Photo courtesy of Rahn Bailey, M.D.
Rahn Bailey, M.D.: "At the same time that we are developing new
strategies to treat brain illnesses, we are also struggling with propaganda,
stigma, and discrimination regarding diagnosis and treatment."
African-American children are especially vulnerable to antipsychiatry
messages condemning treatment for attention-deficit/hyperactivity disorder
(ADHD), experts say, which keeps many from needed treatment.
As a result, some of these untreated children end up in the criminal
justice system and special education settings, where behavioral problems are
less likely to be addressed.
"At the same time that we are developing new strategies to treat
brain illnesses, we are also struggling with propaganda, stigma, and
discrimination regarding diagnosis and treatment," Rahn Bailey, M.D.,
told Psychiatric News. "That burden is shouldered
disproportionately by African Americans."
Bailey, who is chair of the National Medical Association's section on
psychiatry and the behavioral sciences and medical director of Bailey
Psychiatric Associates in Houston, hosted a conference call on ADHD in
African-American communities set up through the National Alliance on Mental
Illness (NAMI) Multicultural Action Center on ADHD in April.
During the call, he noted that many African Americans may be reluctant to
seek psychiatric treatment in general because it is sometimes perceived as
being "contrary to spiritual beliefs" and because family members
and friends may view psychiatric treatment as a "personal
Antipsychiatry groups compound stigmatizing attitudes by flooding these
communities with literature claiming that "Ritalin kills" and"
psychiatry created racism," according to psychiatrist Carl Bell,
M.D., director of the Community Mental Health Council in Chicago.
Even mental health professionals working in African-American communities
are targeted with "slick, 30-page monographs," he said, with
messages warning of the dangers of psychiatric medications.
Bell and his staff carefully evaluate children for ADHD and do not rush to
put them on medications, he said.
Typically, he noted, they may first try family therapy and work with school
personnel to correct behavior problems in children, but "when that
doesn't work, we suggest Ritalin if the child has been diagnosed with
Bell said he feels as if he is fighting an uphill battle.
"Parents tell me that putting their kids on Ritalin is a genocidal
plot," Bell said.
One misconception held by many African Americans, according to Bell and
Bailey, is that ADHD is overdiagnosed in African-American children and that
many are placed on psychostimulants unnecessarily.
Bailey emphasized that psychiatrists can be effective in countering false
or negative antipsychiatry messages with scientific data, which show that
African Americans do not receive adequate treatment for ADHD compared with
For instance, according to Regina Bussing, M.D., in a random sample of
1,615 elementary school students in Florida, a study found that Caucasian
children with elevated scores on an ADHD rating scale were more than twice as
likely as their African-American peers to receive an evaluation for a
behavioral problem, be diagnosed with ADHD, or be under treatment for
The study appeared in the April/June 2003 Journal of Behavioral Health
Services and Research.
Bussing is a professor and training director in the Department of Child and
Adolescent Psychiatry at the University of Florida.
In an earlier study, Bussing found that among the parents of children at
high risk for ADHD, fewer African-American parents than white parents had
heard of the disorder (69 percent vs. 95 percent, respectively).
In addition, only 17.5 percent of African-American parents reported having
received information about ADHD from their physicians, compared with 29
percent of white parents.
A study by Julie Zito, Ph.D., examining 1991 Medicaid data in Maryland
found that among 100 enrollees, African-American youth aged 5 through 14 with
Medicaid insurance were less likely to have been prescribed psychotropic
medications than Caucasian youths with Medicaid insurance (39 percent to 52
Regarding stimulants, African-American children were prescribed
psychostimulants at a ratio of 1:2.5 when compared with the prescription rates
for Caucasian children, Zito found.
The study appeared in the February 1998 Journal of the American Academy
of Child and Adolescent Psychiatry.
According to Bailey, one of the consequences of this disparity in ADHD
treatment for African-American children is that they are often dealt with in
inappropriate ways. "Per capita, there are about twice as many
African-American children in some form of remedial education" as white
youth, he noted, and African-American children are overrepresented in criminal
"It is our job to educate people," he continued."
Treatment is available, and it works." ▪