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Racial Disparity in Diagnosis and Accommodation of Neurodivergent Conditions

Authors: Sariah Burdett and Caroline Cannistra

Editors: Jae Kuhn and Kristin M.


Racial disparity in education for disabled children is a well-documented trend. In American public schools, students of color are less likely to have an individualized education plan (IEP), the document that outlines personalized accommodations for disabled students, than their White peers. This underrepresentation has been observed across multiple time periods, age groups, disability types, and academic achievement levels. A comprehensive study of over 200,000 K-12 students examined the likelihood that students of different racial groups would be identified as disabled while controlling for factors such as income level, gender, and standardized test scores (Morgan et al. 2017). When looking at a sample of fourth graders, the study found that—controlling for other factors and comparing to White students—Black students were 61% as likely to be diagnosed with ADHD, Hispanic students were 48% as likely, Asian students were 29% as likely, American Indian/Alaskan Native students were 58% as likely, and Native American/Pacific Islander students were 34% as likely to be diagnosed (p < 0.01). Black and Hispanic fourth graders were also significantly less likely than their White peers to be diagnosed with autism, and all of the above groups were significantly less likely to be diagnosed with specific learning disabilities (SLD). Similar findings were reported for eighth and twelfth graders, and in datasets from different years. Other studies of school-age children corroborate these findings (Mandell et al. 2009, Coker et al. 2016).

Why do these disparities happen? The authors of one study on autism diagnoses attribute the discrepancy between diagnosis rates of Black children and of White children with what they call “statistical discrimination”, or in other words, institutional racism. Clinicians who unconsciously believe that conditions like autism and ADHD are more common in white children will downplay autism and ADHD symptoms in children of color, or attribute these symptoms to something else. This is part of a larger pattern where the institutions of education and psychiatry “medicalize the struggles of White children while criminalizing those of minority children” (Morgan 2017). A White child’s “unusual” behaviors, in other words, are framed as symptoms of disorder, while a child of color exhibiting the same behaviors would be framed as deviant, dangerous, or criminal. Another example of institutional discrimination provided by Morgan et. al. is that American public schools are not well-equipped to evaluate children with different cultural or linguistic backgrounds for neurodivergence. For example, a counselor may not be able to tell the difference between a child with a learning disability and a child who speaks English as a second language, and counselors do not always have the tools for bilingual assessment. Language barriers may also prevent parents from communicating with teachers about their child’s needs in the classroom. A lack of interpreters or bilingual materials is an example of an institutional barrier for the success of neurodivergent children.

This is only a small slice of the institutional barriers that neurodivergent people of color face in having a good quality of life. For example, this population is also heavily policed in and out of school, and children who aren’t getting their needs met are more likely to “act out” or show symptoms that others might interpret as dangerous. For children of color, this often means being arrested or assaulted by police and becoming part of the “school-to-prison pipeline”, which funnels children into the criminal justice system and often leads to incarceration. Children who don’t get the support they need in school are also less likely to receive appropriate support as adults. They may become homeless or be institutionalized, which puts them at risk for further abuse from police or institution staff. Lack of access to culturally appropriate care is also a problem that exists throughout a person’s life, not just in childhood.

Right now, the most amplified perspectives in the neurodiversity community tend to be from white neurodivergent people. Neurodivergent people of color are pushing against this, and their voices are desperately needed in this community. To start with, I recommend the writing of Morénike Giwa Onaiwu, a Black autistic professor at Rice University. Her article “I, Too, Sing Neurodiversity” targets racism in the neurodiversity community and highlights some of the issues that disproportionately affect people of color, and she has a lot of other great articles published in autistic advocacy journals.


References


Coker, Tumaini R., et al. "Racial and ethnic disparities in ADHD diagnosis and treatment." Pediatrics 138.3 (2016).


Giwa Onaiwu, Morénike. "I, Too, Sing Neurodiversity." Ought: The Journal of Autistic Culture 2.1 (2020): 10.


Mandell, David S., et al. "Racial/ethnic disparities in the identification of children with autism spectrum disorders." American journal of public health 99.3 (2009): 493-498.


Morgan, Paul L., et al. "Replicated evidence of racial and ethnic disparities in disability identification in US schools." Educational Researcher 46.6 (2017): 305-322.




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