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details. Welcome

0:35

to the Attention Deficit Disorder

0:37

Expert Podcast Series by Attitude

0:40

Magazine. Hello

0:46

everyone, I'm Carol Fleck and

0:48

on behalf of the Attitude team, I'm

0:51

pleased to welcome you to today's

0:53

ADHD experts presentation

0:55

titled Health Equity

0:58

in ADHD, Addressing

1:00

Racial Disparities in Diagnosis and

1:02

Treatment. Leading

1:04

today's presentation is Dr. Napoleon

1:06

Hagens. Dr. Hagens

1:09

is a child, adolescent and

1:11

adult psychiatrist in Houston, Texas.

1:14

He is the executive director of

1:16

the Black Psychiatrist of America and

1:19

CEO of Global Health Psychiatry.

1:22

Dr. Hagens is an author

1:24

and co-author of multiple books

1:26

on ADHD, Depression and Grief,

1:29

Mental Health in Black Communities

1:31

and Physician Practice Issues. He

1:34

also specializes in nutrition and health

1:37

to improve patients' well-being. In

1:41

today's webinar, we'll discuss the critical

1:43

issues that often prevent Black children

1:45

and adults from receiving adequate treatment

1:48

for ADHD. These

1:50

issues include structural racism, which

1:53

often results in limited access to

1:55

ADHD care, As well as

1:58

harsh treatment and punishment at school. Sigma

2:01

around diagnoses like a D H

2:03

D. And a deep mistrust of

2:06

the medical community are also barriers to

2:08

care. Our expert

2:10

will discuss the serious consequences.

2:12

Of untreated A D H D. And.

2:15

Share strategies to help ensure proper

2:17

care and treatment. So.

2:20

Without further ado, I'm so pleased

2:22

to welcome tattered Napoleon Higgins. Thank.

2:24

You so much for joining us today and

2:27

leading this discussion. Oh

2:29

thank you so much for your introduction

2:31

is great to be here today of

2:33

her a lot about attitude is the

2:36

I'm very thankful for the opportunity to

2:38

address the group. I did not have

2:40

a ruler a real off it you

2:42

know attitude is large but most are

2:44

started the notification when out that I

2:46

would be speaking a lot of friends

2:48

who be applying a man as the

2:50

you and of your attitude so I'll

2:52

have friends here have been those who

2:54

know me those did not but it's

2:56

great to be here to talk about

2:58

such as important issue. Issue of

3:00

help equity in A D H D:

3:02

The racial disparities in diagnosis and treatment.

3:05

As. Stated I'm I'm and exactly directed

3:07

the black cast Mirka and do a

3:09

lot of different things but you know

3:12

really doing a D H D and

3:14

treating a D H D is of

3:16

both of the work that I've done

3:19

throughout my professional career. I do have

3:21

several are disclosed to say that is

3:23

beat the several pharmaceutical companies A Max

3:25

the outta town Right now I'm in

3:28

Las Vegas. Are. Preparing for it's

3:30

often I'm about to and in

3:32

about another three hours. Or for

3:34

a pharmaceutical company, maybe about five

3:36

hours. So these are the companies

3:38

that I speak for In majority

3:40

are included here. Let's

3:42

jump right in. The. Issue of

3:45

I diagnosed Misdiagnose eighty is the

3:47

as we all know it causes

3:49

missed opportunities so far as the

3:51

issue of not focusing that paying

3:53

attention, difficulty concentrating and then you

3:55

know the the issues that you

3:57

have starting in school was basically

3:59

having the. Your problems are inattentiveness,

4:01

you not learning as you should.

4:04

And. Then a lot of people start to judge

4:06

you. You know that maybe this kid is

4:08

not doing as well I can't do as

4:10

well. And the issue of possible. thinking.

4:12

That they're the care of the floor characters

4:14

you when it's assay a medical diagnosis. That.

4:17

Assay can be worked through well worked

4:19

with but also the issue of neural

4:21

diversity. the some kids think differently so

4:24

went to school system often they are

4:26

set up in a certain way for

4:28

the majority of the students with their

4:30

and part of that makes sense but

4:32

then you also have the neural diverse

4:35

individual right? Who. Also

4:37

has an has has the ability to

4:39

learn but maybe be have been a

4:41

situation where they learn differently. So

4:44

without receiving adequate care, you can

4:46

have a lot of problems that

4:49

can occur at Wildlife if it's

4:51

not identified or dress properly. Other

4:53

contributing factors that we may not

4:55

notice. Secondarily, Happened in

4:57

any community by the Us on the

5:00

black Comedian is your trauma If he

5:02

did not sleep last night because of

5:04

nightmares and size bags or the issue

5:06

of poverty were twenty five cent of.

5:09

A Black children in this country.

5:11

I live underneath. Love the fiery.

5:14

With lack of food ah can

5:16

occur. Not knowing our were life

5:18

is going to head because of

5:20

the issue of changes that can

5:22

seem to occur. The issue of

5:24

nutrition. Inadequate. Nutrition stuff

5:26

was being able to afford to buy

5:28

food or being nutritionally A. If you

5:31

know not knowing what are the correct

5:33

food to eat so often will feed

5:35

our kids you know I don't know.

5:37

Pop tarts know Flame and I see

5:39

those breakfast lunch during Spring Break that

5:41

be comes like to claim it. Too

5:44

bad that Flame that Cheetos there for

5:46

dinner will do like free up rights.

5:48

While the problem is that if your

5:50

brain your child's brain is running off

5:52

flaming hot Cheetos, it is very difficult

5:54

for your child. be able to

5:56

learn in school with a good

5:59

nutritional environment around them, but also

6:01

the environmental issues that occur in

6:03

our neighborhoods. You know, two out of three

6:05

landfills are located next to Black

6:08

and Brown communities throughout the country. All right, two

6:10

out of three are three out of five. Myself,

6:13

I grew up a few

6:15

hundred yards from the landfill. And

6:18

so this issue of being, you know,

6:20

the gases and things that that occur

6:22

that come off of those things also

6:24

living in, living near, near industry are

6:27

the, you know, are the issue of

6:29

those issues of smog and environmental toxins

6:31

that are in the air. Those also

6:33

do impact your ability to focus, pay

6:35

attention because of the impact of the

6:37

environment on the body, but also the

6:40

impact of the environment on the brain.

6:42

Other comorbid disorders that

6:45

are often missed, you know, so,

6:47

so far as depression, anxiety, even

6:49

bipolar disorder, even before the

6:52

talk we got on, we were even talking

6:54

about schizophrenia, all of those can look like

6:56

ADHD. And I tell people this, when

6:58

you're looking at ADHD, it is a

7:01

diagnosis of exclusion. So essentially I ruled

7:03

out bipolar, I ruled out schizophrenia, I

7:05

ruled out anxiety, I ruled out PTSD

7:07

or trauma, I've ruled out the issue

7:10

of sleep. And now we're looking at

7:12

ADHD because the fact is this, in

7:15

every psychiatric disorder, you're going

7:17

to have difficulty with focusing

7:19

and paying attention. Every

7:22

last one of them. All right. Now,

7:24

with most medical issues, you're going to have

7:26

difficulties with paying attention and focusing as well.

7:28

So we have to look at other medical

7:30

diagnosis. So essentially, if you have COVID and

7:32

you're coughing all the time and sneezing all

7:34

the time, I can guarantee you, if you

7:36

don't feel well, you cannot focus and pay

7:38

attention. All right. Or if

7:41

you're having heart disease or asthma, any of

7:43

those types of things. So we have to

7:45

make sure that we're paying close attention to

7:47

making a clear diagnosis of what we're doing.

7:49

And then you're looking at the issues of

7:51

explicit and implicit bias and clinical research and

7:53

evaluators. And that the

7:56

teacher can be biased, the researchers can be biased.

7:58

And that's what we're looking at. And that's What we're. How did

8:00

that occur? Well. I you

8:02

know this for example, I speak

8:05

for several you know pharmaceutical companies

8:07

are now that a charming and

8:09

they specifically said that in this

8:11

particular study. That. Is

8:13

shown in Black and brown. Kids

8:15

are more likely to have opposition

8:18

to buy disorder anaconda disorder. Derive.

8:22

The To. Issues with that. One. Is

8:24

the Study Didn't say that. Is.

8:27

It at the study didn't even look

8:29

at those particular issues that the it

8:32

accordingly even had a at a reference

8:34

for. But the second part of that

8:36

you have to look at the ah,

8:38

explicit and implicit bias of raiders when

8:40

you're looking at, especially looking at black

8:42

children. and even more so even black

8:44

males who may be having symptoms of

8:46

a deist. So

8:49

how do you find a clinician to treat

8:51

a D H D? Well they are multiple

8:53

people. Get rid a D H D! So

8:55

I am a child and adolescent train psychiatrists.

8:57

Also the adults not be of elderly basis

8:59

as well. Saucy. Ahoy! all ages,

9:02

But. Me it and the sub specialist but

9:04

there are a lot of other people who could

9:06

treat a D H D as well. You have

9:09

a psychologist who are even have he says but

9:11

the of South ecologist. But. Your pediatrician,

9:13

your primary care doctor couldn't

9:15

family medicine. Even. Your arm

9:17

of you know, internal medicine doctors,

9:20

well, neurologist and their whole host,

9:22

a nurse practitioners and other individuals

9:24

who could. Three. Is or

9:26

four clinicians who betrayed a D H

9:28

D. So am these baseless oil fallacy

9:30

to serve Specialist A Sallie Mae say

9:32

the South South specialists so you don't

9:34

have to see me forest. Our lot

9:36

of other people who treat a D

9:38

H D and other fans don't understand

9:40

that the majority of a D H

9:42

D is treated outside of psychiatry is

9:44

treated in those are the areas. But

9:46

damn weird as best as to deal

9:48

with. That is what. So

9:51

his years provide. You. Can look on

9:53

the know back of the insurance card. Debt booming

9:55

gonna be at least one to two numbers. One

9:57

is just the job numbers but a lot of

9:59

insurances. Will have a second number on

10:01

their specifically for mental health and substance

10:04

abuse. So. Live Here is your

10:06

provider you have the county serves as if

10:08

you don't have insurance. So. You have,

10:10

you get kids. He I get it

10:12

gets network for parses you may not

10:15

be assured inadequately shared. I even are

10:17

impoverished. Almonds in one group here.

10:19

The Black Sick I actually directories. Dot

10:21

Com. That is a directory

10:23

of the black psychiatrists who are in the

10:25

country. that is not a full directory. right

10:28

side. You know. understanding that if you know

10:30

from black faces they'll wouldn't want to see

10:32

a black. The characters and when I see

10:34

that. I. Have let people know only

10:36

two percent. It's a cast in the country,

10:38

A black and about. Half. Of

10:40

them are located in about five. Know.

10:43

Houston. And. Land on

10:45

your D C L A Z R

10:48

and then I've seen their of a

10:50

psychiatrist and other large cities. Chagos you

10:52

major cities but then he is. There

10:54

may not be a black Cats Were

10:56

you looking at a life in the

10:59

West? I psychology today are doing a

11:01

google search. You. Know on it's own.

11:04

Maladies. Ways A different ways in which

11:06

you can contact with butter. Schedule an appointment.

11:08

You know what is Absolutely no one wants

11:10

to see somebody but we're fear about it

11:12

and you know who want to consider it

11:14

out. If you think you need to see

11:16

someone, are you Charlie to see someone? schedule

11:18

an appointment. And. Them look for the coffin

11:20

and compatibility. You know when you make the appointment

11:23

in you go in the feel comfortable with the

11:25

doctors he did. you come up with the follow

11:27

up in a tree that plants move forward on

11:29

the issues that are impacting you about eighty a

11:31

steep and if you don't agree with that doctors

11:34

there's nothing wrong with the second opinion or if

11:36

you're getting treatment in as a getting better. Nothing.

11:39

Wrong with that at all and I only

11:41

recommend else and adding that. Get upset with

11:43

the basis if they want a second opinion.

11:45

Sometimes you do need a press it have

11:47

eyes on things, see how maybe to see

11:49

how there may be another way to approach

11:51

your particular He's. So.

11:55

how was how do you find someone is

11:57

your doctor culturally competent this is something that

12:00

black people often fear is will

12:02

the doctor understand me? Will they get

12:04

me? So often when we

12:06

have a majority culture, which

12:08

would be white culture in our country, people

12:11

will believe that everybody sees things the same

12:13

way or the best way to see things

12:15

is how the majority sees it. And

12:18

that comes about because the majority gets to say, you

12:21

know, the majority may be controlling most of

12:23

the resources. The majority says

12:26

what ADHD looks like for everyone,

12:28

but everyone does not have the

12:30

same visual or come from

12:32

the same standing point of looking at ADHD

12:34

the same way. And it's

12:36

hard to know somebody is culturally competent. Now, the fact

12:39

is this, I am a black male, I grew up

12:41

in the black community, I've been

12:43

black my whole life, all right? And I've

12:45

pretty much gone to all black schools my

12:47

entire life. So I have a very singular

12:50

view of America from my

12:52

lens. At the same time,

12:54

I live in a majority culture that you're

12:57

constantly inundated with white culture

12:59

as well. So a television, radio,

13:01

print magazines, the educational

13:03

system, the government itself,

13:07

all of these things come into play. But

13:09

as a psychiatrist, I'm also wanting to

13:11

know about other people's cultures. So you

13:14

have to make it a point to

13:17

read stuff, listen to stuff,

13:19

watch movies, podcasts, whatever it

13:22

may be that may be outside of

13:24

your circle, because as a psychiatrist, you

13:26

are a social scientist, you need to

13:28

understand cultures and people. I live

13:30

in the city of Houston. When it comes

13:32

to the city of Houston, half

13:35

of the people who live in the city

13:37

of Houston were born outside of the United

13:39

States. So the

13:41

city of Houston is about 2 to 2.5

13:44

million people live inside

13:46

the city limits with about 7 million

13:48

total. You got to

13:50

understand where people come from, all right?

13:52

So I definitely want to understand issues.

13:54

And if I don't understand, then I

13:56

will ask you, please explain more because

13:58

really I do want... want to

14:00

know and to all my clinicians who are listening.

14:03

When you ask a question, it does not

14:05

show ignorance. Asking the

14:07

question shows that you are interested

14:09

in what is going on with

14:12

them and what is impacting

14:14

them. So make sure we talk to

14:17

our primary care physician. Sometimes

14:19

they will know someone that is very

14:21

good, that they would feel comfortable that

14:23

they send you to, and then your

14:25

community and faith organizations. So often as

14:27

African Americans, we talk to our pastors,

14:30

we talk to people inside of our church, within our

14:32

friends, sororities, fraternities, barbershops,

14:36

all these different places will go when we

14:38

ask for where do we find someone good

14:40

to talk to. And between all of those

14:42

people, they typically know someone. Even if they

14:45

are not African American, they will say, well,

14:47

this doctor is really good, he really helped

14:49

my child out. I would highly recommend going

14:51

to see this particular physician. So

14:55

stigma, there are

14:57

a lot of negative attitudes and beliefs that

15:00

happen inside of all communities, but

15:03

specifically, I would say the black

15:05

community, where people will say

15:07

the ADHD is not a diagnosis. It does

15:09

not even occur. That is something, be honest

15:11

with you, I have heard this said before.

15:13

This is something that white people made up

15:15

to get black children in trouble and

15:18

a lot of negative attitudes and beliefs. And I

15:20

have even seen that in my own practice. I

15:22

had a young man who came in where the

15:24

mother said that the white teacher said he had

15:27

ADHD, and then the next year the white teacher

15:29

said he had ADHD. Then they sent

15:31

us to the school counselor who said the same,

15:33

and then we end up being referred to a

15:35

doctor, he said the same. So I did a

15:37

full evaluation. And I said, well,

15:39

ma'am, it does seem like

15:41

your child has symptoms of ADHD. After

15:43

looking at all the paperwork, we got

15:45

the rating scales back, and she

15:48

told me, well, see, you think like those white

15:50

folks. So understanding just because

15:52

I'm black does not mean everybody

15:54

believes my diagnosis. But these negative

15:57

attitudes and beliefs can put a

15:59

barrier between somebody who needs

16:01

help and somebody who's needing treatment. All

16:04

right, to the actual caregivers. And

16:06

these are really real things that

16:08

keeps people from seeking help. The

16:11

issue of fear and shame, you know,

16:14

that, you know, I've seen parents say that they

16:16

felt they feel like they let their child down

16:18

or that they did something wrong or

16:20

something looked down upon. But the other

16:23

issue of fear is, well, when we

16:25

look at ADHD and what typically happens

16:28

to the ADHD child who is black,

16:30

all right, you have to look at how

16:33

the system treats that child. The

16:35

majority of children, I mean, sorry, the majority

16:37

of adults who are locked up have ADHD

16:39

and impulse control disorders and black people are

16:41

locked up at a higher rate. And then

16:43

we're going to talk a little bit about

16:46

the school system, how they treat, how we

16:48

could treat ADHD. And you find that there's

16:50

a real reason to be afraid. So

16:52

the fear is not from a situation

16:55

of, you know, black people don't trust

16:57

America, which that can be true as

16:59

well. But the other part

17:01

of that is there is a real

17:03

fear that can occur with the diagnosis

17:05

and trying to make sure that people navigate that

17:08

fear to know how once we have a diagnosis

17:10

that's actually to your child's benefit so that we

17:12

can get them the services that they need. Looking

17:15

to faith versus mental health, you

17:17

know, the fact is that, you know, I

17:20

would say 90% of black people are religious.

17:22

90%, actually that's 95%. And about 90%

17:25

of those are going to be Christian

17:28

and about 5 to 10% of

17:30

them are going to practice Islam

17:33

or another religion, Judaism and a lot of

17:35

other religions. So the fact is this, not

17:37

all black people are the same, but they're

17:40

more often and not going to be

17:42

religious, but not all will be. And

17:45

most will turn to mental, to faith when

17:47

it's talking about mental health or even physical

17:49

health. So if you have a health condition,

17:52

people see on Facebook all the time, please

17:54

pray for me. You know, I can't

17:56

wake up in the morning without getting three

17:59

or four. people on

18:01

text messages with the prayer for

18:03

the day coming from my

18:05

community. So turning to

18:07

faith is actually a positive thing, especially if

18:10

it helps your mental health. So I'm not

18:12

never against, you know, turning to your faith,

18:14

but also knowing when you need a mental

18:16

health professional. And I found that in the

18:19

last several years, I see that more churches

18:21

are turning to mental health professionals and recognizing

18:23

the value that we could be for their

18:26

membership. So this

18:28

issue of hesitancy, misinformation, misunderstandings,

18:30

and fear of treatment are

18:33

big, you know, are these illnesses? I've heard

18:35

families say, you know, they fear that they're

18:37

being mind-controlled, that the medication is going to

18:39

be, you know, you know, they're going to

18:41

give your kids something that's just like crack.

18:43

And it's the reason why crack is so

18:46

heavy in the black community is because doctors

18:48

are giving them ADHD medication. I've heard this

18:50

before. And the odd thing

18:52

is that black children are less likely to

18:54

be on ADHD medication, less like to be

18:56

diagnosed. But this fear

18:59

of mind control by medications, the

19:01

fear of labels, and

19:03

that people fear that my child is

19:05

labeled, so therefore they will never be

19:07

able to do well, or the system

19:09

has labeled them so that they will

19:12

not be able to move forward. And

19:14

what happens is this, I make

19:16

the diagnosis, I let the school know, or

19:18

the parents of the school know, and then

19:20

they'll see that special education services

19:23

are now involved, and they

19:25

become afraid. Now they're trying to put

19:27

my kid in special ed because they have ADHD.

19:29

And what I explained to my families is this,

19:33

all educational

19:35

services that require more

19:38

funds go through special education. So

19:41

if your child needs accommodations made, that

19:43

does go through special education. If your

19:46

child isn't gifted and talented, that goes

19:48

through special education. AP courses

19:50

or special programming at the school goes

19:53

through special education. All of that

19:56

is special education. But

19:58

knowing how to navigate that, so that

20:00

you can receive the services needed. And what

20:02

is odd is that I'll have my black

20:05

families, often not all, who

20:07

will run away from special education services. They're

20:09

afraid to let the school know because they're

20:11

afraid of labels. And then next thing you

20:13

know, they will go without services where

20:17

my family is still a majority white, will

20:21

run to those services or want

20:23

special services because there's more money

20:25

there. There's more contact with professionals

20:27

that can help you there. And

20:30

so we have to get through that misinformation

20:32

and misunderstandings because we may think

20:34

that the family is being non-compliant,

20:36

but there may be a actual

20:38

real fear that they have on

20:40

why they're not engaging. The

20:42

mistrust of the medical community, we all hear

20:45

about the Tuskegee incident, but realize that racial

20:47

disparities go on every day in this country.

20:50

There are racial disparities. And then

20:52

also between outcomes of blacks versus

20:54

whites, and then outcomes that black

20:56

patients have with white doctors

20:59

versus black patients with black doctors. There

21:02

is truth to that. That's not the point of this talk,

21:04

but I got plenty of slides

21:06

on that as well. With studies that

21:09

are steadily coming out that

21:11

show that black families tend to

21:13

have worse outcomes with white doctors. And that

21:15

is a sad thing to hear, but if

21:17

we can educate more, maybe we can change

21:20

that. This ADHD Experts Podcast

21:22

episode is brought to you

21:24

by BetterHelp. If

21:26

you're anything like me, you've told yourself

21:28

over and over again, maybe for years,

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21:35

drive them places. While all of

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that might be true, the aha

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moment came for me when I realized

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that therapy could help me create more

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21:46

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important to me and helping

21:50

me devise strategies for prioritizing

21:52

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22:43

attitude. The

22:46

access to quality care, so far as do

22:48

you have insurance. If you don't have, if

22:50

you don't have insurance, are you able to

22:52

get quality care through the community systems? But

22:56

even for the insurance, sometimes all

22:58

treatments are not covered. And if

23:00

you have money and the medication is going to cost

23:02

$500 this month, because you were going

23:05

to argue with back and forth with insurance, most

23:07

families are not going to have $500. But there

23:10

are families that do that gives them a

23:12

distinct advantage, or being able to

23:14

see a professional. If you have insurance

23:16

versus if you're paying cash, you

23:19

know, the fact is that somebody paying cash

23:21

can get in normally quicker, a lot quicker

23:23

than somebody who has insurance, especially if they

23:25

have, you know, a

23:27

governmental type insurance, or

23:29

obviously those who don't have insurance,

23:31

right, and don't have money

23:33

either, who are not on Medicaid,

23:35

Medicare. Understand this, there are

23:38

people in our country and black people

23:40

have a higher number of this, who

23:42

fit within the social services of

23:45

being able to receive government insurance,

23:48

but they don't have that either. So

23:50

the access to care quality ends up going

23:53

through the emergency room or urgent cares, but

23:55

then you're not able to receive treatment for

23:57

ADHD in those areas. this

24:00

diagnosis of ODD and conduct disorder. I

24:02

was an obstetrician to find disorder and conduct

24:05

disorder. Understand this, that

24:07

is a diagnosis that is majority

24:09

diagnosed in black and brown kids.

24:11

And this is shown medically, statistically,

24:14

the numbers of ADHD versus

24:16

ODD and CD are actually

24:18

more skewed towards black and

24:20

brown kids. And I find

24:22

that this is typically the

24:25

issue where the diagnosis is

24:27

difficult to treat. So if

24:30

you are black and your ADHD is not

24:32

responding to the regular medications that we would

24:34

expect, especially if you have an impulse control

24:36

or an anger issue or

24:38

the emotional impulsiveness of ADHD,

24:41

if we can't get it right, then it

24:43

must be ODD and conduct disorder. And

24:45

sadly, I don't see these kids or families come to

24:47

me, especially being black in the

24:50

black community, they'll say that my child is

24:52

not getting better, go see Dr. Higgins. And

24:55

I'll find that the doctor never increased the

24:57

dose of the medication. Like you started the

24:59

starting dose, which normally the starting dose was

25:01

not adequate enough and never increased the dose.

25:04

And so I tell families, all right,

25:06

your child may have opposition to

25:08

find disorder or your child may

25:10

have conduct disorder. But I don't

25:13

know that until we've adequately treated

25:15

the ADHD, until we get the

25:17

ADHD under control, that medical diagnosis

25:19

under control, that I don't find the

25:21

other two to be relevant until we do that. And

25:23

oddly enough, normally when you get

25:26

the ADHD under control, all of a sudden

25:28

they're not just oppositional, defined or conduct disorder.

25:30

I had a young man diagnosed with that

25:32

for multiple years. Once

25:35

he got well, next thing you know, he's making A's

25:37

in class, he still struggles in math a bit, you

25:39

know, so he makes some C's in that. But

25:41

many times he made the A B on a roll. Now

25:44

he's a star basketball player, looking

25:46

at going to college with scholarships,

25:48

but someone had inadequately treated his

25:50

ADHD over years. So

25:54

this fear of bias and trust is

25:56

something that I always want to make

25:58

sure that we understand. than is

26:00

a component in the room that

26:03

may not be discussed openly. And

26:05

then the cultural cultural competence and

26:08

the understanding the individual in front

26:10

of you. So the

26:13

trust of the patient to the

26:15

doctor, but does the doctor actually

26:17

trust the patient? All

26:19

right. Do you trust does the doctor

26:21

believe that you're going to follow the

26:23

you know, the the options that the

26:25

doctor is giving you on

26:27

what to do, the fear of

26:30

a lack of compliance, so that you're not going

26:32

to take the medication or judgment that there's nothing

26:34

that we can do for this kid, this kid

26:36

is just bad. And you've got a bad kid,

26:38

whatever bad means, because all that really can change

26:40

when it comes to treatment. You know, you have

26:42

a bad kid, there's not much we can do

26:44

for you. So we're not even giving you all

26:46

the options, all the things that we can

26:48

do. And also how black people

26:50

describe mental health can be different. All

26:53

right. So I'm using my how

26:55

you say, I'm using my culturally

26:58

appropriate voice to a large community

27:00

of people who may be very diverse.

27:02

But when I'm speaking to say in

27:04

my home, I can speak very differently.

27:06

All right, plus I'm from the south.

27:09

And I'm urban. So I have a

27:11

different dialect that often can

27:14

come out when I'm very comfortable.

27:17

And so when people are speaking to you,

27:19

they may be communicating the symptoms very differently.

27:21

So I have a family to say, you

27:23

know, did you have child your son have

27:25

ADHD? Well, he doesn't have ADHD when he's

27:27

on his phone. He doesn't have ADHD when

27:29

he's playing the game. Alright, so he

27:32

never has ADHD then. So I know he can pay

27:34

attention and focus. Well, ADHD

27:37

is deeper than the phone and the TV in

27:39

the game, you know, now, if I

27:41

tell him to do something, all of a sudden, he

27:43

can't hear what I want to want. He can't hear

27:45

what I'm saying. Or he'll do one thing, but he

27:48

can't do the rest. So he

27:50

does seem to have ADHD. Not

27:52

really. Not at all. I can tell

27:54

you right now. So I don't even know why we're here.

27:56

Well, the thing is that if you don't go deeper and

27:58

know how to ask the questions She's

28:00

telling you the diagnosis, but she's using

28:03

verbiage that is different. And it's the

28:05

doctor who has to pick that information

28:07

out of the patient. I remember I

28:09

had a parent once told me, you know, look at this boy.

28:12

He is so thrilled. Just look at it. All right. Now, a

28:14

lot of people are not from the South or

28:16

not urban does not may have no idea what

28:19

throat is, but I knew exactly what she was

28:21

saying. Um, I found

28:23

it to be funny. Like what if she says that in front of

28:25

one of my colleagues? I don't know if they would pick that up

28:27

at all. Now this

28:29

issues of discrepancy, even inside the

28:31

school system with teacher and parent,

28:34

you know, we're looking at, that was a 2020 video

28:36

clip. This a study done by can get this

28:39

several studies on this, where it found

28:41

that what they would have is black

28:43

and white children in a classroom. None

28:46

of them have ADHD, but they would have

28:49

the teachers and the parents to rate the

28:51

kids and try to pick out which kid

28:53

has ADHD or could have ADHD. And

28:56

it found that the white teachers were

29:00

more likely to see ADHD

29:02

in black children than

29:05

black parents. All

29:07

right. So the white teachers were

29:09

more likely to pick out kids

29:11

with ADHD and they skewed more

29:13

so towards higher ratings for black

29:15

children, but also the,

29:17

on that same study, they looked

29:19

at white teachers and their attitudes

29:21

towards race. So the more

29:23

they had a negative racial attitude towards

29:25

black people in the rating scale, the

29:28

more likely they were seated, they were

29:30

to see ADHD in the black kids.

29:33

So what they're trying to pick up

29:35

is how racist is this person? And

29:37

the more racial they were, the more

29:39

likely they were to see ADHD in

29:42

black children, and they were also more

29:44

likely to see it in black male

29:47

children. Now, black parents were

29:49

less likely to see ADHD in their

29:51

children and black male kids, but

29:54

black parents who had higher rates

29:57

of racial discrimination also saw more

29:59

symptoms. of ADHD and their black

30:01

kids. So if you had a history of

30:03

racial discrimination towards yourself, you were more likely

30:06

to see ADHD and black

30:08

children, and a lot of people would think

30:10

that this may be a protective factor, in

30:13

that you don't want your child to

30:15

be a target by the white community

30:17

because of their behavior. So if they're

30:19

acting up or not acting in a

30:21

way in which the white majority will

30:23

accept, you're more likely to

30:25

have tighter control over them in fear

30:28

that they're going to be targeted because

30:30

of their behaviors. So

30:32

this fear is real. The

30:34

fear that the black teacher has, I

30:36

mean, the black parent has inside of

30:39

the classroom of their child being told

30:41

by a white teacher that they have

30:43

ADHD, well, in his studies, he's shown

30:45

that this is repetitive over and over

30:47

and over that white teachers are

30:50

more likely to see ADHD in black kids.

30:52

Now, the kid may have ADHD, but

30:54

it is definitely skewed. African-Americans

30:57

are 3.5 times more likely to be suspended

31:00

or expelled in schools, all right? That's just

31:02

a flat out number. Children with

31:04

disabilities make up almost 9% of school

31:06

population, but comprise 32% of

31:09

juvenile detention. So

31:11

32% of new juvenile detention are

31:14

those who are neurodiverse, but one

31:16

in four black students with disabilities,

31:18

such as mental disabilities,

31:21

will be suspended versus one in 11 white

31:23

students. And

31:25

when you take a child out of

31:27

class, they will not learn information when

31:29

they're away from the classroom. And

31:33

then the next thing you know, you give

31:35

them more unstructured time because they're not around

31:37

an adult. And we see this with pictures

31:39

of kids being arrested, black

31:42

children being jailed, using a

31:44

fake law. We've seen where,

31:46

I remember the judge who got

31:48

arrested in jail behind sending kids

31:51

with behavioral problems to jail because

31:53

they were getting paid, because

31:56

the judge was getting a kickback in order to do

31:58

so. So. we've

32:00

effectively in this country made

32:03

ADHD a punishment. Kids

32:06

who are neurodiverse, we've made

32:08

them punished, like this is

32:10

something bad, where we're

32:12

pushing them towards alternative schools. And

32:14

then when you go to alternative

32:16

school, you're more likely to end

32:18

up in prison. So it is

32:21

the schoolroom, classrooms, cradle to prison

32:23

pipeline that we've effectively are using

32:25

ADHD in order to do so.

32:27

So far as prioritizing punishment over

32:29

rehabilitation education, I don't know,

32:32

I see a lot of bad kids who all of

32:34

a sudden with treatment, they're not bad anymore. Seeing

32:36

the therapist working with the family, possibly

32:38

needing medication, all of a sudden, this

32:40

kid who couldn't go anywhere is going

32:42

places and doing things that are positive.

32:45

Increased law enforcement impact inside of the

32:47

school. Obviously, this is a different generation

32:49

where they have school shootings, right? This

32:51

didn't happen when I was in school

32:53

that people fear being inside the schoolhouse.

32:56

Well, now that you have police inside

32:58

of schools, police are

33:00

not trained educational individuals, and

33:02

police are not trained trained

33:04

in childhood development. So

33:07

we increase law enforcement, we've decreased

33:09

funding for counselors, and we've decreased

33:11

funding for special education services, where

33:13

our neurodiverse population needs to be.

33:17

And I will tell you, I'm a neurodiverse person,

33:19

I've been told my entire life, you know, as

33:22

a doctor, I became that I

33:24

have difficulty with reading comprehension. Wow.

33:28

All right, I'm a doctor. They say

33:31

I can't read. Well, I can read, but

33:33

I'm reading right now. But the fact is

33:35

that I'm a different type of learner. So

33:37

I found that if you

33:39

give me a sheet of paper that's organized,

33:41

I can memorize the entire sheet, or I

33:43

almost have a photographic memory where I can

33:45

see the entire thing. So I know that

33:48

as a doc, when they read, if it's

33:50

written this way, I know how to put

33:52

my glasses on now, to to a way

33:54

where I change up my thinking where I

33:56

can read long paragraphs effectively. I

33:58

have to learn that over time. crime. But also,

34:00

if you give me a paragraph outline

34:02

form, I can see the whole thing,

34:05

give me five minutes, and I can memorize

34:07

the entire page. But I learned that

34:10

I'm neurodiverse. And I learned differently, maybe

34:12

not like everyone else. Alternative

34:14

schools often do not have

34:17

the same requirements of the public school. So

34:19

when you take the child out of the

34:21

classroom, and you put them into alternative school,

34:23

they go from a teacher who is teaching

34:25

to possibly a teacher who's just hanging out

34:27

worksheets. All right, that

34:29

becomes a problem when you're not learning what your peer

34:31

group is learning, and you have to do 30 days

34:34

or 90 days, and you start to

34:37

have the conversation and talk where you're

34:39

talking penal talk when you're talking about

34:41

days that you've got to do versus

34:43

educational requirements. And then when you run

34:45

to the back, run them back to

34:47

the regular system, they're unprepared and fall

34:50

further behind and increasingly frustrated, because they

34:52

may have missed 90 days

34:54

in alternative school is basically half

34:57

the school year. All right, if

34:59

you get 90 days in alternative school in September,

35:01

you're not coming back to school until January. All

35:04

right. And then when you do this, you

35:06

increase incarceration rates, and you decrease graduation rates

35:08

when you do this to kids. The

35:11

zero tolerance policies. So far as if you

35:13

act up, you automatically get this punishment, no

35:16

matter what's going on with you. This

35:18

causes increased missed school days,

35:20

you have a kid who's struggling, who's now

35:23

not being supervised, maybe if they're at the

35:25

home by themselves, because the parent is working.

35:28

Suspension rates are increasingly and have

35:30

doubled over the last 30 years

35:32

for all kids throughout the United

35:34

States, leaving kids on supervisors and

35:36

supervise increased the chance to fall out. You

35:39

don't have due process when you

35:41

have zero tolerance policies, there's no

35:43

investigation. And then there is no

35:45

change in the community or within

35:47

the culture or where the child

35:49

is living in in the environment.

35:52

I remember being in the

35:54

fourth grade, and the

35:56

teacher was told by another student

35:58

that another kid had a nice in class.

36:01

And so the teacher, you know,

36:03

immediately, you know, came and

36:06

looked in the child's bag and pulled out a knife.

36:08

And she's like, why do you have a knife in

36:10

the bag? And she said that

36:12

the older kids from the middle school are

36:14

bullying her and her sister, and they

36:16

started to push them and

36:18

hit them. So she brought a knife to

36:21

defend herself. Well, what you could do

36:23

is kick this kid out of school, put her

36:25

out of school. So next thing you know, she

36:27

loses the fourth grade of her education and has

36:29

to repeat the year. Or you can actually

36:32

talk and find out what's going on.

36:34

They knew the kids that were bothering

36:36

them. They spoke to the families, all

36:38

right, of those kids. And they got

36:40

those, you know, middle schoolers, you know,

36:42

11 to 13 year olds into

36:45

the home and away from the kids.

36:47

And it completely stopped for all the

36:49

kids in the neighborhood who were going

36:52

past these other juveniles, other

36:54

juvenile young men. When I say

36:56

juvenile, not juvenile jail, but just

36:58

juvenile in age group. That

37:01

was an intervention that stopped the entire

37:03

thing for a group of kids leaving

37:05

the elementary school. But if you do

37:07

zero tolerance policies, and you're not going

37:09

deeper into the situation, you can have

37:11

a lot of kids who are getting

37:13

messed up by the system by adults

37:15

not doing their jobs correctly. So

37:18

you take away the protections that are by

37:21

the school for kids with special needs, and

37:23

you put the law enforcement in instead. And

37:25

this is a bad setup for all children,

37:27

no matter what their race or color is.

37:31

With a law enforcement side of the school, you're more

37:34

likely to have school based arrests. You

37:37

know, rather than teachers intervening, intervening,

37:39

and you have now more arrests for

37:41

children in schools who did not do

37:44

anything violent, but had some sort of

37:46

disruptive behavior. Because if you call the

37:48

cops, the cops do what they're trying to do. All

37:50

right, but they're not doing what they're when a

37:52

school counselor is trained to do. And we need

37:54

to make sure that we have more of that

37:56

because it sets up a poor outcome. So

37:59

when you're kids, they don't

38:01

graduate. And when it comes to that, 70

38:03

to 80% of all black men who not

38:05

finish high school will end up incarcerated. 40%

38:09

of black men who have a diploma will end

38:11

up incarcerated. And those with a college degree is

38:13

about 8%. So school is

38:15

important for our neurodiverse children. They need

38:17

to be in school, in class. We

38:19

need to make the intervention because if

38:21

you don't, the outcomes are poor. So

38:23

when you look at a black family

38:26

and you're looking at a six year

38:28

old and the mom comes in because

38:30

of there's a school issue, she's afraid,

38:32

she's scared, she's scared, she's afraid of

38:34

the system. And then you

38:36

diagnose ADHD and she starts to cry.

38:40

Why? Because

38:42

the system is in a situation where

38:44

this kid is more likely to end

38:46

up incarcerated, even though she's showing up

38:49

for help. So what she does is

38:51

she tries to not show up. She

38:54

tries every other intervention, any

38:56

other way we can do it, including

38:59

spanking or beating the kid, because

39:02

the system will do a

39:04

whole lot worse. So now

39:06

when I say that I'm not proposing

39:09

spanking kids at all, I

39:11

do propose that you get the help that

39:13

you need. But we need to make sure

39:15

that we're in a situation when you get

39:18

the help that you have the correct outcome

39:20

and not this outcome right here, because the

39:22

reason that she's crying is the system with

39:25

ADHD and black children does

39:27

this right here. So

39:32

parent training, does it all do all the

39:34

models fit? Clear

39:36

expectations, you need to know what are the

39:39

expectations of the child? Does the

39:41

child have an expectation? Do they know

39:43

what's going on? What's the expectation of

39:46

the parent? And what is the expectation

39:48

of the clinician? Do not assume that

39:51

your model or your idea is the

39:53

best fit for everyone. I remember,

39:57

you know, I don't want to go through so many analogies. But

40:00

no, it happens all the time where

40:02

you're not knowing what the family is

40:04

looking for when the doctor or

40:08

the clinician comes in. Positive

40:10

reinforcement. For the tired

40:12

parent, that could be very difficult. If you're working

40:15

two jobs with a single mom, you know, you

40:17

left work at six, you can't, you know,

40:19

and then you had your second job, you're not getting

40:21

home until 10 or 11 o'clock at night, that

40:23

can cause difficulties. So, to educate effective

40:26

communication is something that is very important

40:28

for parents to be able to do.

40:31

For the busy parent who's not at home,

40:33

be careful. Also look

40:35

out for who else is taking care

40:37

of the kid. The fact

40:39

is that, especially in single parent

40:42

homes, if the parent is not

40:44

there, it may be the oldest child

40:46

who's responsible. It may be a grandparent,

40:48

friend of the family, somebody from the

40:51

church. So, if you're effectively communicating

40:53

with the parent in the room, but when

40:55

the kid comes home from school from three

40:57

to nine o'clock at night, they may not

40:59

even be seeing that parent. So,

41:01

it's important to make sure you do a good assessment

41:04

of what are the situations in the home.

41:07

Consistent discipline can be very different for an

41:09

exasperated parent, you know, who has to go

41:11

to work, doesn't have time to deal with

41:14

certain things. Emotional regulation

41:17

has to be very carefully controlled. You have to

41:19

look at the power of the teacher of the

41:21

classroom. When it comes to

41:23

dealing with kids, the teacher has a ton of power.

41:26

The school system has a ton of power. And

41:28

if the parent and the school are

41:30

not on the same page, it can

41:32

actually be a heavier consequence to the

41:34

parent than some would recognize. We

41:37

need to make sure that we're promoting

41:39

problem solving for our kids, identifying the

41:41

triggers, identifying alternative solutions that actually fit

41:43

within the situation that is going on

41:46

inside the home. We have

41:48

to look at the collaboration of parents and

41:50

the consistency between homes. So, the

41:52

parents are divorced. Mom has these

41:54

set of rules, dad has that set of rules. But

41:58

then grandma, who actually is taking care of the kid when they get married, they're get

42:00

home from school or where they go out to school

42:02

has a whole different set of rules. So we

42:04

have to make sure that all of the

42:06

child circle is on the same page to

42:08

make sure we have the best outcomes. And

42:11

then the issue of ongoing support,

42:13

the ability to afford the support

42:16

can be problematic for families who are

42:18

on in those margins. Make

42:22

sure that parents and children know

42:24

their rights, educational rights, information, individuals

42:26

with disabilities, Education Act, 504

42:29

plans, individual education plans,

42:31

special education services, other

42:34

accommodations can be done for this child

42:36

for the college, I've been writing letters

42:38

for college students a lot lately, and

42:41

even for the adults on the job. And

42:43

that can be kind of tricky, you know,

42:45

when dealing with adults in the workplace, maybe

42:47

HD, and some of the letters I've had

42:49

requested. I'm like, you

42:51

are anyway, so comprehensive treatment

42:53

plans are important, making sure

42:55

that everybody's ideas and where

42:57

we're trying to go is,

42:59

it's locked in and together.

43:02

Parental consent for services, obviously,

43:05

you can, as as clinicians

43:08

and professionals and as adults and teachers, we

43:11

may want services done for a child, you

43:13

know, but we have to have parental consent,

43:15

making sure that they're on board. Legal

43:17

guardianship versus decision making. As I said before,

43:20

grandma may be taking making the decisions. I've

43:22

seen a parent show up with the child

43:24

in the room, and the dad, mom and

43:26

dad show up with one child. And

43:29

there's somebody else who's going to make the decision on whether

43:31

or not we're going to start medication and treatment. My

43:34

thought is I want everybody inside the

43:36

room who's within that decision making capacity.

43:38

I want all of everyone there, because

43:40

big mama may be the one who's

43:42

making the decision, and not either one

43:44

of those two parents there inside the

43:46

room or the child. We got

43:48

to make sure we advocate for our kids. I've

43:51

written many letters. I remember writing a

43:53

letter for a kid for special services. Despite

43:56

my letter, and what

43:58

the teacher said, They

44:00

decided to deny services for this kid

44:03

and the entire administration of the school got fired

44:06

in the middle of the school year. All right. Now,

44:09

why they chose to say that we're not

44:11

going to follow what the doctor says, we're

44:13

not going to follow what the psychologist says,

44:15

we don't believe the child needs any of

44:18

those services or health care, but realizing that

44:20

these are legal, legal documents that

44:22

you're filling out when you're receiving services.

44:25

And sometimes you need to advocate on

44:27

bus and even within the school system

44:29

to make sure that we're getting the

44:32

right type of services for that kid.

44:35

So what can we do? Hopefully today,

44:37

we've increased education to ourselves,

44:40

to our families and children

44:42

and other providers. We

44:45

need to understand these barriers that occur

44:47

inside the room. So

44:49

these unspoken words and these

44:51

unspoken fears and trust issues

44:53

are there. Ask the family if

44:55

they have any questions. Make sure you're listening to what

44:57

are their needs, what are their desires, what is it

45:00

that you want me to do? Because

45:02

honestly, when you're in my room, you actually paid

45:04

to come and see me either by

45:07

cash, co-pay or by paying insurance.

45:09

And you're there for a reason. Nobody sees a

45:11

child's psychiatrist because you just felt like it today.

45:14

That's like going to the dentist. You go there for

45:17

preventive care, but nobody feels like getting dug in the

45:19

mouth. So these are things that

45:21

we have to do that if they're in front

45:23

of me, then they went through multiple mental steps

45:25

normally to be there. We

45:27

have to be flexible in listening to people

45:29

and what their desires are. Not

45:32

everybody is the same. Educational

45:35

interventions and services have to occur for our

45:37

kids. There needs to be an

45:39

end to zero tolerance policies, especially if you're not

45:42

going to find out what's going on and make

45:44

changes inside the school and inside the home. That

45:48

impacts the kid. Interventions with

45:50

teachers and counselors and other mental health professionals

45:52

needs to occur. Law enforcement

45:54

is not trained. I don't see police

45:56

officers make bad decisions. And we see

45:58

those videos online. dealing with kids. And

46:01

it's, you know, I would say as much as I

46:03

want to be mad at the officer, I can't be

46:05

too mad, because they're not trained in that. That is

46:07

not that what they're trained to do. That's not a

46:09

part of becoming a police officer is

46:12

learning childhood development. Or

46:14

honestly, they're not learning enough about mental

46:16

health, especially when the decision decision making

46:18

occurs when it comes to calls to

46:20

the police. Most 911 calls

46:23

and SWAC calls over half of them are

46:25

going to be because of mental health, and

46:27

the police are not very well trained in

46:29

mental health. I do see some changes, though,

46:31

where they're trying to improve improve that. They're

46:35

typically not going to be trained well. Cultural

46:38

competence in ADHD are very

46:40

important. Understand these issues

46:42

that go on with people

46:45

of different races and cultures. Everyone

46:47

has unique needs and make sure that we

46:49

decrease our blind spots. I cannot

46:51

understand everybody in this country. I don't

46:54

understand everyone's background. As much as I

46:56

try to read and listen and immerse

46:58

myself in people's culture, hang out with

47:01

folks, I don't know everybody. So

47:03

if I have a blind spot, I tell people,

47:05

please let me know, it is not my intent

47:08

to offend. But in order to see a blind

47:10

spot, you have to actually driving in a car,

47:12

your blind spot is to the back left and

47:14

to the back right. But I've got to actually

47:16

turn my head to look, you have to

47:19

look for where your blind spots are, in

47:21

order to be better to address the issues

47:24

of our patients and families needs. So

47:27

if you have any questions, please enter your questions in

47:29

the box in the video player.

47:32

Yep. I have lots

47:35

of questions, really good questions from

47:37

people. Thank you, Dr.

47:39

Higgins for such an informative presentation. Before

47:42

we start the Q&A, I'd like to

47:44

share the final results from today's poll

47:46

question. In your experience, what

47:48

qualities or aspects have you found

47:51

most challenging in the search for

47:53

adequate ADHD care? Here's what you

47:55

said. 29% Said

47:57

finding a provider that specializes in a.

48:00

The H D twenty four percent

48:02

as tiny a provider who was

48:04

culturally competent. Seventeen. Percent

48:06

and Fighting says: Finding an

48:08

affordable provider. Eighteen percent of

48:11

by the a provider I can trust.

48:14

So. Yeah, snazzier

48:16

questions. So.

48:19

Of a few questions about presentation,

48:21

does a D H D presents

48:24

differently in Black and white children

48:26

and particularly in school. I

48:29

would say that. I.

48:32

Don't know. I don't necessarily believe

48:34

it freezes fear from when. We

48:37

just have to make sure that we doing

48:39

a good you know, a good. Ah,

48:42

Clinical interview of the symptoms

48:44

I'll figure freezes differently, but

48:46

I do believe that people

48:48

may say the words differently.

48:51

So essentially, as I said, appearances

48:53

did much outlived his boy throw.

48:56

Right? So obscene. And looking at a young

48:58

man in a very quiet, you know, looking

49:00

like he's in the principal's office because so

49:02

often. People. Assume I'm I'm school

49:05

principals because you're a troubling. You saw me

49:07

out there because you wanted to be to

49:09

and then so I was the it does

49:11

look differently in that way. Ah,

49:13

In how Pierces may express or what

49:15

are their motivations for being there especially

49:18

when you looking young girls they to

49:20

not to be mailbox and wow I

49:22

definitely see that would eighty a senior.

49:24

oh well that's. But. If you're

49:26

a quiet you go to class and you

49:28

look nice he appeared as you dress nice

49:30

A looking forward and you not a behavioral

49:32

problems but you're looking at the board in

49:34

all parts of the board now looking at

49:36

the teachers teaching. People may not recognize you

49:38

have a D H D so I would

49:40

say that. Did. You know the

49:42

diagnosis is diagnosis but the presentation can

49:44

be different based upon who's exactly in

49:47

front of you. That's why we need

49:49

to make sure that we do with

49:51

adequate interview for the pace and Sam.

49:53

Lights you you brought up on.

49:56

Black. Girls and we have a

49:58

question on where are. Way from

50:00

which black women and girls mask and how's

50:02

that different from white women and girls. I

50:07

will cease to always see. There's a difference

50:09

you know. But what else it was Girls

50:11

you know they seem to be a bit

50:14

more pleasant. You know when the in dealing

50:16

with ah I was a young girls. the

50:18

young boys who are having issues with behavior.

50:20

ah do. You. Know the level

50:22

of aggressive and to be less ah

50:24

denouncing with my young boys and I

50:27

would say that also some girls with

50:29

a D H D. C

50:31

in a tin of by. Our

50:33

see: inattentiveness. Initiative.

50:36

To a class where but you may be a social

50:38

butterfly. In

50:40

Back in High that there may be

50:42

some other issues that are going on

50:44

because you may be a very likable

50:46

person. I've also seen were kids will

50:48

feel embarrassed. You. Know that they're not

50:50

able to keep up. So obscene behavioral issues pop

50:53

up when I've seen black women with eighty eight

50:55

The a lot of times you learn how to

50:57

coffins. Compensate. By. By

50:59

doing other things, but also

51:02

you know if you've struggled.

51:04

And then you made it you know

51:06

question made it out of a situation

51:08

he still could. Absences of a D

51:11

H D that others don't notice. saw

51:13

say that with with girls and women

51:15

in general is less likely be diagnosed

51:17

and out on of the less like

51:19

the habit but it does present differently.

51:22

And. You may find yourself as a going

51:24

it's a woman who had going into areas

51:26

ah of work that on more than more

51:28

allow a person to be a D h

51:31

D but out you know with black women

51:33

have seen where the same when he calls

51:35

me know how our have off of these

51:37

diseases because I've gotta take your kids are

51:40

gonna take your family's you know maybe I'm

51:42

a single mom with with are women so

51:44

the point is. A

51:46

lot of times we ignore. Those.

51:49

Are the issues that are going on?

51:51

There needs to be addressed and I've

51:53

had plenty of women in general. The

51:55

plenty of black women also said I

51:57

cannot believe I want this entire time.

52:00

Without treatment. In

52:02

simply, I didn't know, I didn't sneak.

52:04

it could be me. And now that

52:06

I've finally gotten help, I've looked at

52:08

all the missed opportunities. For. Myself but

52:10

I've even had parts of the say from

52:12

Maxi is. A my husband and

52:14

my spouse among families of not being able

52:17

to be there. Like I said because I

52:19

never looked this as an issue that needs

52:21

to be trees. Yeah,

52:23

we hear a lot some women

52:25

in general about a later life

52:27

diagnosis. And how they sing so

52:30

much clear for them. To. Understand

52:32

what they went through and how they

52:34

can tell forward on. We have some

52:36

questions from providers. On.

52:39

How. Can providers. On:

52:42

Be culturally sensitive and have put

52:44

a bomb in their three men

52:46

have a D H D and

52:49

diverse populations and someone writes house.

52:51

I improve my ability to see

52:53

through my own biases to provide

52:55

better diagnosis. You

52:58

know you know of their lotta options. you

53:00

know and or know there's one way to

53:02

particularly do it. but always question your cell

53:05

phones and I do the best other could

53:07

have done. I

53:09

would always ask myself, ah, where

53:11

am I blind spots. Where.

53:13

I'm a biases and try to check them. You

53:16

know, Allow

53:18

the implicit black bias or eight

53:20

was it a H I V

53:22

or the implicit training on testing

53:24

that you could do online of

53:26

the to sell by Harvard. In.

53:30

What it does help you identify where

53:32

you're blind spots or am I thought

53:34

is you won't get rid of you

53:36

blind spots Are I? Because were raised.

53:39

You. Know we raise our race. We've seen

53:41

what we've seen and we've been taught

53:43

bad things. You know about other people.

53:45

You know you. You can go in

53:47

your life in the miracle that erases

53:49

things are different judgments about. you know

53:51

sexuality in one. That and so my

53:54

body is. It's not important. To.

53:56

A You know it's important not to ignore, but

53:58

important to make sure we. That and we

54:00

say to ourselves i'm not going to

54:03

be You know I'm not going to

54:05

be buys today about this. I'm gonna

54:07

make sure I do my job correctly

54:09

and go above and beyond because I

54:11

know I have a bit of a

54:14

biased was this particular group or individual

54:16

or people. You. Know and we

54:18

all have those biases. Nano people Seattle

54:20

see raise lousy sexuality and I'm like,

54:22

wow, know how you can nazi race.

54:25

And. and other and differences and

54:27

others were your brain makes these

54:30

pre judgments. That. May.

54:32

Be. Grossly. A

54:34

Correct. so we have to make sure that

54:36

we're paying close. Just what we do. I

54:39

do an adequate interview or implicit bias training.

54:41

Ah, Been making sure that you when you're in

54:43

the mood that individual patients that I wanted to

54:46

a bath and I'll say as if you don't

54:48

understand. Ask. Questions As

54:50

stated. questions don't so

54:52

ignorance, they show interest.

54:55

So. When you ask me the question

54:57

about so as a black male, how

54:59

do you feel about having to diagnosis

55:01

of major depressive disorder. That.

55:04

Shows me to that doctors bit thing at

55:06

since it's a who I am. a woman

55:08

needs are. And. People

55:11

are more forgiving of a question if

55:13

you are truly interested in the individual

55:15

and the impact of what you're doing

55:17

and in what is the impact of

55:19

what you doing on them. As.

55:21

I think that's a good the. And I

55:24

a massive that creates trust with system is still

55:26

in the community as well the his cell and

55:28

interest. On when they

55:30

heart, when patients have trust issues.

55:34

Definitely. South. African

55:36

Slaves have questions from adults

55:39

that Indians who believe they've

55:41

suffered childhood trauma because their

55:43

parents. Had. Untreated, A D H

55:45

D and all of the manifestations that

55:48

go along with that and sitting at

55:50

the sand and attention to their wellbeing

55:52

and sell on what are your thoughts

55:54

about this and. What are

55:56

some trauma and form fastest is that

55:58

might help them. Well.

56:02

Our say that you have to. I'm.

56:04

You. Know deal with issues of the past. Now

56:07

see a level of forgiveness forgiveness Never

56:09

one to carry anger to people who

56:11

did the best the new to do

56:13

with what they head. Or I'm understanding

56:15

that if you're a D H D

56:18

there's at least avoid since answer when

56:20

he appears as a d his feet.

56:22

Ah because it's very much inheritable and

56:24

the know people will say judge families

56:26

are parents about what we know today

56:28

versus what they did been and. In

56:31

in I am now. tell people I be

56:34

very careful of doing that. Ah, Societies

56:37

move for we know more about eighty

56:39

Ac chances are you parents and never

56:41

even heard of the term A D

56:43

H D Ah I'm and we're not

56:45

passing that, even treated and their parents

56:47

weren't treated and their parents weren't treated.

56:49

So we've gotta be careful about the

56:51

judgment. We've gotta make sure we do

56:53

the time and a therapy to let

56:55

them things go. I do not recommend

56:57

harboring anger. Ah, it's worth individuals It

56:59

may be good to have an understanding

57:01

our discussion with them if you feel

57:03

comfortable doing so. But. Don't

57:06

Judge. Them. By what they didn't

57:08

some of them did the best they did with the tools

57:10

that they hit. On

57:13

lot of your questions and thought in

57:15

school awesomely med school. It's more sensitive

57:17

to black cells or and his circle

57:19

attack that left on death than the

57:21

fast. And cell phone or behaviors

57:24

as a disciplinary matter. Education.

57:28

Education education you know, and in

57:30

also paying attention to the behaves

57:32

of. Sieges. In I

57:34

was at a restaurant last night. And. I'm

57:37

a hurts who people are testing.

57:39

Ah he wanted to starting a

57:41

fire and he was to I

57:43

people and the white male says

57:45

it away. Female well see her

57:47

scare. Far from being racist. As

57:50

like wow, somebody got far from being

57:52

racist. is i know

57:54

people are a soda and far

57:57

often at all rights so by

57:59

israel realizing here in Vegas, it's a

58:01

very diverse group of people who come from

58:03

all over the world. You've got a worker

58:05

in your restaurant who has race issues now.

58:07

And then I'm still listening and acting like

58:09

I'm cutting into my steak and

58:12

eggs or whatever. And he said, yeah, well,

58:15

the complaints kept coming from black

58:17

people and all the black people

58:19

don't complain about all the white people here.

58:21

It came from black workers and

58:23

from black people

58:25

paying for food. And

58:28

they fired her on the spot because it's

58:30

been going on for days. It was a

58:32

new hire. So I'm like, wow. If

58:35

the teacher is racist and

58:38

they keep getting complaints, I

58:40

think they should be fired. Your dad is

58:43

treating to

58:46

educate children and you've got a bias that's

58:48

causing some children not to be educated. Even

58:51

if that's 10% of the room, you

58:53

got 10% of the room who has a problem inside your

58:55

classroom. Yeah, I think you should be fired. And

58:59

if this is a problem in your district, we need

59:01

to pay attention to that. So I would say that

59:03

we have to stop allowing certain things to happen. We

59:05

do need to educate individuals. But I would think that

59:07

if you got fired for one thing on your last

59:09

job, but on your next job, you do better with

59:11

it. And trying to

59:13

not allow toleration of that behavior

59:16

inside of our school systems where

59:18

kids are supposed to be getting educated.

59:20

I was talking to a family the

59:22

other day, a kid has ADHD and

59:24

autism. And she was like, if this

59:26

school that is 90%

59:29

white, why is it only... Why

59:32

in that special classroom for math,

59:35

for kids who are falling behind, it's

59:38

only four black boys. It's

59:40

four black boys in that classroom out of

59:43

this whole school. How does that

59:45

happen? I'm like, well,

59:47

I'm assuming that's some kind of structural racism

59:49

issue. And that if less than five percent

59:51

of that school is black, but all

59:53

the ones who are in this one lower class

59:55

are black, that tells me there's a structural problem

59:57

inside of that class, inside that school system. inside

1:00:00

that school itself. And you gotta

1:00:03

make sure that you're paying attention to that and

1:00:05

realize that no, you're not crazy. You're looking at

1:00:07

the numbers and it's not haphazard for that to

1:00:09

occur. When

1:00:12

teachers suspect ADHD in a

1:00:14

child and the parents are

1:00:16

resistant to get the

1:00:18

child evaluated, how can, especially

1:00:20

if they're a white teacher and a black family,

1:00:23

how can the white teacher talk

1:00:25

to the black family in a way that

1:00:28

won't conjure negative

1:00:30

feelings, but that it's just working to try

1:00:32

and get the child evaluated for

1:00:35

his or her own best interest? Well,

1:00:38

I would always recommend that you've gotta let a family

1:00:40

know if you think that there's something going

1:00:42

on. And so being

1:00:44

honest, having

1:00:46

information will help. Things

1:00:49

to look at for

1:00:51

them to make a decision. So, I would

1:00:53

say your child has

1:00:56

ADHD, it's not good enough. You've gotta make sure

1:00:58

that you're doing all the things that you need

1:01:00

to do, but also you have to be careful

1:01:02

of, well, because the family won't trust me, I'll

1:01:05

decide not to share the information because they won't

1:01:07

listen anyway. So we'll just continue to struggle in

1:01:09

the classroom. Also looking at what you could do

1:01:12

in the classroom yourself as a teacher. If you

1:01:14

notice the kid is having issues with focus and

1:01:16

attention, moving them up to the front, making sure

1:01:18

that you stay in communication with the parents, you don't

1:01:20

have to wait for the IEP. And

1:01:23

I used to teach school. All right,

1:01:25

so you don't have to wait for the IEP

1:01:28

to make an intervention inside of your classroom. So

1:01:31

you have to let the parent know, but

1:01:33

you don't have to wait for them to do

1:01:35

something. You can actually start to do things

1:01:38

on your own. Then, as a

1:01:40

point of self disclosure, remember my daughter,

1:01:42

we moved from a mixed neighborhood to

1:01:44

a heavily white neighborhood. And

1:01:46

then the school was one of the best in the country. I

1:01:48

won't even say they were certified by Ivy Leagues

1:01:51

and all this. And we got

1:01:53

there and our child started doing poorly. You

1:01:56

know, she started to regress in her development.

1:01:59

And even in her... learning and I had a

1:02:01

teacher to tell me that they felt like

1:02:03

my child was you

1:02:06

know, not developmentally up to par with you

1:02:08

know, other kids in the classroom. We may

1:02:10

want to consider other

1:02:12

resources now realizing that the

1:02:14

teacher is a 17

1:02:17

year old rising junior in high school

1:02:19

talking to a child and adolescent psychiatrist

1:02:22

and a pediatrician which was my way. Wow.

1:02:29

Alright. So I've

1:02:31

seen this myself. Where

1:02:35

my child doesn't have autism,

1:02:38

you know, or whatever she thought was going on, but it

1:02:40

was a problem in the school and then we changed

1:02:43

schools and all of a sudden my daughter was doing

1:02:45

well again. Well, you

1:02:47

know, you know, so these are real

1:02:49

things that happen in the community that

1:02:51

can even happen to ourselves. So what

1:02:53

if I believe this person and

1:02:56

now I'm taking my child in for

1:02:58

developmental testing to

1:03:00

look for and find issues with autism

1:03:03

and they pick up something and then I

1:03:05

have paperwork and we take it to the

1:03:07

school yada yada yada and you

1:03:09

know, not to mention she's in college now

1:03:11

with a 3.7 GPA and doing it, you

1:03:14

know, looking at the internship for

1:03:16

with, you know, with the NASA

1:03:18

related company. But

1:03:21

I'm like, okay, it's time

1:03:23

for us to go. It

1:03:25

happens to us. Now, I don't

1:03:27

believe she knew I was a child psychiatrist.

1:03:29

My wife's pediatrician. We are the people who

1:03:31

do this work. But

1:03:35

no, you can't trust everybody. That's

1:03:37

a fact. Well,

1:03:39

unfortunately, that has to be our last question

1:03:42

because we're out of time. But Dr. Higgins,

1:03:44

thank you so much for joining us today

1:03:46

and for sharing your expertise with our

1:03:48

ADHD community. We appreciate

1:03:50

you. Thank you

1:03:53

all so much for having me. I greatly appreciate it.

1:03:55

I look forward to working with you all in the

1:03:57

future. Just let me know. Call me up. And

1:04:01

thank you to today's listeners. If

1:04:03

you would like to access the

1:04:05

event resources, visit attitudemag.com and search

1:04:07

podcast 495. The

1:04:10

slides and recording are posted a few

1:04:12

hours after each live webinar. If

1:04:14

you're listening in replay mode, simply click

1:04:17

on the episode description. Please know

1:04:19

there are full library of Attitude webinars

1:04:22

is available as a podcast. It's

1:04:24

called the ADHD Experts Podcast, and

1:04:26

it's available on all streaming platforms.

1:04:30

Make sure you don't miss future Attitude

1:04:32

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1:04:35

signing up for a fee of free email

1:04:37

newsletters at attitudemag.com plus

1:04:40

newsletters. Thanks everyone, have a

1:04:42

great day. For

1:04:45

more Attitude podcasts and information on

1:04:48

living well with attention deficit, visit

1:04:51

attitudemag.com. That's

1:04:53

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