MedicalResearch.com Interview with:
George J. DuPaul, PhD
Department of Education and Human Services
Charles Barrett. Ph.D.
Loudon County Virginia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Numerous studies have shown that Black children are more likely to receive ratings that are more indicative of displaying externalizing behavior difficulties, including Attention Deficit Hyperactivity Disorder (ADHD). However, many of these studies included teachers as the informants. Consistent with most teachers in the United States, raters have typically been White females. For this reason, it is unclear if these outcomes would exist if the rater and child shared the same racial/ethnic background. Additionally, most research in the United States that involved cross-cultural comparisons has used White and Hispanic boys. Few empirical studies have examined differences between Black and White boys.
The present study sought to address several limitations in the field. Most notably, cross-cultural comparisons between Black and White boys were included instead of Hispanic and White children. Next, maternal figures, rather than teachers, were included as the informants.
The present study was developed using a similar methodology that examined Hispanic and White boys’ behavior from the perspective of Hispanic and White teachers (Dominguez de Ramirez & Shapiro, 2005). In sum, we sought to determine if there were differences in how Black and White maternal figures rated Black and White boys who were demonstrating the same level/type of behavior (i.e., sub-clinical levels of ADHD). Notably, although the boys’ behaviors were the same, maternal ratings were not identical.
Specifically, using the ADHD Rating Scale, Fourth Edition (ARS-4), Black mothers assigned higher ratings to both Black and White boys.
MedicalResearch.com: What should readers take away from your report?
Response: One of the most important implications of these data is the importance of clinicians adopting a multi-modal and multi-informant assessment paradigm when evaluating students for various conditions. Because the boys’ behavior was essentially identical but subsequent ratings from Black and White mothers were different, these results question the accuracy of such ratings. In other words, data that are gathered using behavior rating scales must be interpreted through the lens of the informant. Moreover, such data may reveal as much about the rater as the target child. These results challenge psychologists and other clinicians who are intimately involved in evaluating children for a variety of psychological conditions to interpret rating scale data in the context of other assessment measures. Although this does not necessarily mean that informants’ (e.g., parents/families or teachers) ratings are inherently inaccurate, it is imperative for clinicians to uncover the reasons that contribute to different ratings. A multi-informant and multi-modal assessment paradigm allows clinicians to corroborate evidence with various types of data (e.g., naturalistic observations and teacher and family interviews).
In sum, before thinking about children as having a disorder based on rating scale data alone, clinicians should consider alternative explanations to ultimately formulate the most accurate diagnostic impressions and decisions.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Among other improvements, future studies should apply qualitative methods to better understand outcome data. For example, although Black and White mothers perceived and rated Black and White boys’ behavior differently, it is unclear what these differences meant from a diagnostic perspective. Said another way, were Black mothers’ ratings simply a reflection of what they observed while watching the videotapes? Or, were their ratings higher and also indicative of a diagnosable condition? Given the differing views on diagnosing/labeling children between Black and White families, it is possible that Black mothers’ ratings were higher but not necessarily indicative of disordered functioning. Adding a question such as, “Do you think the child that you viewed should be diagnosed with ADHD?” would be quite informative.
Although we attempted to measure the effects of socioeconomic status (SES) and acculturation (Black mothers, only) on behavior ratings, no significant effects emerged. However, this could be due to the lack of variability within the sample. Specifically, all mothers were generally middle class and the Black mothers generally fell within the same range of acculturation. Future studies should intentionally recruit mothers from all socioeconomic strata to determine its effect on subsequent behavior ratings. Similarly, individuals from different acculturation levels should also be recruited. Last, due to measurement limitations in how acculturation is measured in Black (African American) individuals, future studies should consider whether Black Racial Identity Development is a more appropriate model to predict Black mothers’ behavior ratings.
Disclosures: Dr. DuPaul receives royalties from Guilford Press for the ADHD Rating Scale-IV, the assessment measure used in this study.
Charles Barrett, George J. DuPaul. Impact of Maternal and Child Race on Maternal Ratings of ADHD Symptoms in Black and White Boys. Journal of Attention Disorders, 2015; 22 (13): 1246 DOI: 1177/1087054715616489
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