Prevent inappropriate ADHD referrals for students of color

Learn four actions to take to avoid having Black students unnecessarily being labeled with ADHD or another disability when they return to school.

Teachers may be stressed about returning to school buildings for safety reasons related to COVID-19. They may also be concerned about their own children’s health and learning while trying to educate others. This stress may diminish their ability to give students the benefit of the doubt when they exhibit challenging behavior, such as not paying attention in class and being disruptive.

For students of color, this may be particularly disadvantageous because they may be referred for an evaluation for ADHD or another disability when they may instead need social-emotional support or other resources. You may need to remind teachers that students of color may be returning with their own baggage from the pandemic and racial unrest during the spring and summer. You may also want to expand the questions you ask a student and his family before conducting an evaluation.

“We know that Black kids are more likely to be diagnosed with conduct disorders and ADHD, while white kids are more likely to be diagnosed with bipolar disorder and PTSD,” says Sarah Y. Vinson, a physician who specializes in adult, child, adolescent and forensic psychiatry and founder of the Lorio Psych Group in Atlanta. “We have an opportunity to get ahead of this. It may be hard for teachers to realize what they’re doing. Schools have to address and keep track of this.”

Follow these tips to prevent inappropriate referrals and evaluations of students of color for ADHD:

  1. Investigate how active the student has been during quarantine. A student of color who seems inattentive or impulsive may just have had no meaningful connection with his peers for months and no opportunity to engage in activities that allowed him to expel energy, Vinson said. But a teacher, particularly of a different race, may inadvertently conclude that the student has ADHD and requires a referral. “If a boy who is extroverted and loves sports was not able to be around his friends for months, it is likely going to impact how he acts in school,” she says.
  2. Look into what educational resources have been available. If the student didn’t have access to the internet or could only access it on a cellphone or had to share one laptop or tablet with three other siblings, that may also have caused the student to get behind and have difficulty transitioning back to the school environment, Vinson says. “It’s really important to keep in mind the student’s resources and the caregiver’s resources.”
  3. Find out if the student is grieving or has experienced trauma. The student may live in a community that has been hard hit by the pandemic and be grieving the loss of neighbors, friends, or family members, Vinson says. The student may be experiencing trauma rather than ADHD and need mental health supports. Trauma from before the outbreak may have been exacerbated by all the changes associated with the pandemic and could also be affecting the student’s behavior. If the student’s records are not clear about the trauma the student experienced, add more details if they are available so the student’s behavior is not the sole focus when a referral is made, Vinson adds. Mention in the student’s records how his trauma manifests. For example, he may exhibit irritability when his traumatic past bubbles up. “It would be a disservice to the kid and end up harming them down the line if their behavior is the sole focus,” she says.
  4. Seek information on the student’s community resources. Recognize that if the student’s only local grocery store shut down because of COVID-19, he may not have access to much more than fast food outside of school and be showing behavioral issues because of that. The student may also not be sleeping in his own bed because of his family’s housing issues and he may not be getting enough rest. “That obviously has implications for how the brain works,” she says. “Mental health professionals don’t always screen for food security and housing security. To do a thorough job, they need to assess [these] psychosocial factors. So many symptoms of ADHD overlap with not being well rested.”

Cara Nissman covers autism, school psychology, and IEP team issues for Special Ed Connection, a DA sister publication.

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