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Black
Children Often Mislabelled as Hyperactive in the United States
By Katherine Stapp
Inter Press Service
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NEW YORK, Apr 25 (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. |
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Behavioral
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.
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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.
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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.
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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.
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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 stigmatized as disabled, ''dumb''
or ''unmanageable''.
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''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.
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''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.''
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Dr
Janice Hutchinson, a child psychiatrist at the Psychiatric
Institute of Washington, emphasized that ''all identified
as hyperactivity is not ADHD.'' Depression, stress or abuse,
for example, will often manifest as inattentiveness, she says.
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''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.''
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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.
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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.
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''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.''
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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.''
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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.''
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''It's
not rocket science,'' she says. ''There are a lot of assumptions
made about black kids. The same behavior in white kids wouldn't
be interpreted the same way. Some teachers have a very low
tolerance, so it's easier to refer.''
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''Special
Ed classes are awful,'' Zukowsky says candidly. ''Thousands
of kids labeled 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.''
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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.
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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.
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But sadly, minority children are also at a disadvantage in
terms of access to drugs like Ritalin.
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Although the racial dimensions of the problem have not been
adequately studied, they can be inferred from data on access
to mental health care.
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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.''
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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. |
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And
again, boys were two to three times as likely as girls to be
diagnosed with ADHD and given Ritalin. |
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''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.''
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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. |
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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.'' |
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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. |
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Most stressed non-medical interventions, like better training
for administrators and teachers, smaller class size and more
help for parents. |
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''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''. |
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'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 labeled and diagnosed.'' |
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This article
is free of copyright restrictions and can be reproduced provided
that Inter Press Service is credited.
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