educational environment, if they get what they need, they will be great. If they don't get what they need, they lose traction and look for other ways to cope.

And if it's not in a healthy way, it's still going to be coping in a way that works for “me,” whether I avoid making important decisions and I just don't make them, or if I make important decisions when I make bad ones. They still add up to being negative outcomes.

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