Conduct Disorder vs. Attention-Deficit Hyperactivity Disorder: Diagnostic Implications for African-American Adolescent Males

Article excerpt

It seems that the buzz diagnosis for adolescents experiencing difficulties focusing and attending in class, as well as staying on task, and following instructions, is Attention-Deficit Hyperactivity Disorder (ADHD). Attention-Deficit Hyperactivity Disorder formerly Attention-Deficit Disorder (ADD), has its semantic derivation in the 1970s. ADHD is defined symptomatologically. It is a behavioral disorder characterized by two separate subtypes. Those two subtypes are inattention and hyperactivity-impulsivity. ADHD with inattention describes in part a child who fails to pay close attention to details, has difficulty sustaining attention, does not seem to listen when spoken to, or who has difficulty organizing tasks and activities (DSM-IV, 1994). ADHD with hyperactivity-impulsivity describes in part a child who appears fidgety, leaves seat in classroom regularly without permission, runs about excessively, or blurts out answers before questions have been completed (DSM-IV, 1994). It is estimated that 3 to 5% of all children have some form of a primary ADHD with or without hyperactivity (Barren, 1994). The pharmacological drug of choice in treating this behavioral disorder is ritalin. As numbers of students receiving an ADHD diagnosis continue to grow, so has prescriptions for ritalin (Howell, 1997). Interestingly enough, teachers become very instrumental in identifying student behaviors that may be indicative of an attention and/or hyperactivity disorder. With the aforementioned in mind, the role of teachers and school counselors in identifying behaviors that contribute to a diagnosis of Attention-Deficit Disorder becomes very important.

Another disorder that seems to be finding its way into our schools is Conduct Disorder (CD). By contrast to its attention-counterpart which is characterized by inattentive and hyperactivity/impulsivity, Conduct Disorder is characterized as a "repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated" (DSM IV, 1994). The implications for treatment of the afore-mentioned respective disorders become significant when one considers the etiological factors offered for the disorders. ADHD is attributed to central nervous system dysfunction (Barren, 1994), whereas Conduct Disorder is attributed largely to social maladjustment.

In many school systems, teachers, administrators, and counselors serve as informal diagnostic teams in assessing students' behavioral issues. This is particularly true to systems that have alternative educational settings for students who have been diagnosed with behavior problems or conduct disorder. There is a marked disparity in the diagnoses of White males and African-American males with regard to ADHD and Conduct Disorder. In a society where negative stereotypes unfortunately still persist of African-American males, it is no wonder that Black males who exhibit Attention-Deficit Disorder characterized by lack of impulse control are often given an immediate and informal diagnosis of Conduct Disorder.

Conduct Disorder and Attention-Deficit Hyperactivity Disorder are widely diagnosed. It appears that a particularly large number of African-American males particularly are diagnosed as CD as opposed to ADHD. Educators and counselors play an increasingly important role in the diagnostic process. A lack of a clear understanding of our personal perceptions and prejudices coupled with a lack of knowledge of the DSM-IV criteria for diagnosis can result in misdiagnosis of African-American adolescent males.

The purpose of this paper is to make counselors and educators aware of their need to examine and explore personal prejudices and to increase their knowledge of the criteria for diagnosing both Attention-Deficit Hyperactivity Disorder and Conduct Disorder.

There is a mistrust of counseling and service delivery systems by oppressed populations (Atkinson, Morton, & Sue, 1998). …