Attention Deficit Hyperactivity Disorder among Asian American Families: Challenges in Assessment and Treatment
Pham, Andy V., National Association of School Psychologists. Communique
Studies addressing assessment and treatment of attention deficit hyperactivity disorder (ADHD) have primarily been focused on Caucasian populations, although a growing number of studies have included ethnic minority populations, particularly Hispanic and African American children (Bailey, 2005; Perry, Hatton, & Kendall, 2005). However, there is a paucity of literature investigating ADHD among Asian Americans, due to negligible prevalence rates of disruptive behavior disorders in this population compared to other racial groups living in the United States. These estimated rates range from 1% to 2% (Cuffe, Moore, & McKeown, 2005). Treatment studies have consistently shown that ethnic minority populations, including Asian American youth, are not receiving treatment for ADHD at rates comparable to Caucasian youth (Bauermeister et al., 2003; Rowland et al., 2002).
Findings regarding the relationship between ADHD diagnosis and race have not been consistent, although Asian Americans generally report lower rates of ADHD (Cuffe et al., 2005) compared to Caucasian and other ethnic minority parents. These rates are also significantly lower than in Asian countries such as China, Japan, and Korea, where prevalence rates of children with ADHD range from 7%-io% (Soma, Nakamura, Oyama, Tsuchiya, & Yamamoto, 2009). Limited access to treatment and lack of knowledge about ADHD may also explain these lower rates in the United States, although a recent study suggested that ethnic minority parents, particularly African American and Hispanic families, appear just as knowledgeable about ADHD and its treatment as Caucasian parents (Pham, Carlson, & Kosciulek, 2010). However, there have not been any studies directly exploring knowledge of ADHD among Asian American families.
Asian Americans are among the fastest-growing ethnic minority populations in the United States. According to the U.S. Department of Commerce, Census Bureau (2009), Asian and Pacific Islanders comprised 4.8% (14.6 million) of the total U.S. population. Asian Americans constitute at least 28 ethnic groups with the greatest number being of Chinese descent (3.8 million) followed by Filipino (3.2 million), Asian Indian (2.8 million), Vietnamese (1.7 million), Korean (1.6 million), and Japanese (1.3 million) descent. Despite the growth in the number of Asian American families within the past decade, research is still limited on the potential risk or protective factors that may explain their low prevalence rate of ADHD. While some researchers suggest that Asian American children and adolescents experience fewer disruptive behaviors relative to the general population due to apparent protective factors (e.g., family stability and clear expectations for behavior), others believe that cultural perceptions of child behavior and ADHD treatment are likely factors that contribute to the underestimation of Asian American children with ADHD and the underutilization of ADHD treatment (Cuffe et al, 2005).
CULTURAL PERCEPTIONS OF CHILD BEHAVIORS
In determining whether one has a mental health disorder, Asian Americans may use different criteria from those used by non-Asian families (Dinh 8c Nguyen, 2006) . Additionally, traditional Asian perspectives concentrate less on psychopathology and more on enlightenment and ideal mental health (Lau 8c Takeuchi, 2001). These differences in defining behavioral problems may also lead to different rates of reporting symptoms of ADHD. Researchers exploring help-seeking behaviors (Eiraldi, Mazzuca, Clarke, 8c Power, 2006) among ethnic minority populations also proposed that cultural values influence parental attitudes, leading to different thresholds regarding how they view and tolerate children's behavior problems. This also will in part determine how likely adults are to seek help through clinical intervention for their children. For example, although Asian American parenting style tends to be more directive than that of nonAmerican families, a relaxed parenting style is used with children younger than 6 or 7 years of age (Jose, Huntsinger, Huntsinger, 8c Liaw, 2000). …