America's Melting Pot and Treatment of ADHD
Jan. 24, 2000 (Los Angeles) -- Treatment for attention deficit hyperactivity disorder (ADHD) may be more effective when doctors take their patients' ethnic or cultural backgrounds into account, according to a paper in the Journal of the American Academy of Child and Adolescent Psychiatry. In his perspective, author Richard Livingston, MD, presents five cases to illustrate the impact of cultural factors on a patient's progress.
People of different ethnic and cultural groups face different demands at home, school, and in the community, Livingston writes. "There are also cultural issues in attitudes and beliefs about illness, choice of care, access to care, degree of trust toward majority institutions, and authority figures, and tolerances for certain behaviors. There are also some significant religious issues." As the U.S. becomes rapidly more culturally diverse, awareness of these issues is becoming important for physicians to effectively treat their patients.
However, in an interview seeking objective comment, clinical psychologist Peter Jaksa, PhD, tells WebMD that a patient's background should not interfere with the diagnosis or treatment of ADHD if the clinician is thorough and uses the proper diagnostic methods. Jaksa is president of the National Attention Deficit Disorder Association.
The first patient that Livingston cites is a 19-year-old American Indian woman who was using amphetamines and marijuana to help her concentrate at work and "'come down' smoothly each night." At first she said her substance abuse was "'just an Indian thing,'" but an American Indian psychiatrist helped her realize that she was really self-medicating for symptoms of ADHD.
Livingston, who is medical director of Charter Behavioral Health Systems in Little Rock, Ark., notes that "the relative ease with which [the patient] and her psychiatrist developed some rapport may have been enhanced by their coming from similar ethnic backgrounds." However, Jaksa believes it is impractical for every patient to find a clinician of the same background. "As professionals, we need to be sensitive to those issues," he says.
The second patient Livingston cites is a young man of Islamic background who was preparing for Ramadan, a month-long holiday requiring daily fasting from sunrise to sunset, and was concerned about the effects of the fast on his ADHD medication. His clinician prescribed longer-acting tablets to get him through the month. Livingston points out that clinicians should familiarize themselves with the religious and ethnic requirements of each patient's background to help them in similar situations.
The next patient described is a 9-year-old boy who attended a Jewish private school with a demanding schedule and curriculum. He was taking his ADHD medicine at breakfast and lunch but his symptoms would return within a few hours. When his medication schedule was adjusted to accommodate his 8-and-1/2-hour school day, and his teachers were persuaded to modify his homework assignments, he improved markedly. Jaksa says that he often recommends that a child change teachers or even schools if his or her needs can be better met elsewhere.