Community Perspectives of Childhood Behavioral Problems and ADHD Among African American Parents


      To explore parents’ perceptions of childhood behavior problems and attention-deficit/hyperactivity disorder (ADHD) among a sample of African American (AA) parents.


      Five focus groups were conducted in inner-city Baltimore and the Washington, DC, metropolitan region with 5 to 7 AA parents per group. Adults with children under the age of 17 years were recruited from pediatric practices. One investigator moderated each focus group, and a second took notes. Sessions averaged 1.5 hours long, were recorded on audiotape, and were transcribed verbatim. The narrative data were coded for recurring themes.


      Five major themes emerged from the analysis: causes of behavioral problems in children, the legitimacy of ADHD as a diagnosis, attitudes about doctors, opinions of medication, and perceptions of the school environment. Many participants felt that behavior issues, including those accompanying ADHD, were caused by inappropriate parenting and disciplinary practices. Some viewed the diagnosis as a label applied with racial inequality to exert social control over AAs. Several expressed distrust in physicians who were quick to make a diagnosis of ADHD and recommend medications. Others worried that medication would lead to drug addiction in adulthood. Some perceived that children were labeled with ADHD because of poor educational environments that were unresponsive to the needs of AA children.


      These focus groups identified important community perceptions about ADHD and its medical treatment. Understanding how these perceptions contribute to racial disparities in ADHD diagnosis and treatment can help inform culturally sensitive interventions to improve the management of ADHD among AA children.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Centers for Disease Control and Prevention
        Prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder—United States, 2003.
        MMWR Morb Mortal Wkly Rep. 2005; 54: 842-847
        • MTA Cooperative Group
        A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder.
        Arch General Psychiatry. 1999; 56: 1073-1086
        • LeFever G.B.
        • Dawson K.V.
        • Morrow A.L.
        The extent of drug therapy for attention-deficit–hyperactivity disorder among children in public schools.
        Am J Public Health. 1999; 89: 1359-1364
        • Zito J.M.
        • Safer D.J.
        • dosReis S.
        • Magder L.S.
        • Riddle M.A.
        Methylphenidate patterns among Medicaid youths.
        Psychopharmacol Bull. 1997; 33: 143-147
        • Zito J.M.
        • Safer D.J.
        • dosReis S.
        • Riddle M.A.
        Racial disparity in psychotropic medications prescribed for youths with Medicaid insurance in Maryland.
        J Am Acad Child Adolesc Psychiatry. 1998; 37: 179-184
        • Bussing R.
        • Zima B.T.
        • Perwien A.R.
        • Belin T.R.
        • Widawski M.
        Children in special education programs: attention deficit hyperactivity disorder, use of services, and unmet needs.
        Am J Public Health. 1998; 88: 880-886
        • Hoagwood K.
        • Kelleher K.J.
        • Feil M.
        • Comer D.M.
        Treatment services for children with ADHD: a national perspective.
        J Am Acad Child Adolesc Psychiatry. 2000; 39: 198-206
        • Olfson M.
        • Gameroff M.J.
        • Marcus S.C.
        • Jensen P.S.
        National trends in the treatment of attention deficit hyperactivity disorder.
        Am J Psychiatry. 2003; 160: 1071-1077
        • Kendall J.
        • Hatton D.
        Racism as a source of health disparity in families with children with attention deficit hyperactivity disorder.
        Adv Nurs Sci. 2002; 25: 22-39
        • Guevara J.P.
        • Feudtner C.
        • Romer D.
        • et al.
        Fragmented care for inner-city minority children with attention-deficit/hyperactivity disorder.
        Pediatrics. 2005; 116: e512-e517
        • Bussing R.
        • Zima B.T.
        • Gary F.A.
        • et al.
        Social networks, caregiver strain, and utilization of mental health services among elementary school students at high risk for ADHD.
        J Am Acad Child Adolesc Psychiatry. 2003; 42: 842-850
        • Stevens P.E.
        Focus groups: collecting aggregate-level data to understand community health phenomena.
        Public Health Nurs. 1996; 13: 170-176
        • Morgan D.L.
        Focus Groups as Qualitative Research. 2nd ed. Sage Publications, Thousand Oaks, Calif1997
        • Bogdan R.C.
        • Bilken S.K.
        Qualitative Research for Education: An Introduction to Theory and Methods. Allyn & Bacon, Boston, Mass1992
        • Garcia Coll C.
        • Pachter L.M.
        Ethnic and minority parenting.
        Handbook Parenting. 2002; 4: 1-20
        • Garcia Coll C.
        • Lamberty G.
        • Jenkins R.
        • et al.
        An integrative model for the study of developmental competencies in minority children.
        Child Dev. 1996; 67: 1891-1914
        • Jones C.P.
        “Race,” racism, and the practice of epidemiology.
        Am J Epidemiol. 2001; 154: 299-304
        • Jones C.P.
        Levels of racism: a theoretic framework and a gardener’s tale.
        Am J Public Health. 2000; 90: 1212-1215
        • Cheung F.K.
        • Snowden L.R.
        Community mental health and ethnic minority populations.
        Community Ment Health J. 1990; 26: 277-291
        • Bussing R.
        • Schoenberg N.E.
        • Perwien A.R.
        Knowledge and information about ADHD: evidence of cultural differences among African-American and white parents.
        Soc Sci Med. 1998; 46: 919-928
        • Bradley C.
        Parenting: a community responsibility.
        in: Sanders J.L. Bradley C. Counseling African American Families. American Counseling Association, Alexandria, Va2002: 29-40
        • Schnittker J.
        Misgivings of medicine?.
        J Health Soc Behav. 2003; 44: 506-524
        • Bussing R.
        • Gary F.A.
        • Mills T.L.
        • Garvan C.W.
        Parental explanatory models of ADHD: gender and cultural variations.
        Soc Psychiatry Psychiatr Epidemiol. 2003; 38: 563-575
        • Snowden L.R.
        Barriers to effective mental health services for African Americans.
        Ment Health Services Res. 2001; 3: 181-187
        • Ajrouch K.J.
        • Antonucci T.C.
        • Janevic M.R.
        Social networks among blacks and whites: the interaction between race and age.
        J Gerontol Ser B Psychol Sci Soc Sci. 2001; 56B: S112-S118
        • Mathews J.J.
        The communication process in clinical settings.
        Soc Sci Med. 1983; 17: 1371-1378
        • Cooper-Patrick L.
        • Gallo J.J.
        • Gonzales J.J.
        • et al.
        Race, gender, and partnership in the patient-physician relationship.
        JAMA. 1999; 282: 583-589
        • Wasserman R.C.
        • Inui T.S.
        • Barriatua R.D.
        • Carter W.B.
        • Lippincott P.
        Pediatric clinicians’ support for parents makes a difference: an outcome-based analysis of clinician-parent interaction.
        Pediatrics. 1984; 74: 1047-1053
        • Greenfield S.
        • Kaplan S.
        • Ware Jr, J.E.
        Expanding patient involvement in care: effects on patient outcomes.
        Ann Intern Med. 1985; 102: 520-528