Latinos and ADHD: A look at why Latinos are not getting diagnosed
By Carlos Cruz
It is the middle of December as the fall semester is coming to a close. The sun is setting on the Sunday evening before the beginning of finals week. Through the snow trickling upon their faces, students all across John Carroll University’s campus are flooding every lounge possible in a last attempt to ensure they pass their final exams. In sea of students rushing towards the campus library, one student is walking in the opposite direction, heading for the one place he sees as his campus sanctuary.
He rushes up the stairs in the student center, trying to escape the frigid temperatures, and makes it through the front doors. He stops to check his surroundings and finds that no one is around him. The student continues to walk towards a hidden lounge that only a few other students know about. When he reaches the door, he unlocks the room where he will be spending the next four days studying.
Greeted with absolute silence, he flips the light switch, brightening the space, and a room full of vibrant art and scattered furniture awaits his occupation. He unzips his backpack, places his laptop on the table in preparation to study for his exam the next morning. The student opens his internet browser to begin his studies but, not knowing where to begin, his mind goes blank.
He begins to pace around the lounge, attempting to center his focus. After much pacing, the boy quickly walks out of the room to escape the silent setting that before him. He walks out the doors of the atrium to get some fresh air. He sits on a nearby bench and looks at the ground.
There, a lonely tear rolls down his face as voices cry in his head, “You’re lazy! You’re not cut out for this! You’re smart, but why can’t you apply yourself?”
He goes back inside the lounge and sits back down at his computer, only to find that the majority of the night has passed with no progress made on his studies.
It was then that I knew I had to do something.
Attention-Deficit/Hyperactivity Disorder, otherwise known as ADHD, is a mental condition that impairs a person’s ability to maintain focus in an academic, social or work setting. According to Alyson Gerdes and a team of researchers, in a 2013 article in the Journal of Attention Disorders, ADHD is one of the most common mental health disorders in the United States. Yet, the article estimates fewer than half of all children with a mental health disability receive any sort of professional assistance.
More than 31 percent of Latinos in the U.S. do not speak English well or, in some cases, hardly speak it at all, which can greatly affect an ADHD screening process, note Ricardo Eiraldi and Laurie Mazzuca, in an article published in the journal Behavioral Health Management in 2004. Given that the majority of clinicians are not bilingual, it is a challenge to communicate with Spanish-speaking patients. Eiraldi and Mazzuca suggest that clinicians should seek the assistance of a staff member who speaks the language.
All of this means Latino youth are less likely to get clinical treatment. Three factors are outlined by Gerdes and her colleagues: a lack of knowledge amongst Latino parents, the need for cultural familiarization in clinical practices, and a shortage of bilingual mental health providers.
Sofi Mira, a chemistry major at Case Western Reserve University, describes the ADHD diagnosis process as “long, annoying and expensive. The results were really helpful and informative but the whole thing took almost three months to complete because I felt the [psychiatry] office did not prioritize scheduling me.”
Even when the assessment is done and they know what’s the matter, for Latino youth in the U.S., it can be a daunting challenge just to take advantage of an opportunity to get help.
“Latino parents have been found to be less likely to seek out professional help for their children and when they do, they are more likely to prematurely drop out of treatment,” writes Gerdes and another team of researchers, in a 2014 study published in the journal of Administration and Policy in Mental Health.
Keeping Latino children in treatment until it can be successful is a challenge that several researchers have noted. In a 2009 study published in the journal of Clinical Case Studies, Gerdes and Brian Schneider found that clinicians have struggled to engage with Latinos descending from Spanish-speaking families. They say that treatment for ADHD can be effective for ethnic minority families, but only if they remain in treatment.
Eiraldi and Mazzuca say something as simple as referring to parents as señor or señora can begin to close cultural gaps between a Latino family and a psychiatrist attempting to treat their child. They emphasize these most of these needs can be met by involving parents in decisions regarding their child’s path of treatment.
Even the task of looking for help for mental health problems does not begin, the Gerdes team writes, until a significant problem that cannot go away on its own is identified by the child’s parent. In some instances, perception of a problem can be clouded for Latino parents, like many others, because they don’t want to accept it.
Latina student Jessi Hargett, an integrated marketing communication major at John Carroll University, shared that her parents originally denied her ADHD diagnosis.
“At first, my parents denied I was depressed or had ADHD. They claimed I was just stressed from school and encouraged me to power though it,” Hargett stated. “However, as I got older, my parents began to see how it was all affecting me and it wasn’t something I was just making up.”
It was not until her college years that Hargett’s parents accepted her condition. “Now my mom is supportive and understands that sometimes I have ADHD. It’s not my fault sometimes that my mind wanders. My dad just continues to act like nothing’s wrong.”
However, not all Latinos diagnosed with ADHD have families who struggle to accept the disorder. Jon Gonzalez, a political science student at John Carroll University, says, “I was in 8th Grade when I was diagnosed. I remember my parents being very worried that I could never really pay attention in class. I was very fidgety and I would be very forgetful of the smallest tasks, so they decided to get me tested. They took the diagnosis well because it explained why I couldn’t concentrate. We were glad to have an answer.”
Both a lack of knowledge about ADHD within Latino families and a need for culturally appropriate mental health practices in the mental health industry consistently create obstacles for Latino youth seeking treatment. There is yet another problem: a lack of clinical research with Latino families. Gerdes and colleagues claim, in the 2014 article mentioned above, that these factors are contributing to the discrepancy between the need for mental health services and actual utilization of those services among the families of Latino youth.
The impact of cultural values on what researchers call “help-seeking behavior” is an important part of the problem for Latino youth and their families.
“Although not all Latinos share the same cultural values and/or degree of acculturation, most Latinos share cultural values that have been found to affect help-seeking behavior and rate of treatment use,” Eiraldi and Mazzuca wrote in the 2004 article mentioned above. Two of the most important values are personalismo (degree of personal goodness) and familismo (strength of attachment with family members) which Latinos share when identifying with themselves and their families.
“In a patient-doctor encounter, many Latinos present as very friendly and affectionate,” Eiraldi and Mazzuca write. “If the clinician does not reciprocate, the patient might take this as a sign that the clinician doesn’t care.”
“Growing up in Miami you see a lot about what Latino kids go through,” said Sean Chaplin, race and ethnic studies professor at John Carroll University. “I remember having a friend, while I was growing up, who had ADHD. He told me that his parents used to get mad at him when he tried to convince them. But because he valued his relationship with his family so much, he decided to deal with it on his own.”
Many obstacles are presented to a Latino to overcome when seeking treatment for ADHD. These issues are not separate or unique from one another and are very interrelated, making it more difficult for most clinicians in the U.S. to properly treat Latino patients within the family’s cultural barriers.
If mental health institutions were able to gather more data to understand behavior patterns of marginalized Latino communities, Latinos living in the U.S. would have a better chance of receiving culturally appropriate treatment for ADHD from mental health professionals and ultimately, manage their children’s cognitive inabilities.
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