Adult ADHD in Black, Indigenous, and People of Color

Medically Reviewed by Dan Brennan, MD on July 11, 2022
5 min read

More American adults are being diagnosed with attention deficit hyperactivity disorder (ADHD) than ever, with a 36% increase between 2008 and 2013 alone. When it comes to different ethnic and cultural groups, though, the numbers don’t always balance out. A large study found Black, Indigenous, and people of color (BIPOC) were far less likely to be diagnosed with ADHD than white people.

Researchers couldn’t rule out the possibility there really is more ADHD among white adults. Yet many factors drive the inequity people of color can face when it comes to proper diagnosis. Other, often cultural, barriers can deter them from seeking treatment for ADHD at all, too.

A diverse study spanned racial and cultural groups including Blacks, Native Americans, Pacific Islanders, Latinx people, Asian Americans, and whites. All groups except Native Americans reported an increase in ADHD diagnoses over the past 10 years, but still with a much lower detection rate than white people.

With BIPOC, there’s evidence of over-treatment – meaning unneeded or even harmful diagnoses – as well as under-treatment, too. This also throws accurate diagnoses out of balance. The reasons for the inequity are complex and can differ among ethnic groups and cultures.

Some of the many factors that can come into play include:

Poor access to quality evaluation and treatment. Meager community resources, inadequate insurance, and economic burden can play a large part in why BIPOC don’t or can’t seek treatment for ADHD.

Not enough culturally competent practitioners. Cultural competence means the health care provider understands and works effectively with people of different belief systems and cultures than their own. For example, they can spot how “normal behavior” in other societies varies so they can better detect and manage ADHD.

Cultural competence also requires tuning in to personal details such as family background, education and knowledge levels, and resources at hand.

Cultural practices and traits vary wildly. A practitioner should understand their patient’s language, both spoken and not. This includes:

  • How the ethnic or cultural group views people in authority. For example, many people in Latinx and Asian cultures avoid making eye contact as a show of respect.
  • In some cultures, there’s a need to warm up when talking about sensitive subjects before “diving in.” This might make them seem less direct and requires patience.
  • Body language plays a large part in how different cultures communicate and show emotion. It can range from how they speak to gestures they make. A healthcare provider needs to know how to interpret them.

Likewise, the practitioner’s approach has to be clear and easy to understand. They must meet the needs and expectations of BIPOC.

Misdiagnosis and mistrust. Black people have long endured patterns of abuse and incorrect diagnoses from the government and medical community. A deep-seated lack of trust has become part of the culture.

Cultural stigma surrounding mental illness. Proper ADHD diagnosis has been linked to other psychiatric diagnoses. Yet cultural beliefs and fear of judgment can be a huge barrier to seeking help and following through with diagnosis and successful treatment.

For example, many Black Americans think of ADHD behavior not as a mental health concern, but a disciplinary issue. On a deeper level, they tend to have a “survivalist’s” view that mental health care is a crutch, and it’s a sign of weakness to seek it.

The “pray it away” POV. Many racial and ethnic groups have strong religious beliefs, including the Black community. The solid faith of these groups tends to vastly outweigh trust in medicine.

Untreated childhood ADHD. While its own subject, untreated childhood ADHD can cast a long shadow into adulthood. Research shows that it ups the risks down the road for depression, substance use disorder (SUD), and other behavioral health disorders.

Lack of proper treatment for ADHD can extend farther into a person’s general health, quality of life, and family stability.

In order to recognize, diagnose, and treat ADHD across all racial and ethnic backgrounds, researchers have set several goals and practices that can transcend race, beliefs, and cultural systems. Everyone needs access to high quality treatment for ADHD.

  • The health care industry needs to strive for unbiased, careful, and tightly structured screening. This includes proper logging of symptoms to better trace patterns of related conditions and possible outcomes of various treatments.
  • The medical community needs to find ways to approach and bridge cultural differences so people will be more likely to seek and access mental health care. This includes gaining a firm grasp of the social, biological, and psychological differences among BIPOC and working on culturally sensitive approaches to ID and treat ADHD across all populations.

If you’re part of a BIPOC community and want to look into diagnosis and treatment for ADHD, guidance from mental health professionals who also are BIPOC can be the most helpful. A few tips to start with:

  • It’s ideal to have your family’s and friends’ support when seeking any medical treatment. If ADHD is a negative label in your community, don’t let it hold it back. You might stay quiet on the issue for now.
  • Keep in mind that ADHD usually runs in the family. If it’s an issue for you, it likely will be for another family member. If you keep the topic off-limits, you risk the chance of someone else not getting the help they need. It can be a tricky situation, so just do your best and follow your instincts.
  • Find ways to spread knowledge and shut down stigma. If people understand more about ADHD and what’s happening with you, they might be more willing to offer support to you, and others. When opportunities come up, try to help skeptics see mental illness not as something to joke about or brush off, but as a general health problem. It’s an issue with your mind and brain instead of another body part. Because your brain controls behavior, though, it’s key to treat it when something’s not working right. People suffer when they avoid treatment – whether it’s to address behavior or take meds, or both – that can bring relief and offer a higher quality of life.