Latino/Hispanic Cultural Influences on Assessing and Treating AD/HD
Learn how culture affects assessment and treatment of AD/HD - and how sensitivity can help.
By José J. Bauermeister, Ph.D. for CHADD
Attention-Deficit/Hyperactivity Disorder (AD/HD) is a universal condition with a strong biological and hereditary predisposition that presents itself similarly across the world. Research suggests that Latino/Hispanic children with the disorder present a neurocognitive, educational, social and clinical impairment profile similar to that reported among Anglo American children with the disorder (Bauermeister et al., 2005a; Bauermeister et al., 2005b). In spite of this similarity, the cultural background of a child can significantly influence the expression of AD/HD, the meaning given to these behaviors, the level of tolerance toward them and the disposition to seek treatment (U.S. Department of Health and Human Services, 2001).
Understanding the influence of culture is especially relevant for Latino/Hispanic individuals with AD/HD since there is evidence that they are not properly identified and treated (Bauermeister et al., 2003; Leslie et al., in press). This article focuses on how the background, language and culture of Latino/Hispanic groups can have significant implications for the assessment and treatment of Latino/Hispanic children with AD/HD living in the United States.
Although Latino/Hispanic subgroups share common values and beliefs, they differ in history, race, socioeconomic position and acculturation (Zea, Quezada, Belgrave, 1994). Considerable diversity among Latino/ Hispanic groups in the United States exists, and it is not possible to talk about a uniform Latino/Hispanic culture. Any discussion about cultural values should not be indiscriminately applied to members of the Latino/Hispanic culture or to mainstream American culture for that matter.
Understanding the family context of Latino/Hispanic children has important implications for effective and culturally sensitive AD/HD diagnosis and treatment. Latino/Hispanic families are frequently in transition, so it is virtually impossible to describe what "typical" Latino/Hispanic family is like (Zea et al.,1994; Zuniga, 1992). Some Latino/Hispanic children may witness traumatic life experiences such as civil unrest and violence in their countries of origin and separation from family members due to migration. Among Hispanic American (Latinos) living in the United States, stressful experiences associated with assimilation and acculturation to a new country, culture, language and school system can contribute to temporary adjustment problems. These experiences may significantly impact Latino/Hispanic children's emotional development and could result in behaviors that can be confused with, or aggravate, the symptoms of AD/HD.
Latinos also differ considerably in their proficiency of the English language. Understanding language barriers is essential to avoiding serious diagnostic and assessment errors in using AD/HD rating scales, questionnaires and other tests in English. Children with poor English language skills can present behaviors such as not following instructions or not appearing to listen when spoken to directly that may be confused with symptoms of AD/HD. Moreover, the fact that a Latino/Hispanic person has acquired English conversational skills does not imply that he or she has the language proficiency needed for reading and writing.
Finally, parents of Latino/Hispanic children with AD/HD that lack English proficiency and literacy can have difficulty participating in activities such as attending parent-teacher conferences, helping with homework, seeking services for their child and participating in other orientation and educational activities. This apparent lack of parental involvement can be misperceived as lack of responsibility toward the child with AD/HD. Teachers and service providers need to be aware of these language issues and their implications.Competent and culturally sensitive interpreters can be valuable in facilitating effective communication between Latino/Hispanic parents and teachers and service providers.
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