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Cultural Factors and ADHD: A Few Findings of Note

Cultural Factors and ADHD: A Few Findings of Note. James H. Johnson, Ph.D., ABPP. International Differences. Prevalence rates In Canada: 9% for boys, 3.3% for girls In Chinese children, rates range from 1.3% to 13%, 3% met DSM-III criteria In Puerto Rico, rates range from 16.5% to 9.5%

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Cultural Factors and ADHD: A Few Findings of Note

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  1. Cultural Factors and ADHD:A Few Findings of Note James H. Johnson, Ph.D., ABPP

  2. International Differences • Prevalence rates • In Canada: 9% for boys, 3.3% for girls • In Chinese children, rates range from 1.3% to 13%, 3% met DSM-III criteria • In Puerto Rico, rates range from 16.5% to 9.5% • 6.9% probable cases in a sample of Italian 4th graders (Gingerich et al.,1998)

  3. International Differences • Prevalence rates for ADHD varied cross-culturally when same cutoff was used on Conner’s Teacher Rating Scale • 8% in Germany • 15% in New Zealand • 16% in Spain • 12% in Italy • 4.5% in Scotland • 9% in Hong Kong • 12% in Australia • 5% in Israel (Gingerich et al.,1998)

  4. Ethnic Groups in the U.S. • Minority status has been associated with a higher prevalence of ADHD and greater severity of symptoms • Differences in prevalence and severity may be due to: • Variations in assessment instruments • Differences in diagnostic strategies • True differences in frequency of ADHD (Gingerich et al.,1998)

  5. Ethnic Groups within the U.S. • Studies in the 1970’s compared African American, Latino, and Asian American children to established White norms • African American children rated as more hyperactive than expected • Latino children as hyperactive as expected • Asian American children less than expected (Gingerich et al.,1998)

  6. Cultural sensitivity of diagnostic tools • ADHD Rating Scale-IV School Version • Assessed African American and Caucasian boys • Teachers rated African American boys higher on all scales (Reid et al., 1998)

  7. Cultural sensitivity of diagnostic tools • Conner’s Abbreviated Teacher Rating Scale • Compared teacher ratings of Hispanic and non-Hispanic children • Children were rated similarly on subscales of ADHD symptoms • Hispanic and Caucasian children were rated similarly on overall measures of behavior problems (Ramirez et al., 1998)

  8. Knowledge about ADHD • Compared the perceptions about medication treatment between White and nonwhite parents • Nonwhite parents were more likely to believe that diet and sugar intake influence hyperactive behavior • Nonwhite parents were more likely to believe that counseling is the best treatment for ADHD • Equal proportions of White and nonwhite parents believed that medication is over prescribed for ADHD (Dosreis et al., 2003)

  9. Knowledge about ADHD • An interview study by Bussing et al. (1998) compared knowledge and information about ADHD between African-American and White parents whose child was at risk for ADHD • African-American parents were less likely to attribute ADHD to genetics. • They were more likely to label their child as “bad”

  10. Knowledge about ADHD • Over half of parents cited doctors as the most common source of information about ADHD • Physicians ranked as the most preferred sources of information about ADHD followed by the library, then mental health professionals • Lower SES parents had lower knowledge scores • After controlling for SES, African American parents had significantly lower knowledge scores (Bussing et al., 1998)

  11. What accounts for differences in knowledge about ADHD? • Why are there “alternative interpretations of ADHD”? • Initial medical advice comes from more informal networks • Symptomatic behaviors may be perceived by African Americans as normal and not in need of professional intervention • ADHD may be viewed by African Americans as a way for their children to be targeted for discriminatory practices • ADHD may rank low compared to other competing needs and concerns (Bussing et al., 1998)

  12. Perceptions of Symptomatology • Ratings by parents and teachers were influenced by the ethnicity and SES of the child • Teacher ratings were more stable • Parent ratings were more influenced by ethnicity than SES • School psychologists rated “lower class” boys as more hyperactive (Stevens, 1981)

  13. Socioeconomic status • Low SES has been associated with less utilization of health care services, lower incidence of prenatal care, and higher incidence of substance abuse • Individuals from low SES background have been found to be less compliant with treatment • Less compliant with medication than with psychotherapy

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