ADHD rates low among Latinos
Findings baffle health researchers
Johanny Hernandez is alone among her Latino relatives and friends to have a child diagnosed with attention-deficit hyperactivity disorder.
Growing up in the Dominican Republic, the 30-year-old mother of four had never heard of this condition - until her son’s kindergarten teacher suggested that he be evaluated. The boy struggled to comply with school rules, sometimes racing out of the classroom and climbing on tabletops.
Many of her friends seemed skeptical about ADHD, insisting that her son was just very active, sometimes mischievous, but not “loco,’’ the Spanish word for crazy. She had to agree that her son, 9, would probably never have this diagnosis in her native country. Still, her son’s classroom behavior has improved since he started therapy and taking ADHD medication, and Hernandez tries to block out what she hears from others.
Among Latinos, said the Mattapan mother, “there’s an unfair prejudice against the illness.’’
Hernandez’s experience may offer some insight into a statistic that has stumped public health researchers: Latino children in the United States are diagnosed with ADHD at roughly half the rate of non-Latino black and white children. Even among Latino children diagnosed with this neurobehavioral condition, Latino youngsters are medicated at a significantly lower rate.
Statistics released this year by the US Centers for Disease Control and Prevention found that roughly 3.9 percent of Latino children over the past decade were reported by their parents to have been diagnosed with ADHD, compared with 7.8 percent among white children and 6.3 percent among black children. Another major federal study, analyzing the most current data, from 2007, found a typical American child has a 9.5 percent chance of ever being diagnosed with ADHD, but the rate for Latino children was 5.6 percent.
The strikingly low ADHD rates for Latino youth add to a longstanding controversy over this common behavioral disorder, identified through marked impulsivity and inattention. Some clinicians see uneven diagnosis patterns as reflecting the broad subjectivity of this condition, which they say is overdiagnosed in some groups, particularly boys. Others, however, say it is a disorder with a biological basis that is generally accurately diagnosed. They speculate that low Latino rates may reflect some genetic advantage, or that they either choose against - or cannot afford - medical care for these behaviors.
“I’m not sure what to conclude from the different rates for Hispanic and non-Hispanic children,’’ said Susanna Visser, a lead epidemiologist for the CDC and coauthor of the two major studies this year on ADHD. “But it suggests we have much more to learn.’’
There are recent signs the diagnosis gap may be gradually narrowing, and some clinicians who serve Latino families say they are ambivalent about seeing the community’s rates climb to the national average. While they believe the low ADHD rates among Latino children are largely due to little awareness of the disorder in their communities, or lack of health insurance, they worry that ADHD is too often misapplied to disruptive children whose underlying problem is something else - such as trauma or family problems.
“Too often ADHD is a catch-all term for a bunch of problems,’’ said Dr. Jose Hidalgo, a psychiatrist and medical director of the Latin American Health Institute in Boston.
Hidalgo also said that the group’s rates may reflect a cultural tendency among Latinos to accept a wide range of behavior in young children, in part because of the way extended families often coexist.
“When you have large groups of people together, they are used to closer personal space and have more tolerance for higher levels of activity,’’ he said.
John Ribeiro, a retired probation officer and board member of a nonprofit mental health agency that serves many Latino families, said many low-income Latino children have trouble getting treatment for a range of conditions, have little access to Spanish-speaking providers, and come from families