Health Disparities: Barriers to ADHD Diagnosis and Treatment
Podcast Date: June 9, 2020
- Learn potential diagnosis and treatment barriers for different communities.
- Learn how barriers affect African-American, Latino-American, and immigrant communities.
- Understand how access to care impacts academic achievement, relationships, and quality of life.
- Learn common gaps for school-aged children with ADHD and how it follows into adulthood.
- Understand how parents, teachers, and medical personnel can collaborate.
Sarah Brown: Hi, I'm Sarah Brown and you're listening to ADHD 365.
Sponsor: This episode is brought to you by Recoop. Recoop provides an all-natural supplement that gives you a smarter slant on health and may reduce side effects and sick days. Take 25% off their wellness lines with code CHADD, C-H-A-D-D.
Sarah Brown: Today we're here with Brandi Walker. Hi, Brandy.
Dr. Brandi Walker: Hi, Sarah. How are you today?
Sarah Brown: I'm good. Can you give us a little bit about yourself?
Dr. Brandi Walker: Sure. I am a Howard University graduate. I am a PhD in clinical psychology. I'm also an army psychologist, so I work with soldiers on a regular basis, but I'm also interested in our pediatric population. I do a lot of work around ADHD and sleep. I probably should let you all know that my views are not representative of the United States Army, or the U.S. Government, or the Department of Defense. They are my views and my opinion.
Sarah Brown: Okay. CHADD is thinking about … diagnosis and barriers to diagnosis and treatment for different communities. Can you talk a little bit about that?
Dr. Brandi Walker: Yes. One of the things that we're focusing on is what we will call health disparities. Those are barriers to diagnosis or barriers with assessment or treatment, and they're based around different factors, such as not being able to have access to care, or access to opportunities for care or access to resources. A lot of those barriers are because of socioeconomic status. They may be because of demographic differences, such as race or ethnicity, maybe age or disability status. So, there are several reasons that kind of contribute to health disparities and why they continue to exist.
Sarah Brown: Are they more prevalent in one community than another?
Dr. Brandi Walker: Oftentimes we see a lot of disparities for the African-American population, the Latino-American population. It also shows up with different populations, people with various immigrant statuses. So, it happens quite frequently.
Sarah Brown: So, is it access to care or is it not getting the information that they need to go for a referral? Like they don't understand that maybe this is ADHD happening?
Dr. Brandi Walker: So, it's both.
Sarah Brown: Okay.
Dr. Brandi Walker: There are challenges with systems in terms of maybe school systems, maybe programming, maybe communities, access to those resources that would alternatively provide the care. So not being able to get a diagnosis, for instance, for African-Americans. Some African American kids will get a diagnosis two years later than their counterparts, which means that they're academically behind. They may have a learning disability going on as well. A lot of times with ADHD there's also comorbid anxiety or depression. So, it's having all of those challenges that you typically wouldn't have if you weren't demographically differentiated in terms of resources and support.
Sarah Brown: Where is the gap?
Dr. Brandi Walker: A lot of times it can happen in a classroom. When a student might be misbehaving or have symptoms of ADHD and it's just considered misbehavior, depending on the route that's taken. So, if a teacher, first of all, if it's a classroom where it's like 29 kids and one teacher, then there is a strong possibility that child might get missed, versus a classroom where there's a teacher, or maybe a teacher's assistant. So even at the school level there could be disparities in the consistency of care or the access to even being assessed or diagnosed properly.
It shows up in a medical system when a child with ADHD, maybe just seeing a general practitioner or someone who just generally provides basic care to families, but rather than getting the support from being evaluated by a specialist. So, specialists may be able to get more insight if it's ADHD, it might just be sleep deprivation. The ability to comprehensively assess children is probably one of the number one reasons why you may have either the diagnosis comes late, or the diagnosis isn't assigned at all, or you're diagnosing something that's not ADHD, but something else. And the other issue is being able to get the treatment when there is a diagnosis present, or the idea that maybe a diagnosis is existing.
Sarah Brown: So, it seems like maybe they need more training for teachers, talk to parents, and then parents need the education. And also the pediatricians, so all three have a gap.
Dr. Brandi Walker: Yes. And that gap is what we would consider in some cases or a lot of cases when it continuously happens for populations that are underserved or historically underrepresented. Those are the ones where you kind of start seeing a difference in care. And when you see the difference in care, you start seeing a difference in school and academic achievement. You see the difference with adults and their productivity. You see the difference in stability. And the other component of health disparities is the increase for health problems that people would not actually be susceptible to. So, they're preventable medical conditions or medical problems that would otherwise be prevented if the person would have had proper access to care.
Sarah Brown: So, can you give me an example?
Dr. Brandi Walker: A child who grows up in a neighborhood where they have a lower socioeconomic status. There are no healthy grocery stores, so you won't have a Whole Foods, but you'll have like a 7-Eleven convenience store. You have several fast food restaurants instead of places that sell fresh fruit. So that child is already at-risk for cardiovascular diseases, obesity, and maybe even asthma, depending on the quality of the air. So, there's all these different things that could potentially be preventable if the child has access to care or community resources, or if those resources are better in quality in terms of what they can provide.
Sarah Brown: So, let's go back to this child that's not diagnosed. Health is one long-term issue, but if they're diagnosed two years later than other children, then what other kind of impacts do you see?
Dr. Brandi Walker: So, there's issues with academic achievement. For children with ADHD, diagnosed or undiagnosed, the rate of high school dropout is 35%. So, you take one of those large high schools. We're talking classrooms full of students that are dropping out because they have ADHD and can't manage their condition. The difference at academic achievement, it continues … that gap continues to widen. So, a child who has the diagnosis, and say most kids get diagnosed at age seven, but an African American child may not get their diagnosis until nine. So then, it's two years loss of academic achievement, or they may be minimally achieving when they could have been achieving well beyond what they actually are getting because of the diagnosis. That same child, as they're moving along to the next grade and next grade, they're just kind of falling behind, falling behind and the ability to get them where they're supposed to be is such a larger challenge than had they been receiving the care all along. And so those are the students who probably are at a greater risk for dropping out of school or disconnecting. Low self-esteem, the other impact.
Sarah Brown: Right, that's what I was thinking of, the low self-esteem. If you're two years behind and getting diagnosed in two years, then you're hearing all that negative, ‘cause you're not doing what you, you're not learning, you're not, what's wrong with you?
Dr. Brandi Walker: Yes.
Sarah Brown: In that kind of negative way, instead of, "Okay, this is an issue, we need to treat it."
Dr. Brandi Walker: So, the impact on a family, there's, you can imagine that there's a discord or distress in the family. Like we said, the self-esteem is an issue. We know ADHD already is comorbid with anxiety and depression. So, 50%, even higher, 50 to 70% of children who have ADHD also have anxiety issues. And the numbers are kind of similar when it comes to depression too. So, a child who is dealing with undiagnosed ADHD also is still dealing with anxiety or depression, whether it's diagnosed or not, or the likelihood. The sleep is impacted. That happens to 50 to 70% of kids with a diagnosis as well.
And we talk about this person, just getting older, still having these same problems. Now we have a person who's an adult, but having all these challenges and still difficulty, you know, maintaining a job or being productive or efficient at your job. So, there's challenges for organization skills, memory, all of the key symptoms of ADHD still show up for an adult. But as an adult, you are now much more responsible where you're supposed to be more responsible for all these other things. So, it gets, it becomes a problem in terms of economically there's a cost. A cost for that lost productivity.
Sarah Brown: Now, they're finding that adults have not been diagnosed. So, what is the disparity there? So, here …the adults that didn't get diagnosed as children, and if they're not even knowing that this is an issue.
Dr. Brandi Walker: Yes.
Sarah Brown: Then what do we do?
Dr. Brandi Walker: The impact is huge, because relationships are impacted, a person's quality of life is changed significantly. And again, with the health disparity aspect, the risk for preventable medical conditions or health problems is higher. Socioeconomic status, stability, maintaining a home, just to be able to get transportation to and from work. All of those things that we kind of take for granted become major challenges for this person to navigate on a regular basis.
Sarah Brown: Now it's overwhelming. What can we do? What do we need to do?
Dr. Brandi Walker: So, one of the things is awareness…understanding that when you see something and it doesn't look right. If you're seeing behaviors in a child—not so much situational, like something happened and they're reacting--but more chronic and over time, then being okay and willing to at least get information.
What I appreciate about CHADD is the website is full of resources. The opportunity to get information and take that information to the next step.
If you think your child has a diagnosis, not being afraid to ask the doctor or ask the teacher what they're seeing. Collaborating with teachers, collaborating with the doctor and being okay with having conversations. If the adult is having issues, not being afraid to tell it to the doctor and say, "Hey, this is what's happening for me. Do you think that maybe I have anxiety? Or what if I have ADHD?"
Because on the other side of that coin, once you have a diagnosis or you have more information about what's going on, then you have access to resources. And the resources are excellent at allowing a person to be productive, allowing them to improve their quality of life.
Sarah Brown: You control your life instead of it controlling you with the disability?
Dr. Brandi Walker: Absolutely.
Sarah Brown: Any other tips that you might want to give before we end today?
Dr. Brandi Walker: Yes. So, the issue of health disparities is very real. We see it all the time and just understanding, raising awareness that it does happen, and that there is something that every person can do. Practitioner, teachers, everybody can be involved.
Sarah Brown: Wonderful. Thank you so much.
Dr. Brandi Walker: Thank you. Thanks for having me. It's been a pleasure.
Sponsor: This episode was brought to you by Recoop. Recoop provides an all-natural supplement system that gives you a smarter slant on health and may reduce side effects and sick days. Made with natural ingredients that are vegetarian and gluten-free, you can learn more at getrecoop.com. Recoop is offering a 25% discount on their natural wellness lines with code CHADD. Find out more at getrecoop.com. And remember, always consult with your doctor before taking any supplements.
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