AD/HD Undertreated in Hispanic/Latino Children.

Representatives from some of the nation’s leading public health agencies called for elimination of barriers to quality information and treatment for Hispanic/Latino children with attention-deficit/hyperactivity disorder (AD/HD) at a Capitol Hill briefing hosted by CHADD, the nation’s leading advocacy organization serving individuals with AD/HD. The panel cited a combination of cultural factors — including language barriers and stigma — for the reluctance of Hispanics/Latinos to seek medical assistance and receive treatments for mental health disorders, including AD/HD. The briefing was supported by Reps. Grace F. Napolitano (D-CA) and Hilda L. Solis (D-CA). Napolitano is chair of the Congressional Hispanic Caucus, and Solis is chair of the Caucus’s Health Taskforce.

Panel members included:

* Jose Cordero, M.D., M.P.H, representative of the Centers for Disease Control and Prevention (CDC)
* Regina James, M.D., child psychiatrist, representative of the National Institute of Mental Health (NIMH)
* Ricardo Galbis, M.D., director, Andromeda Transcultural Health Center, Washington, D.C.
* Milton Beltran, moderator, parent of two children with AD/HD, CHADD board member, Puerto Rico
* Ana Romero, parent of a child with AD/HD, Los Angeles, Calif.
* Anuca Valverde, parent of two children with AD/HD, Miami, Fla.

“Hispanic/Latino parents are as concerned as any parent about their children’s development. But stigma, lack of appropriate services and language barriers, too often lead to the underdiagnosis and undertreatment of AD/HD in the Hispanic/Latino community,” said Jose Cordero, M.D., M.P.H, director of the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention. “It, therefore, is critical that we work collaboratively to address these disparities so that Hispanic/Latino children everywhere can lead fulfilling, healthy and successful lives.”

Cross-cultural differences significantly influence parental views about what is considered appropriate and socially acceptable behavior in children. For example, previous studies have found that Hispanics/Latinos are more likely to use general health practitioners and other influential individuals – – including pediatricians, social workers and religious figures — rather than specially trained professionals in the mental health field.(1,2)

Unfortunately, this may lead to the use of non-evidence-based treatments. Some reports indicate that the Hispanic/Latino population uses mental health services at less than half the rate of Caucasians.(3,4,5,6)

“As a parent of two children with AD/HD, my wife and I know too well how the disorder impacts every aspect of our children’s lives, as well as how it affects the rest of our family,” said Milton Beltran, program moderator and member of CHADD’s board of directors. “Policymakers, parents, school administrators, educators and health professionals must work together to address the wide array of disparities that adversely affect Hispanic/Latino families.”

The following primary barriers to mental health care among Hispanic/Latino individuals have been studied:(7)

Service-related Factors

* Lack of culturally competent services

* Dissimilarity between Hispanic/Latino patients and treatment providers in their understanding of mental illness and treatment

* Lack of awareness of available mental health services

Instrumental Barriers

* Language barriers

* Lack of transportation

* Financial difficulties and lack of insurance

Socio-demographic factors

* Low income within households

* Lack of education

* Unemployment

Community-level factors

* Hispanic/Latino values and beliefs

* Stigma associated with mental illness

1. Guarnaccia, P.J. & Martinez, I. (2002). Comprehensive In-depth Literature Review and Analysis of Hispanic Mental Health Issues. New Jersey Mental Health Institute, Inc.

2. Hough, R.L., Hazen, A.L., Soriano, F.I., Wood, P. & McCabe, K. (2002). Mental health services for Latino adolescents with psychiatric disorders. Psychiatric Services, 53: 1556-1562.

3. Wells, K., Klap, R., Koike, A. & Sherbourne, C. (2001). Ethnic disparities in unmet need for alcoholism, drug abuse and mental health care. American Journal of Psychiatry, 156: 928-934.

4. Pescosolido, B.A., Wright, E.R., Alegria, M. & Vera, M. (1998). Social networks and patterns of use among the poor with mental health problems in Puerto Rico. Medical Care, 36: 1057-1072.

5. Vega, W.A., Kolody, B., Aguilar-Gaxiola, A. & Catalano, R. (1999). Gaps in service utilization by Mexican Americans with mental health problems. American Journal of Psychiatry, 156: 928-934.

6. Vega, W.A., & Alegria, M. (2001). Latino mental health and treatment in the United States. In Aguirre-Molina, M., Molina C. & Zambrana, R., eds. Health Issues in the Latino Community. San Francisco : Jossey-Bass, 179-208.

7. Diaz, Y., Raggi, V.L., Chronis, A.M. (2005). AD/HD in Latinos. Attention!(R), 12(1): 38-43.

8. U.S. Department of Health and Human Services. (2001). Mental Health: Culture, Race and Ethnicity-A Supplement to Mental Health: A Report of the Surgeon General. Rockville, Md.: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

9. New Freedom Commission on Mental Health. (July 2003). Achieving the Promise: Transforming Mental Health Care in America. Final Report. DHHS Pub. No. SMA-03-38. Rockville, Md.

10. National Institute of Mental Health. Attention Deficit Hyperactivity Disorder (ADHD)-Questions and Answers. Retrieved May 23, 2005 from http://www.nimh.nih.gov/healthinformation/adhdmenu.cfm.

11. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association.

12. Barkley, R.A. (1998). Attention Deficit Hyperactivity Disorders: A Handbook for Diagnosis and Treatment. New York: Guilford Press.

13. Wolraich, M.L., Hannah, J.N., Pinnock, T.Y., Baumgaertel, A., & Brown, J. (1996). Comparison of diagnostic criteria for attention-deficit hyperactivity disorder in a county-wide sample. Journal of the American Academy of Child and Adolescent Psychiatry, 35: 319-324.

14. Murphy, K. R. & Barkley, R.A. (1996). The prevalence of DSM-IV symptoms of AD/HD in adult licensed drivers: Implications for clinical diagnosis. Comprehensive Psychiatry, 37: 393-401.