Between cultural incompetence and reimbursement requirements from insurance companies, I don’t know which is more responsible for misdiagnosing more minority children–particularly black boys.
ADHD is probably the most diagnosed mental illness amongst mental health agencies. In my work as a therapist, nearly every black child I’ve treated had a diagnosis of ADHD on their record. Some of which truly exhibited signs of the disorder–and others not so much.
What is ADHD
Before I get into why I believe many kids are misdiagnosed with ADHD, I want to give a brief explanation of what ADHD is from a clinical perspective.
Attention Deficit and Hyperactivity Disorder, more commonly known as ADHD is a brain disorder that affects a person’s attentiveness, ability to sit still, as well as their self-control. The symptoms of ADHD are most evident in school and work settings.
ADHD Looks different in different people, as there are three main types of ADHD. ADHD can be primarily inattentive, hyperactive, or a combination of inattentiveness and hyperactivity.
Inattentive symptoms tend to look like laziness or clumsiness to an untrained eye (people who aren’t educated on ADHD symptoms). Often kids with this type of ADHD have difficulty following detailed instructions. Those with inattentive ADHD tend to make a lot of careless mistakes in work and school settings, like forgetting important details or losing items such as keys, wallets, or other valuable things that other kids can typically keep track of.
Then you have individuals who are the hyperactive type. These people usually have a seemingly endless supply of energy. Hyperactive ADHD children also tend to struggle in school settings, as they are often viewed as troublesome students due to their inability to be quiet or sit still for long periods of time. Many teachers and parents are ill-equipped to deal with this type of mental illness. So they usually employ unhelpful, and sometimes harmful strategies to manage their child’s behavior, like harsh punishments and unfair criticism.
Lastly, you have the combined type of ADHD which is a little bit (or a lot) of both. This is when a child experiences both of the above-mentioned types of ADHD. Sometimes, a child may experience one type more than the other but, overall, both types of ADHD are present.
Why Your Child Probably Doesn’t Have ADHD.
Often the symptoms people believe are ADHD are actually other issues. For instance, one of ADHD’s most distinctive symptoms is inattentiveness. But a lack of concentration is also a lesser-known sign of depression.
Hyperactivity, perhaps ADHD’s most recognized symptom could be a variety of other issues, too. Mania, which is a symptom commonly associated with bipolar disorder, involves abnormally high-levels of energy, which to an untrained eye, could resemble ADHD.
And sometimes, the problems a child experiences in school may be due to a learning disability; people often confuse the two. ADHD is when a child has problems with attention or hyperactivity, but can still be extremely adept at learning (i.e., grasping and retaining information). Whereas, a child with a learning disability has specific problems which prevent them from understanding (or learning) things in the way most people do.
ADHD is a brain disorder that mainly affects behavior, which makes it harder to learn, but is not necessarily a “learning disability,” as some kids with ADHD are exceptional learners, and have no issues in school or any other setting. A person with a learning disability, however, such as dyslexia may have trouble reading; or they may have dyscalculia, which affects an individual’s ability to understand numbers and math facts.
Make no mistake, people can have ADHD and the other disorders I’ve mentioned concurrently. But, as parents, it is in our best interest to rule out the other disorders out before accepting an ADHD diagnosis.
Cultural Ignorance is a Big Reason Your Child Probably Doesn’t Have ADHD.
Mistaken cultural nuance is one of the most prevalent barriers to adequate mental health treatment. Therapists who are of different cultures than their clients often misunderstand certain behaviors that their clients present. For example, a caucasian therapist may mistakenly interpret an African-American child’s over-top-clownlike personality as hyperactive ADHD, when in fact he or she is seeking attention from his or her peers. Any therapist of any color can misinterpret their client’s culture, as culture is not exclusive to race, but I’d be lying if I said that this phenomenon isn’t especially problematic amongst minority children.
Insurance Companies Can Be Problematic Too.
One of the most troublesome aspects of the mental health field is that many insurance companies require practitioners to give patients a diagnosis in order to be reimbursed for the services they provide. In other words, insurance companies require mental health providers to assign diagnoses to insurees to ensure their treatment is medically necessary for the company to cover the expenses of therapy; or else any Tom, Dick, or Harry could get therapy without actually having anything wrong with them and have insurance pay for it.
To me and you, that might not seem like a big deal, but to an insurance company, whose objective is to maximize profits by paying out as little as possible, it is essential to provide reimbursement only to those who truly need it.
The above-mentioned dilemma between mental health practitioners and insurance companies usually happens when clients don’t fit squarely into the diagnostic criteria for ADHD, and practitioners have to assign a diagnosis to a client just to get paid by the insurance company. This kind of situation is problematic for both therapists and their clients.
Many kids who don’t have ADHD get diagnosed with the disorder simply because their therapist can’t justifiably diagnose them with another disorder; sometimes, this may be because the therapist doesn’t have enough information at the time of the evaluation to make an accurate diagnosis, as insurance companies tend to expect diagnoses to be made in a timely manner.
And in some instances, a therapist may give the chid a revisional (temporary) diagnosis of ADHD until they can better understand the child’s issues. But as high client dropout rates are a pervasive issue in the mental health field, many clients don’t stay in treatment long enough to receive an updated diagnosis–which again, underscores the problematic nature of insurance reimbursement requirements concerning ADHD.
ADHD is, in many cases, a “filler” or “best-guess” diagnosis, which tends to impede a child’s progress to recovery from their actual disorder, if it isn’t, indeed, ADHD.
The Final Verdict.
This article is not to insinuate that insurance companies are not useful or are harmful to children with ADHD. After all, if it weren’t for insurance companies, many people would not be able to afford treatment at all. And it is certainly not my intention to suggest that all therapists are somehow incompetent when it comes to diagnosing ADHD because I am a therapist, who has competently diagnosed children with the disorder throughout my career.
At the end of the day, I am not here to tell you that your child doesn’t have ADHD, because there may be a possibility he or she does. The goal of this article is to inform parents that the diagnosis of ADHD is often incorrect and it’s in your (or your child’s) best interest to do your due diligence to determine if your child actually has ADHD.