WASHINGTON – The rate of ADHD among Latino youth is relatively low, but that percentage is misleading, according to an expert in cultural diversity and mental health.
Dr. Andres J. Pumariega, who has worked in this clinical area for 30 years, said a 2010 survey from the Centers for Disease Control and Prevention found that the percentage of Latinos who were diagnosed with ADHD is 5.6%, compared with 9.5% of whites and 10.1% of blacks (MMWR 2010;59:1439-43). ADHD is typically diagnosed through parental report. Dr. Pumariega, chairman of the psychiatry department at Cooper University Hospital in Camden, N.J., suspects that cultural misconceptions might prevent parents from recognizing or acknowledging the illness in their children.
Parents "often believe ADHD is misdiagnosed in Latino children, but they often think that it is being overdiagnosed, and our data from more objective studies actually point to it being underdiagnosed. That’s a big gap," said Dr. Pumariega, who presented the findings at the annual conference of the National Hispanic Medical Association.
Other data support Dr. Pumariega’s contention. For example, the 2010 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey revealed that Latino children were less likely to receive stimulant medication. Results were based on data from 26,000 office- and hospital-based primary care visits. In addition, a longitudinal study of 2,000 caregivers in Puerto Rico showed that only 3.6% of children with ADHD adhered to their medication after a year (J. Am. Acad. Child Adolesc. Psychiatry, 2007;46:5-14).
In a related presentation, Dr. Eugenio M. Rothe cited an article he wrote suggesting that disparities in treatment between Latino youth and their white counterparts might be tied to several factors, including language barriers and a lack of parental understanding (J. Natl. Med. Assoc. 2005;97[suppl. 10]:17S-23).
Dr. Rothe also cited a national survey conducted by Harris Interactive that found that Latinos were less likely to be familiar with ADHD and nearly 10% less likely to know where to get treatment. In addition, Dr. Rothe said, 23% of Latinos vs. 14% of whites thought that ADHD is misdiagnosed in Latino children. The survey was based on online and phone interviews with more than 3,300 parents or caregivers of children aged 6-17 years, said Dr. Rothe, professor of psychiatry and public health at Florida International University, Miami.
Another complicating factor is the acculturation gap between Latino youth and their parents. That gap can generate conflict that can be further aggravated by ADHD, according to Dr. Pumariega. "ADHD can add fuel to the fire in terms of more impulsivity and less adaptive capacity on the part of the youth," he said.
He also suggested that ADHD can contribute to some of the psychosocial problems of Latino youth, including the school dropout rate, the teen pregnancy rate, and substance abuse.
To bridge the gap in diagnosis and treatment of ADHD in Latinos, Dr. Rothe recommended practices aimed at increasing the availability of Spanish-translated ADHD patient education materials, as well as increasing the number of Spanish-speaking physicians, nurses, and health care providers.
The Latino value of strong personal relationships and attachment to family should be factored into care, Dr. Rothe suggested.
"Therefore, clinicians may increase rapport with patients by seeking the opinion of respected family members, decreasing personal space during interactions, using friendly gestures, and displaying a genuine interest in the life of the patient to increase the probability of patient adherence and earn the trust of the patient," Dr. Rothe said.
Dr. Pumariega has chaired the Latino ADHD Advisory Panel for Shire Pharmaceuticals. Dr. Rothe has no relevant disclosures.