Development & Aid, Education, Headlines

UNITED STATES: Black Children Often Mislabelled as Hyperactive

Katherine Stapp

NEW YORK, Apr 25 2000 (IPS) - African American children, especially boys, are at increased risk for being diagnosed with a hyperactivity disorder and placed in special education, but lack the same access to treatment as their white counterparts.

Behavioural disorders in children, and how they are treated, have come under increased scrutiny since it was revealed in February that the number of American children taking psychotropic drugs to control hyperactivity has skyrocketed in the nineties.

The National Medical Association (NMA), a group of some 20,000 African American doctors, says hyperactivity disorders are being over-diagnosed in the black community, aggravating the concentration of minority children in special education classes.

Attention Deficit Hyperactivity Disorder (ADHD) is not new, but it is a rapidly growing phenomenon, according to doctors, teachers and researchers, and currently affects some 3.5 million American children.

By far the most popular drug to treat ADHD is methylphenidate, or Ritalin, whose use by children has spiked accordingly. Although Ritalin is a stimulant, it has a reverse effect on most hyperactive people, calming them and helping them to focus.

The exact causes of ADHD are still unknown, but its symptoms include extreme restlessness, an inability to concentrate and hyperactivity. While this kind of behaviour is hardly unusual in children, taken to the extreme, it can land a child in special education classes, where he is often stigmatised as disabled, “dumb” or “unmanageable”.

“To our concern, black children are heavily over-represented in most systems as being at risk,” says Rhonda Carlos Smith of the Washington DC-based Black Child Development Institute.

“Overcrowding creates a situation where teachers have a need to be in control much more and are not able to meet children’s individual needs,” she explains. “We have found that black children were disproportionately referred to early intervention programmes because of speech and language delays. That raised some red flags for us.”

Dr Janice Hutchinson, a child psychiatrist at the Psychiatric Institute of Washington, emphasised that “all identified as hyperactivity is not ADHD.” Depression, stress or abuse, for example, will often manifest as inattentiveness, she says.

“It’s clear to me as a black female that there’s a lot of fear about black males,” Dr Hutchinson says. “It does them a great, great disservice.”

There is both a gender gap and a race gap in American schools. According to federal statistics, more than two-thirds of all special education students are male. And although African Americans make up about 12 percent of the US population, they comprise 28 percent of special education students.

The 1998 annual report of the federal Office of Special Education Programs noted that between 1980 and 1990, black children were placed in special education at more than twice the rate of whites. Hispanics fared even worse, with a 53 percent increase — compared to six percent for whites.

“It’s kind of horrifying,” says Kathleen Boundy, an attorney and co-director of the Center for Law and Education in Boston. “For a long time, there has been a fear (in the black community) that Special Ed would become a dumping ground. There are issues of race and poverty interfacing.”

Sharman Dennis, a member of the NMA and a former special education teacher in Washington DC, agrees. “There are a large number of children in special education programmes that may not need to be there,” she says. “One problem is that they’re not looking at the whole of the child. If you haven’t had anything to eat since yesterday at lunchtime, you won’t be able to focus.”

Sheila Zukowsky, who evaluates 50 to 60 children a year for special education services in New York City — most of them black or Hispanic — stressed that “the biggest predictor of success in school is socio-economic status, and a lot of black kids are from a lower socio-economic class.”

“It’s not rocket science,” she says. “There are a lot of assumptions made about black kids. The same behaviour in white kids wouldn’t be interpreted the same way. Some teachers have a very low tolerance, so it’s easier to refer.”

“Special Ed classes are awful,” Zukowsky says candidly. “Thousands of kids labelled learning disabled really aren’t, they just don’t have a good learning experience. In 99 percent of the cases, I don’t think there’s anything wrong with them … and a drug is completely the wrong track to deal with it.”

There has been a public backlash against Ritalin since the Journal of the American Medical Association reported in February that the number of young children taking stimulants like Ritalin had more than doubled in the early 1990s.

Most doctors and educators advise against dismissing drugs out of hand, and note that while there may be overmedication occurring, Ritalin is still one of the most effective treatments for ADHD.

But sadly, minority children are also at a disadvantage in terms of access to drugs like Ritalin.

Although the racial dimensions of the problem have not been adequately studied, they can be inferred from data on access to mental health care.

A recent review of two national studies on the treatment of children with ADHD concluded that “minority youths, primarily African American, are less than half as likely to have been prescribed psychotropic medications as white youths.”

The review, published in February in the ‘Journal of the American Academy of Child and Adolescent Psychiatry’, found that an identical disparity existed even among patients with access to free health care through Medicaid.

And again, boys were two to three times as likely as girls to be diagnosed with ADHD and given Ritalin.

“In my clinical experience, the most common presentation is a single mother with a hyperactive boy,” says Dr Paul Organ, an Arizona-based specialist in adolescent psychiatry. “The school system tends to push these children into special education.”

The problem clearly goes deeper than mere socio-economic status, according to Dr Beth Hahn of the Agency for Health Care Policy and Research. Hahn found that black and hispanic children were less likely to be prescribed medication than whites even after income, diagnosis and number of doctor visits were factored out.

The National Institute of Mental Health (NIMH), which just launched a 5-million-dollar study into psychotropic drug use among children, concedes that “there are significant differences in access to mental health services between children of different racial groups.”

Experts from a variety of disciplines who were interviewed said solving the problems surrounding hyperactivity in minority children will require a collaborative effort by teachers, health care providers, parents and children.

Most stressed non-medical interventions, like better training for administrators and teachers, smaller class size and more help for parents.

“Learning to read at an early age is the single most effective intervention for ADHD,” Dr Organ says. While he welcomed the NIMH study into ADHD, he expressed concern that one component of the research was seeking an “ADHD gene”.

“It is primarily an environmental problem,” Dr Organ says. “I am very, very concerned about a genetic basis for ADHD when it is such a subjective diagnosis. I fear that if we don’t fight that trend, we are setting up future generations of black children to be labelled and diagnosed.”

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