Ask Dr. Saline: What Does ADHD Look in Black and Brown Girls?

African-American family in their house Dear Dr. Saline,  Yesterday, I received a phone call from the school counselor about my daughter, age 12. She’s not completing her work in class, often forgets to turn in her homework, can’t recall directions, and spaces out during lessons. When she’s frustrated with an assignment, she loses her temper quickly. She’s been losing friends too. Based on some research, I’ve noticed these behaviors at home, and I think that she is showing “classic” symptoms of ADHD. But, at our last visit with Dr. Picone, he seemed to minimize my concerns about attention issues and talked about depression instead. He wanted to give her Prozac, but I refused. I think she is being underdiagnosed or misunderstood as a young Black girl, but I don’t know exactly what to do. Can you please explain how ADHD looks in Black and Brown girls and what I can do to figure this out? Thank you, Michelle. Sign-up for my newsletter + Free Handout | Ask Dr. Saline  

From Dr. Saline 

Dear Michelle: I’m sorry to hear that you and your daughter are having such a frustrating experience. I’m glad that you waited to give her Prozac without more information. Unfortunately, many physicians, therapists and educators treat BIPOC children and teens differently than they do white kids. BIPOC boys and girls are less likely to be evaluated for ADHD even though they may show the same level of symptoms. Unfortunately, this is often due to implicit bias about Black and Brown people in the United States. We must acknowledge that structural racism affects outcomes. Practitioners have to take the time to investigate and receive training about the nature of our biases and how they could emerge in treatment. Sadly, Black and Brown people in America have been subjected to unfair treatment by health care and mental health practitioners over the years and have been coerced to be subjects in inhumane studies as well (e.g., the Tuskegee Syphilis Experiment). This makes it harder for them to trust a system to help when it’s caused so much harm in the past.

Misdiagnosing ADHD Symptoms

Young black or brown girl being chastisedSo many girls are referred for counseling for anxiety or depression without considering other factors such as attention or learning challenges. This is especially true for Black and Brown girls. They may hide what’s really happening to avoid getting in trouble, being considered stupid, or getting teased. Misdiagnosing or overlooking ADHD symptoms means that your daughter, like other kids with ADHD, is more likely to engage in risky behaviors and substance use and demonstrate serious mood disorders later in life. This is especially true for ADHD in Black and Brown girls. They often come across as older than they actually are. This complicates things for kids with ADHD, who can be up to three years less mature than their peers. Plus, many BIPOC parents think that ADHD is another unwanted label. It may be possible that their students deny their struggles in an effort to comply with this cultural belief.

Client Experience

Recently, the father of one of my clients, a ten-year-old African-American male who was just diagnosed with ADHD and dyslexia, said to me: “Dr. Sharon, I don’t want him to have another label. It’s hard enough growing up Black today. This could just be something else that holds him back.” This is a very valid concern, and I really empathize. However, research shows that kids of all ethnicity with ADHD do better with useful interventions at school combined with family therapy to develop effective strategies at home and, lastly, medication. While pills don’t teach skills and the decision to take medication is personal, it is worth noting that the combination treatment produces the best results. Many families, especially those with limited access to health care, can be misinformed about the effects and benefits of medication. Do some research on well-respected sites such as ADDitudemag.com, Chadd.org, add.org, WebMD.com, Healthline.com, or Understood.com.

“While pills don’t teach skills and the decision to take medication is a personal one, it is worth noting that the combination treatment produces the best results.” ~ Dr. Sharon Saline, Clinical Psychologist

Getting An Accurate Diagnosis

Let’s look beyond your daughter’s symptoms to what else might happen. Almost 64% of kids with ADHD have a co-occurring second diagnosis, often a learning disability, anxiety, or something else. Unfortunately, many educators and providers over-focus on the secondary diagnosis or make character judgments without investigating further, especially for BIPOC kids. Too many adults zoom in on objectionable behaviors without sufficiently considering racial, socioeconomic, and psychological stressors. That’s why getting a valid diagnosis is critical.

Two Ways to Get An Evaluation:

1) Go to the principal or guidance counselor at her school and ask how you initiate a special education evaluation, or go directly to the pupil services office for your school district and initiate the process. 2) Check with your insurance company and your doctor’s office for referrals of people who perform assessments. In my last Ask Dr. Sharon blog, I detailed what to look for in this evaluation, but it should include tests of intellectual capabilities, visual and spatial processing skills, and rating forms that target anxiety, trauma, depression, and executive functioning skills. It’s important for the evaluator to understand that life stressors may worsen executive functioning skills. Remember, schools can’t diagnose ADHD because it is a health condition, but they can say that results point in that direction.

Research

Recently, a new study from the CDC found an alarming increase in sadness and exposure to violence among teen girls. This isYoung woman writing on paper particularly alarming for neurodivergent girls, particularly those of color, who are frequently misperceived by adults as older than they are, may be unfairly targeted as being aggressive, and may already lack self-esteem or confidence. When you add into the mix that inattentive girls are often diagnosed later in life because so many adults miss the signs or ignore them, the risk of missing ADHD in BIPOC girls increases. Instead, there are multiple referrals for anxiety, depression or oppositional behaviors. Then these girls can be excluded from their peers because of missing social cues or spacing out during the conversation at lunch.

In Conclusion

If your daughter receives a diagnosis of ADHD, help her take ownership of it. As a family, seek out research, so all of you fully understand what it means to wrestle with attention issues as a person of color. Learning about how her brain works are critical to accepting her challenges and advocating for her needs. It’s very important for Black and Brown kids to be able to identify what is helpful, what is working, and what they need so they feel empowered as learners and as neurodivergent adults. This will set the stage for self-advocacy throughout their lives. With a thorough evaluation, thoughtful interventions at school and home, and possibly medication, your daughter can thrive and develop into the productive, successful, and confident adult you want her to become. Thank you for your question! Be sure to join my upcoming webinars to learn more.  

Ask Dr. Saline

 

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Perfectionism and ADHD: Making ‘Good Enough’ Work for You

Twitter: Man cutting grass with scissors.

Making ‘Good Enough’ Work for You

In this webinar, I explain how to stop setting unreasonable standards, engaging in negative comparisons to others, and criticizing yourself for living with ADHD. You will learn how to understand and manage the root causes of perfectionism, examine the role of imposter syndrome, decrease negative self-talk, and increase your capacity for personal compassion. You will understand how to improve executive functioning skills related to procrastination and productivity, stop reflexive shame, and create techniques for managing stress. With these resources, you’ll begin to nurture the essential resilience of a growth mindset and accept yourself as you truly are — perfectly imperfect. Read More>>  

The Connection Between ADHD and Imposter Syndrome

Woman doubting herself

Stop doubting yourself and start believing instead.

Many adults (and kids) with ADHD have trouble accepting positive feedback about themselves. Years of hearing about their deficiencies or experiencing challenges related to having a neurodivergent brain lead many folks with ADHD to walk around with a persistent feeling that they are just not good enough. Read More>>  

Moving Past “NO” with The PAUSE Program for Defiant Kids and Teens with ADHD

parents and teen daughter smiling on couchParents of kids and teens with ADHD often seek advice on managing oppositional behavior. What may start with a defiant “NO” can escalate into a tantrum quickly, taking a long time to subside. These explosions likely happen when kids feel both flooded and agitated. Neurodivergent youth put a lot of effort into managing their feelings at school or with friends. When they get home, they don’t feel obligated to hold it together anymore. As Oliver, age 13, said to me: “If I get in trouble at school, I can get kicked out. I’m not going to be kicked out of my family.” And so, parents often take the brunt of these escalations. You can move past “NO” with what I call The PAUSE Program. PAUSE helps parents lower the heat of tense episodes of pushback, anger, and frustration by restoring calm in the home.

How the ADHD brain responds to overwhelm

With working memory and processing speed challenges, kids and teens with ADHD often feel emotionally, cognitively, and/or socially overwhelmed. Biologically, they lack adequate amounts of dopamine and norepinephrine in their brains. This deficiency makes it difficult for people with ADHD to process and recall information efficiently and keep up with all the activities around them. In addition, neurodivergent youngsters frequently struggle to articulate these unconscious cognitive processes. So when kids feel stressed or flooded by emotions, they often act out with resistant or oppositional behaviors to set a limit on the overwhelming input around and inside of them. “NO” simply becomes the default response when tensions rise.

What ‘NO’ Might Mean

little boy thumbs downDon’t be tempted to take ‘NO’ at face value. It could be your child’s way of expressing a wide range of emotions they can’t articulate. A ‘NO’ might respond to what your child or teen may grasp as a demand rather than a request. Before you investigate what ‘NO’ means, reflect on how you ask your child to do something or engage them in a task. Invitations, doing something alongside them (being a body double), and noticing their efforts contribute to better cooperation. Find a quiet moment and ask them about ‘NO,’ keeping an open mind and an open heart. Be curious and gather some information. Is saying ‘NO’ about setting limits, being contrary, slowing things down, or something else? Maybe it’s a combination of things. Brainstorm alternatives to ‘NO’ that include coming up with a few words/phrases to use when they need time to think more.

The PAUSE Program: Plan to Accept, Understand, Set Limits & Encourage

Nobody likes meltdowns, explosions, or arguments, including your child or teen. Instead of being surprised every time your youngster pushes back or refuses something, understand that these behaviors are a natural part of growing up and exploring independence. Expect these incidents to occur, and rely on a steady, calming strategy for when they do.

Plan (Plan ahead with options)    

mother and child crossedlegged on couch meditatingMake a plan ahead of time for coping with the pattern of anger for yourself and your child rather than reacting rashly in the middle of the storm. In a quiet moment, make a list of what you can easily do to stay grounded. If you are dysregulated, you won’t be able to respond effectively or help your youngster calm down. Whether it’s making a cup of tea or opening a window, break up the action in a non-threatening way. This re-centering needs to be your initial reflexive step to slow down the fast-paced action. Once you’ve clarified this for yourself, sit with your child or teen and ask what helps them regroup. What helps them slow things down? What types of activities would soothe their upset? Follow up by asking how much time they need for this. Write down their options, and post the list in their bedroom or the kitchen.

Accept (Nurture and acknowledge) 

Stop trying to convince your child or teen of anything. Instead, accept where you both are in a given moment. Your child stopped listening when they became activated. They also want to be seen and heard by you. Acknowledge what they say with reflective listening: “I heard you say this; is that right?” When they feel that you are paying attention–instead of correcting them for cursing at you or justifying why you called the school about their F in English–they will start to see the support you are offering and be open to settling and dialogue. 

Understand (Practice compassion)

As tough as it can be, empathy is what’s called for when kids–especially neurodivergent kids–are distressed. mother comforting upset teen daughterKids and teens with ADHD often feel overwhelmed. Their thinking brains and weaker executive functioning skills simply cannot manage their heightened emotions. They act out because they lack the resources to do anything different in those moments. Kids need adults to dig deep and find compassion rather than explode about how they should get their act together. Many parents feel desperate to regain authority and establish stability when a child is resistant or oppositional. But while punishments may offer short-term relief, they don’t bring long-term success. Avoid saying things like, “I’m taking away your phone for three days. You can’t talk to me that way.” Instead, turn it around and say, “You have not earned the privilege of using your phone with that language. You’ll get it back when you can go for 3 days without cursing. That’s the agreement we have.” Relying on appropriate incentives is what shifts negativity to cooperation.

Set limits (Clear rules with family meetings to foster collaboration) 

Parenting high fiving childThe goal is to help kids improve executive functioning for self-regulation, interpersonal connections, and achieving goals. It’s a natural part of living to become angry, wants to get your own way and avoid disappointment. However, it’s not okay to act out with aggression. Punishment doesn’t teach any lasting skills, and it rules by fear. Logical consequences, in contrast, allow you to set limits and use meaningful incentives as motivators. The trick is staying steady in the face of your child or teen’s displeasure and following through. For example, in a family meeting, make collaborative agreements about unwelcome actions and words and clarify the consequences of breaking these agreements.

Encourage (Focus on the present and moving forward)   

Once the storm has passed, focus on the present moment. What needs to happen NOW to move beyond its wreckage? This is not a time to teach lessons; the situation is too raw for your child or teen and may trigger another outburst. They need encouragement rather than blame. Talk about the next move to get on with things instead. Later, casually wonder about the takeaways from what happened. Was there anything each of you regretted? How would you like to deal with that behavior in the future? These questions open up the conversation, explore options and validate positive engagement. When tensions rise, and anger escalates, it’s best to pause to regain control of yourself and ensure you won’t do or say things you regret. The PAUSE Program is a practical strategy for de-escalating your child’s defiant outbursts and staying collected throughout the process. The steadier you stay, the faster you’ll be able to diffuse the conflict and reset. And that’s a winning strategy for the whole family.  

Ask Dr. Saline

 

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Become A Member

Please become a member of my newsletter community. You can find support and resources and connect with a group that understands your questions and needs. Click here  Follow me on social media: YouTubeFacebookTwitter, and Instagram. Invite Me to Speak | Join A Group | Newsletter | Read my blog  

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How To Advocate For Your Child During ADHD Evaluations (& Other Learning Challenges)

mom and daughter

3 Ways to Receive an ADHD Diagnosis

Often parents receive contradictory or inadequate information about the process, and navigating the maze toward diagnosis and treatment can be perplexing. In particular, the tween and teen years are development stages when trouble with attention, organization, and distractibility come to the forefront. Read three ways you can receive an accurate diagnosis. Read More>> 

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