Management of ADHD in Hispanic Patients: Disparities in Cultural Beliefs between Hispanics and Whites
Disparities in Cultural Beliefs between Hispanics and Whites
In addition to the distinguishing features of individual Hispanic subgroups, clinicians who treat Hispanic children with ADHD must consider important cultural differences that distinguish the overall Hispanic population from non-Hispanic white children. A large national survey conducted for McNeil Consumer & Specialty Pharmaceuticals by Harris Interactive online and through telephone interviews sought to explore cultural differences among more than 3,300 parents or caregivers of children from 6-17 years of age. A random selection process with two sampling methods was used to sample respondents. The first sample was generated through random-digit-dialing procedures and was comprised of respondents who completed a survey within the past two years. The second sample was also a random-digit telephone sample but was targeted to exchanges with a high-er-than-average number of minority residents. This ensured inclusion of minority participants who might have been excluded if the survey were limited to Internet users alone. People who chose not to answer >3 questions were not included in the total sample. The survey asked questions about ADHD, including how familiar the caregivers were with the symptoms and treatment of ADHD and how they believed race or ethnicity might have an impact on the diagnosis of ADHD. Approximately 30% of these respondents were Hispanic (1,034), including persons from Latin America, Mexico, Puerto Rico and Cuba.
The majority of Hispanic respondents were female (69%), 30-49 years of age (70%), and had graduated from high school (23%) or completed >1 years of college (66%). The percentage of Hispanics (25%) who reported having an income <$25,000 was more than double that of white respondents (10%), whereas the percentage of Hispanics (16%) who reported an income of $50,000-$74,999 was nearly half that of white respondents (28%). One-third of Hispanic respondents (33%) completed the interview/questionnaire in Spanish.
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Findings from this large survey revealed salient differences between Hispanic and white respondents (Figure 2). Specifically, Hispanics were more likely than white respondents to be “not at all” familiar with ADHD and were more likely to report that they would not know where to seek treatment for ADHD. Hispanics were somewhat more likely than whites (23% vs. 14%, respectively) to believe that ADHD is misdiagnosed in Hispanic children. In addition, 16% of Hispanics and 8% of whites believed that Hispanics were told they had ADHD more often than whites, and 25% of Hispanics and 12% of whites believed that teachers were more likely to blame ADHD for learning and behavioral problems in Hispanics, compared with students from other racial or ethnic backgrounds. Of those with a child who had been diagnosed with ADHD, Hispanic respondents were much more likely to use prescription medication on an as-needed basis. Compared with 5% of white respondents, twice as many Hispanics (10%) were “very concerned” about what others would think if their child were diagnosed with ADHD.
Figure 2. Differences between Hispanic and white parents in practices, knowledge and beliefs about attention-deficit/hyperactivity disorder
Among those with children who received prescription treatment for ADHD, Hispanic respondents were almost twice as likely as white respondents to cite a “significant improvement” in behavior at home. This difference may have been the result of a disproportionate appreciation of improved child behaviors by Hispanic parents; although intolerance of parental disrespect is not limited to one ethnic group, it has been described as especially troubling to Latino parents. Hispanics (59%) were less likely than whites (69%) to feel that parents “use ADHD as an excuse for inappropriate behavior.” One-third of Hispanics (32%) acknowledged that language barriers prevented appropriate treatment of ADHD “a great deal,” compared with 23% of whites. These analyses are limited because no statistical test data were available and potential confounders, such as education and acculturation, were not controlled for in these analyses. levitra professional