Medication Decision Making Among African American Caregivers of Children With ADHD: A Review of the Literature

Abstract

Background: Significant pharmacotherapy disparities exist among children from ethnic minorities with ADHD. Objective: The purpose of this review is to synthesize existing evidence on African American caregiver medication decision making (MDM) for children with ADHD. Method: Databases queried for this review included the Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsychINFO, PubMed, and Education Resources Information Center (ERIC). Information regarding the unique culturally specific barriers and supports to MDM were examined through the relevant literature search. Results: Fourteen articles were included in this review (seven observational studies, four qualitative studies, three mixed methods studies). Three main themes were identified which include (a) fundamental perspectives of ADHD, and cultural norms for child behavior; (b) the impact of fundamental perspectives on MDM in ADHD; and (c) ADHD diagnosis and treatment as forms of social control. Conclusion: Evidence-based recommendations for clinicians are provided, along with direction for future research.

Treatment of US Children With Attention-Deficit/Hyperactivity Disorder in the Adolescent Brain Cognitive Development Study

“…Strong population-based racial and ethnic gradients exist in prescriptions for stimulants and other controlled substances, with the highest rates in majority-White areas . As a result of structural racism, Black parents’ perspectives might further influence ADHD management decisions through mistrust in clinicians and concerns over safety and efficacy of stimulants . Physician efforts to recognize and manage their own implicit biases, together with patient-centered clinical approaches that promote shared decision-making, including open explorations of Black parents’ knowledge, attitudes, and beliefs concerning ADHD and its management, might help reduce these treatment disparities.…”

Disparities in ADHD Diagnosis and Treatment by Race/Ethnicity in Youth Receiving Kentucky Medicaid in 2017

“…15,16 Providers from diverse backgrounds and clinical strategies for providing culturally appropriate services including interpretive language services, are needed to reduce personal, family, and public stigma; and improve uptake of mental health services for ethnic and racial minority families. [15][16][17][18][19][20][21] The literature suggests that families from some racial/ethnic minority groups are more concerned about stigma associated with mental health diagnoses and treatments 17,22 and this serves as a barrier for seeking treatment. 18,23,24 For many Asian cultures, little data are available that address the experience of parental caregivers of children and adolescents with mental health problems.…”

Medication Decision Making in Low-Income Families of Black Children With ADHD: A Mixed Methods Study

“…Regarding attitudinal barriers, ADHD knowledge, exposure, belief in an explanatory model, behavioral attributions and norms, and concern for medication side-effects and efficacy vary significantly between Black and White caregivers of children with ADHD, and contribute to medication treatment decisions (Glasofer et al, 2021). Compounding the impact of these factors is a general hesitancy among Black parents to administer psychiatric medications for behavioral issues.…”

“…Navigating ADHD treatment barriers is complex for any parent, and more so for those experiencing structural inequities. While barriers to medication treatment of ADHD have been described, research to date has not sufficiently explored the processes that Black families navigate when making decisions about medications for their children with ADHD (Glasofer et al, 2021; Olaniyan et al, 2007). Though many factors contribute, family, peer, and social norms play a significant role in decisions to treat pediatric mental health diagnoses; thus, parental decision making is an essential component to explore in addressing ADHD treatment disparities (Glasofer et al, 2021; Rostain et al, 2015).…”