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Cutlural Variations and Symptoms of ADD/ADHD

Submitted by an LD OnLine user on

I read the following statement within the a document on this site referring to the myths and facts of ADD/ADHD:

[quote]Before children are considered to have ADD, they must show symptoms that demonstrate behavior greatly different from what is expected for children of their age and background. They start to show the behaviors characteristic of ADD between ages three and seven, including fidgeting; restlessness; difficulty remaining seated; being easily distracted; difficulty waiting their turn; blurting out answers; difficulty obeying instructions; difficulty paying attention; shifting from one uncompleted activity to another; difficulty playing quietly; talking excessively; interrupting; not listening; often losing things; and not considering the consequences of their actions.[/quote]

Although, the above facts are used to determine if a child exhibits signs of having ADD with hyperactivity I did want to share one concern that stood out for me when reading this. There was no reference to the impact of an adult misinterpreting or misunderstanding cultural variations, or looking at the tchild’s behavior without the lens of what the bicognitive or cultural rules are of the child exhibiting the behavior. For example, in the European American culture which is also the dominant culture fo the Continental U.S turn taking looks similar to “one person having the floor at one time”. Whereas, in the African American culture it could look like, “the most assertive person has the floor”. A child who may be considered to be blurting out the answer could in fact be exhibiting a form of assertiveness in hopes of obtaining the opportunity to be the one to share at that time. Children who learn best through interperssonal connections will find it more difficult to work alone because their best thinking is done when others interact with them. Difficulty obeying instructions would depend on what those instructions are. In the field of education the use of guidance strategies that utilize questions as a form of making requests of children could send a mixed message to a child who is used to direct instruction. For example, asking a child, “I wonder where these scissors go?” in hopes that the child would take the scissors and critically think about where they belong would be one example of a mixed message. They are more likely not going to respond until, “Take these scissors and place them on the shelf” along with the use of a pointing gesture or other form of body language to let the child know where the shelf we are speaking about is located, or something similar is said. Also, the bodily kinesthetic child who does his/her best thinking when they are able to have movement involved could also be misdiagnosed. With this in mind it is important that cultural rules, bicognitive and also bicultural development be taken into consideration when these decisions are made. It is a wonder that children of color (specifically, males) are diagnosed more frequently. It found to happen more frequently with teachers who are of the dominant culture and/or who have more field independent styles of communication and thinking than if the teacher is of the child’s own culture or other group of color who understand the cultural codes of that child and his/her family or who may have a field sensitive bicognitive style.

Warmly, Debi Jenkins
Early Childhood Education
Developmental Psychologist
Bicultural Developmental Specialist

Submitted by Steve on Tue, 02/15/2005 - 7:00 PM

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Thanks for that perspective! I hope all teachers and parents read it very carefully.

Submitted by Anonymous on Tue, 02/15/2005 - 7:07 PM

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The only thing you’ve said that I really disagree with is “For example, in the European American culture which is also the dominant culture fo the Continental U.S turn taking looks similar to “one person having the floor at one time”.”

I’ve spent too much time with Italian-American families, Armenian-American families, one particular Polish/German-American family and my own Scots/Irish-American family to agree that ‘we’ take turns talking. Everybody talks at the same time. The worst of the bunch are married and good friends - she is pure Italian on both sides and he is a mix of PuertoRican/NativeAmerican/Irish and I can’t remember, maybe Spanish. They don’t talk all at once, they yell all at once. :)

I do agree that diagnosis is best left to the professional diagnosticians with extensive clinical experience. Anyway, teachers are not allowed by law to diagnose.

John

P.S. - I had to Google bicognitive for a definition. It only returned 268 items. Learn something new every day.

Submitted by Chris4158 on Fri, 02/25/2005 - 6:00 AM

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as I understand it, to have ADHD/ADD (according to DSM-IV), you must have a certain number of symptoms, yes, BUT, the symptoms have to meet the test for clinically significant impairment in social, occupational, or academic functioning AND must be present in two or more settings. Now, if in my culture, being impulsive was the norm, I would definetely not rate my child on any rating scale as being “impulsive”. If racing around the house like a wind up toy is normal in my culture, I would again not rate this as being a problem. My child, according to me, is normally active. Therefore, using logic, if the behavioral complaints are coming from school or daycare (one-setting) only, unless the little darling is tearing up the exam room for the evaluator, it may be very difficult to make a case for ADHD because symptoms are not exhibited in two settings. I think if you follow the criteria, then the cultural issue takes care of itself.

I’d be interested in knowing the source of the information about black children (boys) being diagnosed more than others. I always thought they were disproportionately under-identified and treated. Let us know.

I think this is a very thought-provoking topic, and I think there should be some sort of culturally specific way to measure behavioral disorders. The same also goes for other psychiatric problems such as anxiety and depression I think.

Submitted by izmebe on Fri, 03/04/2005 - 4:00 AM

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Boys in general are more likely to have ADHD. Children from low income families wether caucasian, black, hispanic, ect. are hugely over represented in the ADHD category as well as the learning disability category in general becuase they are not able to have the same experiences as well as things in general that middle income and high oncome families are able to and are misdiagnosed as having a learning disability due to the lack of experiences.

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