Child behavior, maternal mental health
Community Perspectives of Childhood Behavioral Problems and ADHD Among African American Parents

https://doi.org/10.1016/j.ambp.2007.02.002Get rights and content

Objective

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

Methods

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.

Results

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.

Conclusions

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.

Section snippets

Design

This is a qualitative study that uses focus group methods as a first step for studying community perceptions regarding the complex and potentially sensitive issue of behavior problems in children and ADHD. Focus groups are a powerful means to understand participant attitudes, feelings, beliefs, and experiences in a group context. They are particularly useful when there is a power differential between participants and decision-makers or language, cultural, religious, or educational differences

Results

Descriptive characteristics of the 31 participants are presented in the Table. Their average age was 35 (SD = 9.8) years. On average, participants each had 2 children whose mean age was 9 (SD = 7.8) years. Only 3 participants had a child with a history of ADHD diagnosis.

Five main domains relating to behavioral problems in children emerged from the narratives: (1) causes of behavioral problems; (2) ADHD as a diagnosis; (3) attitudes about doctors; (4) opinions of medication; and (5) perceptions

Discussion

This study explored views of AA parents about childhood behavioral problems and ADHD. Although participants had a broad range of experiences, similarities emerged across all focus groups. When viewed against the backdrop of disparities in today’s society, what is gained is a rich description of how a sample of AA parents perceives behavioral problems and what they believe constitutes appropriate management within the context of their community. Understanding perspectives of minority parents is

Acknowledgments

The authors do not have any affiliation, financial agreement, or other conflict of interest. This work was funded in part by an Ambulatory Pediatrics Association Region IV Regional Research Project Grant (primary investigator, Dr Olaniyan) and the National Center on Minority Health and Health Disparities P20 MD 00165. This project was led by Omolara Olaniyan, MD, MPH, who died in December 2004. We greatly miss her leadership and dedication to children and families.

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