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As a Black male completing his undergraduate studies, Dr. Charles Barrett, now the lead school psychologist at Loudon County Virginia Public Schools, was curious about what he was hearing anecdotally related to the higher than expected Attention Deficit Hyperactivity Disorder (ADHD) symptom ratings for Black males and subsequent possible placement in special education. 

Upon meeting Dr. George DuPaul, professor of school psychology at Lehigh University, he learned that his interest was actually in the assessment practices that contribute to diagnostic outcomes. 

“In other words, how are children diagnosed with ADHD?” Dr. Barrett explained to us. “And, is there something about the assessment process that needs to be examined that could help us to understand the higher than expected parent and teacher ratings of ADHD symptoms received by Black male children?”

ADHD is the most common childhood neurodevelopmental disorder affecting 6.4 million children in the United States between the ages of four and 17. Symptoms first typically appear between the ages of three and six. The most common age at which a child is diagnosed is seven years.

Studies have shown rates of ADHD to be higher among Black children, especially boys. A new study published in the Journal of Attention Disorders titled, Impact of Maternal and Child Race on Maternal Ratings of ADHD Symptoms in Black and White Boys, authored by Dr. Barrett and Dr. DuPaul, looked at why this may be the case.

“First, we wanted to examine the extent to which parent rater characteristics (race/ethnicity, socioeconomic status {SES}, and acculturation status) influenced subsequent ratings of children’s behavior,” Dr. Barrett and Dr. DuPaul told us. “Specifically, we wanted to compare how Black and White mothers/maternal figures rated Black and White boys who were displaying sub-clinical levels of ADHD.”

Most of the research on the topic of ADHD and assessments up to this point has only included Hispanic and White children with Hispanic and White informants. Dr. Barrett and Dr. DuPaul wanted to address the ‘key gaps’ in the existing literature by including Black and White boys and mothers.

“Based on the variables that were included in our analyses—rater race/ethnicity, SES, and acculturation for the Black participants—we were hoping to determine if any of these factors contributed to differences in behavior ratings of Black and White boys,” Dr. DuPaul and Dr. Barrett told us.  “In other words, if there were differences between Black and White mothers’ ratings, would these remain after accounting for the effects of SES and/or acculturation?”

A previous study using Hispanic and White teachers rating Hispanic and White boys (Dominguez de Ramirez & Shapiro, 2005) showed that group differences between Hispanic and White teachers’ ratings were better accounted for by the acculturation level of the Hispanic teachers.

As previous research often showed that Black children received higher ratings than their White counterparts for a variety of externalizing behavior conditions, Dr. DuPaul and Dr. Barrett hypothesized that the current study’s results would be similar.  

“This study’s research design was quite simple,” Dr. Barrett and Dr. DuPaul told us. “After producing two videos (one of a Black boy and the other of a White boy) displaying identical behaviors that were suggestive of ADHD, we recruited approximately 130 Black and White mothers/maternal figures randomly assigned to watch either video.”

The way the video viewing occurred is that a Black mother would watch a Black child, a Black mother would watch a White child, a White mother would watch a Black child, or a White mother would watch a White child. 

“Essentially, if the behaviors on the video were the same, the subsequent ratings should be the same,” Dr. Barrett and Dr. DuPaul explained to us. “If not, it is worth considering the degree to which the raters themselves bring something to the assessment process that influences how they perceive and rate children’s behavior.”

Although the researchers collected data on all participants’ SES and the Black mothers/maternal figures’ acculturation level, maternal race was the only significant factor that predicted behavior ratings. Specifically, Black mothers’ ratings were higher than White mothers’ for both the Black and White child.

Dr. DuPaul and Dr. Barrett were somewhat surprised with the results.

“Although Black children have often been rated as showing more ADHD behaviors compared to White children, most of these studies included participants who were from a different racial background (e.g., White),” explained Dr. DuPaul and Dr. Barrett. “Therefore, were those results a function of the Black children’s behavior or the cultural mismatch between the child and the rater?” 

Because the current study’s design allowed for matching the race of the rater and child, Dr. DuPaul and Dr. Barrett found that these outcomes remained when a Black mother rated a Black child. 

“Next, although we were surprised that SES and acculturation level did not provide any additional explanatory evidence for the results, study limitations may be the reason,” Dr. DuPaul and Dr. Barrett told us. “In other words, because both Black and White participants were generally middle class, the sample did not have enough variability to measure the effect of low, middle, and high SES on subsequent ratings.  Similarly, most of the Black individuals fell within the same range of acculturation, which did not allow us to analyze the impact of different levels of acculturation on behavior ratings.  These limitations are certainly opportunities for future research.”

Dr. DuPaul and Dr. Barrett hope that their study sheds light on the importance of clinicians critically examining the manner in which they approach assessing and diagnosing children for a variety of conditions. Although behavior rating scales are a necessary and helpful aspect of the assessment process, before viewing data from these instruments as the absolute truth about children, evaluators should corroborate rating scale data with other sources of information (e.g., naturalistic observations, parent and teacher interviews).

“Very importantly, although Black mothers rated Black and White boys as displaying behaviors that are associated with ADHD, it is premature to conclude that they also viewed the boys as having a diagnosable condition,” Dr. DuPaul and Dr. Barrett explained. “Additional qualitative information is needed to better understand what these ratings actually mean. Were Black mothers’ ratings higher but not necessarily indicative of disordered functioning (e.g., a diagnosable condition)? Were their ratings higher but merely representative of the level of behavior that the children were displaying?”