Podcast Transcript
Disparities in ADHD Care of Black Children
Podcast Date: January 29, 2021
Objectives:
- Learn about ADHD symptoms and how they affect daily functioning.
- Identify barriers to receiving diagnosis and treatment within the African American community.
- Learn about the challenges that can cause ADHD-like symptoms.
- Gain suggestions on what parents can do to make sure their child is receiving proper care.
- Learn how professionals and the community can work together to develop cultural competence.
Melvin Bogard: You're listening to The All-Things ADHD podcast. Hey, thanks for joining. I'm your host, Melvin Bogard. Today's show will focus on the challenges of ADHD diagnosing and treatment, ADHD-like symptoms and some of its causes, and overcoming barriers in the Black community. My guest today is psychologist and author, Dr. Nekeshia Hammond. Welcome, Dr. Hammond. Please tell me more about you and your work.
Dr. Hammond: Sure. Doctor Nekeshia Hammond, as you said, I'm an author, a speaker, and a psychologist. I have been in private practice for 12 years. One of my subspecialties is ADHD evaluations with youth. Also, adults but mostly youth. And I'm really honored to be in the community as well as a board member of the Ryan Lee Foundation, and a board member of Rising Media Stars and a lot of other community endeavors.
Melvin Bogard: Well, let's get started. What is attention deficit hyperactivity disorder, and how does it interfere with a person's daily living?
Dr. Hammond: Great question. It's a condition that can really affect someone's functioning. Whether they're in school, whether they're at work, whether they're in the community. And it really is a condition that can be persistent and pervasive, affecting of course, attention and concentration, sometimes hyperactivity and impulsivity. But most importantly, depending on how the person has treated this condition depends on how it's going to affect their lives.
Melvin Bogard: Please discuss some of the signs and symptoms.
Dr. Hammond: There are a lot of signs and symptoms, actually. Some of the common ones that people have heard of are difficulties focusing. Maybe they're losing stuff. They can't concentrate on their tasks that they're doing. For kids that have the hyperactivity/impulsivity part of ADHD, they're getting out of their seat in school or they're very restless. Those are some of the common symptoms. A couple of the signs that I think are most important for people to understand is that this is a condition that has to be lasting in order to get the diagnosis for at least a minimum of six months. I think that's important because a lot of people go through things in their life. A lot of kids are going through things. If they have not been able to concentrate for a month or two, we can't automatically assume it's ADHD and they were perfectly fine before that.
I want really people to keep in mind at a minimum, these things have to be really persistent, these symptoms, and at least six months in the making. Also, they have to be occurring in more than one place. If a kid is just really having problems at home, but they're great at school or vice versa, and great elsewhere, again, probably not ADHD. It's really at least two places, home, school, maybe it's in the community, in sports or art, or whatever they're participating in. But it can be a very persistent condition and very pervasive in someone's life.
Melvin Bogard: Are signs and symptoms the same regardless of race, ethnicity, gender, or age?
Dr. Hammond: Some of them are and some of them aren't. We do know from the research, a lot of the younger crowd, I would say, the preschool, elementary aged kids, maybe even middle school, they have more of the hyperactive part of ADHD, because there's three different types of ADHD. Versus like the teens and the adults generally have less of the hyperactive symptoms. When it comes to gender, boys typically, again, depending on the setting, have more of the hyperactive component as well and are more diagnosed with ADHD than girls. We do start to see some differences. But there's mostly a lot of overlap depending on those factors.
Melvin Bogard: Research also shows that African Americans aren't as likely to receive treatment after being diagnosed, even though many studies show that it can drastically help kids and adults manage symptoms. Why is this happening and what needs to be done to fix the problem?
Dr. Hammond: It's really unfortunate. It's a major issue. One of the things being the stigma of mental health. A couple years ago when I was president of the Florida Psychological Association and got to have an opportunity to travel throughout the country. I heard just from different people. And basically, there was this false idea of what mental health treatment means. That “you're weak,” that “you're not smart,” that maybe it's mixing, and you're not supposed to, "Go to therapy and also go to church." And there's all these myths about mental health and mental health treatment, which unfortunately really, really affects the Black and Brown communities. What I think needs to be done is there's a massive need for education about what it means. For myself, I host something called Mental Health Moment online. And I've had a lot of discussion about what mental health means, especially for Black and Brown communities. That you can go to church, for example, and still receive treatment. Because that's a big issue.
There's just fear from a lot of parents that what does that mean if I start to get, again, the label of, "ADHD," for my child now. Not only are they Black or a Brown child in school and having to deal with racism, discrimination, and prejudice, which we know exists. But now there's another issue that they're afraid of teachers or administration labeling them and having different stereotypes about them. It's a very deep issue and complex issue, but I definitely think there's hope with more education surrounding this stigma and really trying to lessen the stigma so that, to your point, people can get the help they need because the outcomes do show with the treatment and with the help, kids can get better.
Melvin Bogard: Black children face a lot of challenges, some more than other racial groups, and some circumstances can cause ADHD like symptoms. Can you talk more about the causes of ADHD-like symptoms and give us some examples? Also, are there safeguards parents or caregivers can take to ensure their child is receiving a proper diagnosis?
Dr. Hammond: Great question. Anecdotally, what I've seen the most in my practice over the past decade or so is that a lot of kids are having issues with attention and concentration. Not necessarily because of ADHD all the time, of course, but because of something like bullying. Man, I cannot express how many times when you really get to the root of a lot of kids, not all kids, of course, but a lot of kids in their struggles with attention, or depression, or anxiety, and it's rooted in bullying. Now, we know that the data shows for Black and Brown communities, there's a higher rate of bullying. It's almost like identity bullying. So, it's something that can't be changed. When you have Black or Brown skin, it's not something you can change. It's not changing your hair color. It's not changing your shoes. It's a part of who you are.
It hits a lot deeper when these kids are being bullied like that. So that is, for example, something that has really affected our youth. And again, I've seen kids that are misdiagnosed with ADHD when they're really struggling with the trauma from the physical and or verbal bullying that they're receiving. But I've also seen kids that struggle with a lot of other issues, divorce or moving. Even right now, dealing with COVID, that sort of thing. And they do have those issues and they have issues with concentration, but they also still have ADHD as well. So, to your second part of the question with what are the safeguards for that? I am a huge, strong advocate. I know that I do it myself. I do the evaluations for ADHD. But I can't express how important it is to have comprehensive evaluations, to sort out what is happening with this child. And looking at the whole child, not taking five or 10 minutes with whoever is professional to hear that they have attention problems and automatically assume it's ADHD. But instead taking the time to see, is there a learning issue too?
Is it trauma from bullying? Is it because their parents recently got a divorce? There's a lot of things that affect kids. Is it because of COVID right now and all of the changes that these kids are going through? We have to answer those questions and stop assuming. And again, sometimes kids have ADHD and something else. The CDC actually shows that practically two-thirds of kids with ADHD have another condition also, which we again tend to ignore. But it really boils down to understanding the child as a whole and what they are going through in order to properly get them diagnosed and properly get them the treatment that they need.
Melvin Bogard: We know there is a long road to overcoming implicit racial biases in America and the world. We know correcting the disparities will require schools, doctors, and communities to work together. What would you say to each of these groups to get us started on a path of seeing people beyond race, ethnicity, and gender?
Dr. Hammond: Yeah. I love that question. A couple of things. First of all, we know, what we know and what we do are two different things sometimes, right? But we know as a community, we have to collaborate in order to better the lives of youth. We know that. Now, how that manifests are a different story. I am a huge advocate also for social media and connecting in that way as professionals. I think that there's so much good information that others are sharing. Are you also collaborating with those individuals? Not just if you work at a school, not just the people you work with at a school, but the physicians that you know. The psychologists that you know. Maybe it's a place of worship, people there that you know. As a community, the nonprofit organizations that want to help the schools and want to help kids with ADHD, are we all taking the time to, even on social media, starting there. Sharing that information, connecting with each other as professionals.
If we want to really help youth; we have to be connected with other professionals. And I am just a huge proponent, as I mentioned, with social media, getting the word out, getting the information out, connecting with each other. And how can you help your fellow professionals that also work with youth? Because that really, really is the key. I can list about 12 other things, but I don't want to overwhelm people. You can go legislatively. You can advocate on that level. I'm proud to have been in Washington DC several times advocating at the federal level for patients with mental health issues. As well as in Florida, our state Capitol. There are so many things that you can be doing. It takes a village and it really takes for us to have this collaborative mindset if we're really going to help youth.
Melvin Bogard: How do you become culturally competent?
Dr. Hammond: It's really tough sometimes with cultural competence, because some people think that it's reading an article, like reading one article and I'm like, "I'm culturally competent." It's a little bit deeper than that. But really delving into and understanding, I mean, it could be reading a lot of articles actually, and communicating with other colleagues, asking questions, interacting with others that have different experiences than you. I'm happy that I've had the opportunity to travel to different countries and talk to people throughout the world and hear their experience. I'm not saying everyone has to travel to different countries. But even where you're at, are you having conversations with others to understand different experiences? Even in the U.S. I've traveled to some places that are extremely rural, where they have very small communities, it's a different life than New York City, vastly different. So again, having these conversations, even if it's virtual, getting into groups where you can understand better. It gives you a better, deeper understanding of people and where they come from. To appreciate that as a professional is just so important.
It goes beyond just reading a book. I know after the death of George Floyd, thankfully, yes, there was a lot of information, I mean, just podcasts and books and so much information out there. Overwhelming amount of information out there for people to learn. And it's a great start, but I just hope people listening to this right now will understand that reading one book or reading one article does not make you culturally competent. It is the start, but it's a lot deeper than that. And you have to really continue on that journey. And lastly, I also want to say, you have to ask the right questions with the person directly in front of you too. Because you also don't want to be stereotyping just because you know something about a certain culture. So, asking them specifically for them. The cultural background, or the religion, or whatever it is for them that's important, and how it impacts this family is going to be very important.
Melvin Bogard: What type of questions should a parent ask when seeking a healthcare provider?
Dr. Hammond: First, I really believe that the person that's assessing the child, let's say, they hopefully really should have experience in the area they're assessing, number one. Which sounds pretty basic, but it's really important. I always tell people if you're getting an assessment for a child, please make sure the person has experience working with kids. Please, please make sure it's different. Please make sure if you're looking for, let's say an ADHD evaluation, that this person has an experience with ADHD. Depending on who you are, you may want certain things. So, if you say, "I want someone that has experience working with Black individuals. I want someone who has experienced working with someone who speaks Spanish," or whatever your criteria are. You should ask those questions over the phone before even going to that appointment. If it's that important to you. I have had individuals that call our office and say, "I want, specifically a Black female psychologist."
Well, here I am. Right? I fit that because that is important to that individual. All sorts of different things. Sometimes people want someone that has a Christian background or whatever certain religious background. My point is it is perfectly fine and okay to have whatever preferences you want. Please find someone competent though. But also, it's important on the part of the patient, if you will, or the patient's family going in, to express what it is for you that's important for this professional to know. Again, some people ask the right questions. Some people are not aware. But you make them aware, "Hey, this," whatever it is, "This part of my culture, this part of my religion, this part of my spirituality, whatever it is, is very important to our family. And here's how it's affecting our child." That needs to be a conversation that again, sometimes some professionals will bring up and sometimes not. But as a parent, that's something that you can bring up.
Melvin Bogard: What would you say to Black parents overcoming ADHD stigma, diagnosing, which you sort of touched on, and if medically advised, starting their child on medication?
Dr. Hammond: I would definitely say to start this process early. When I say this process, meaning, starting with a thorough evaluation. I am not at all a fan of someone sitting down with your child for five minutes and immediately saying they have ADHD when they've talked to you for five minutes. I know it happens all over the world. I'm not a fan of it. At all. You just can't know everything you want to know in five or 10 minutes. Second thing is that it's really, really important to make sure that you get a comprehensive psychological evaluation. There are neuropsychological evaluations. There's a lot of different evaluations. But the point is, it should not be something that takes five or 10 minutes.
And really thinking about what treatment might mean for your child. Meaning, if the person recommends therapy, let's say, I know it can be hard. I know that there's a stigma. I know that there's a lot of myths about what therapy means. But understanding that your child does not have to suffer unnecessarily. I can't even tell you how many teens, 11th graders, 12th graders, that I've seen, and it's heartbreaking. The stories, when I'm like, "If you only had this evaluation 10 years ago, the heartache, pain, struggles through school, suspensions, just headache could have been prevented." So, I love when people come into my office and they're in elementary school, let's say, or even preschool, because it's a whole new world when you get the proper diagnosis, first of all. Then from there, you get the proper treatment, which may or may not include medication. And you save yourself and your family a lot of heartache and pain unnecessarily when you take those steps. So, I highly recommend starting early, do not wait. Do not wait.
I also want people to understand that there are some children that get psychological evaluations, and the results are, they're fine. Like, they're okay. They're having a normal reaction to whatever's happening in their world. That happens too. So, it's not always, you come out on the other side and you have depression, anxiety, and ADHD, and all these other things. Sometimes, yes. But you would want, just as how you get as an adult, blood work done, and someone says, "You're fine. There's nothing wrong with any part of you. You are healthy. All your blood work is great." It's basically the same thing with a psychological evaluation. You look at a lot of different parts. You say, "Okay. They don't have this, this, this, this, or this. But this is what's happening with them."
Melvin Bogard: Do you have any last words you would like to share?
Dr. Hammond: Yes. I want to encourage parents, and teachers and whoever's listening with this, that have kids with ADHD, or think they have kids with ADHD, or are working with them, I really want to encourage you to understand that there is hope. There's a lot of negative information online, especially if you do a Google search about ADHD and what it means. But what normally doesn't show up is that there's a lot of youth that do have ADHD that thrive and that do well. And with the proper interventions, they have great, happy successful lives. That's of course usually not shown. Of course, we see the negative end. So, I just want to encourage people to have hope, share information, positive, reputable information about ADHD, and don't be afraid to get the help that you need.
Melvin Bogard: Thank you so much.
Dr. Hammond: Thank you.
Melvin Bogard: Thank you for listening to another episode of All Things ADHD. To learn more about ADHD, visit CHADD at CHADD.org.
This podcast is supported by Cooperative Agreement Number NU38DD000002-01-00 from the Centers for Disease Control and Prevention (CDC). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.