Black Boys and ADHD: Biology or Culture Clash?

African-American children are quickly catching up to white children in the rate of diagnoses for attention deficit/hyperactivity disorder.

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American Promise
Idris Brewster, left, and Oluwaseun Summers in the documentary film American Promise

Michele Stephenson

A black Brooklyn couple sit in their car waiting to hear what New York City’s elite Dalton School has to say about their son now. The dad wonders: “The question is, what is it about Idris that makes him disruptive?”

They take turns reading the school’s latest communiqué: “Talks out of turn continuously ... impulse control. Has trouble respecting other students’ physical boundaries. [Needs to] focus on not distracting others."

The boy’s mother, Michèle Stephenson, an Ivy League-trained attorney, rolls her eyes. Her husband, Dr. Joe Brewster, an Ivy League-trained psychiatrist, sighs. “They have decided our son is a problem,” Brewster says. “He’s not a problem at home. He’s not a problem in the community. He’s a problem at Dalton.”

As we learn in the couple’s documentary film American Promise, which aired Monday on PBS and is available for streaming online starting today, the school suggested that the boy might have attention deficit/hyperactivity disorder. When Idris was 4, the couple had him independently evaluated. They accepted the diagnosis but resisted prescription-drug treatment—at first. Later in the film, which follows their son and his best friend from kindergarten though high school graduation, Idris pleads with his parents to reconsider. His grades were mediocre. It might help, he reasoned.

When I saw this scene, my heart dropped—nearly as much as it did when young Idris said that he would be better off at his school if he were white.  

I will admit to being one of those slightly paranoid black people who suspect that big pharma is trying to put us back in chains. But researchers have similar fears for a generation of kids of all races. In the recent New York Times investigation “The Selling of Attention Deficit Disorder,” prominent researchers called the marketing-driven explosion in diagnoses (600,000 in 1990 to 3.5 million today) a “national disaster of dangerous proportions.”

Black children are still diagnosed and medicated less frequently than white children, but they are catching up fast. Between 2001 and 2010, there was a 70 percent increase in diagnoses among black boys and girls ages 5 to 11, according to a Kaiser Permanente study released last year.

The increase in the number of diagnoses is positive in the sense that the stigma around having this and other neurological and mental disorders is melting away, and children are getting the help they need. But I fear that slick marketing (Maroon 5’s Adam Levine is the face of one ADHD campaign) and the academic pressure cooker is turning ADHD meds into performance-enhancing drugs for the classroom.

Some doctors admit to prescribing Adderall and other ADHD drugs to low-income kids, not because they have a disorder but just to help them do better in school. “We might not know the long-term effects, but we do know the short-term costs of school failure, which are real,” a pediatrician told the New York Times. 

In some ways the disorder is becoming another way to keep up with the Joneses. In upper-middle-class communities, parents trade intelligence on compliant psychiatrists right along with good tutors. A white friend once advised me to get the diagnosis before my son reached seventh grade.