Why ADHD Is Underdiagnosed in the Asian American Community — and How to Recognize It
Key takeaways:
ADHD is underdiagnosed in Asian Americans because of differences in cultural values, societal pressures, and access to culturally competent mental health professionals and services.
ADHD symptoms may present differently in Asian Americans. For example, they may mask their hyperactive symptoms to fit in. Or develop perfectionist habits to avoid bad grades.
It’s important to find culturally competent mental health professionals to get the support and the help you need to manage the challenges of ADHD.
Table of contents
Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects someone’s attention, impulse control, and activity level. It can affect anything from performance at school to personal relationships. But with the right diagnosis and treatment, managing these challenges can be much easier.
The diagnosis of ADHD has increased significantly over the past 10 years. But Asian Americans, Native Hawaiians, and Pacific Islanders (AANPHI) consistently have the lowest rates of diagnosis. One study of children found that only 6% of Asian American children were diagnosed with ADHD, compared with white (14%) and Black (12%) children. Asian American children are also less likely to receive treatment.
There are several theories for why ADHD might be missed in the AANPHI community. Let’s take a closer look at how cultural and societal factors affect the ADHD experience, and how Asian Americans may experience it differently.
Why is ADHD underdiagnosed among Asian Americans?
Each culture that falls under the AANHPI community is different. But there are some common factors that can affect people’s symptoms and experiences with ADHD:
Pressure to be well-behaved: Many Asian cultures value when people are quiet and polite. But people with ADHD often experience hyperactivity and emotional dysregulation.
Idealized path to success: Many Asian cultures believe that hard work will lead to success, and that “trying harder” will solve challenges at work or school. Common ADHD traits — such as an inability to focus — may be labeled as laziness.
Lack of mental health discussion: In many families, it’s not acceptable to discuss emotions or feelings. This can make it difficult for children to share their struggles with their parents.
Communication barriers: About 31% of Asian Americans aren’t fluent in English. These language barriers can cause communication breakdowns between parents, children, and healthcare professionals. And some symptoms don’t translate well.
Asian Americans may also be less likely to seek out diagnosis and treatment.
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This could be partly because of the false stereotype that Asians are naturally smarter than their peers. But even though this a myth, it still puts pressure on Asians to meet unachievable expectations — and can lead to feelings of shame and insecurity when they don’t. So this can discourage them from talking about any challenges at school.
There’s also a harmful stigma in Asian culture that mental health conditions are the individual’s fault. This can discourage people from seeking outside help.
“Medication, in particular, is heavily stigmatized,” said Angela Nguyen, MSW, family and adult therapist. “Many of the Asian American clients I have worked with have been hesitant to seek therapy or coaching, and have been particularly hesitant about medication.”
A lack of culturally competent mental health professionals may pose another problem. Healthcare professionals, providers, and services that don’t understand how ADHD may present differently in Asian Americans may end up diagnosing other mental health issues, such as depression, anxiety, and bipolar disorder instead of ADHD.
How might ADHD signs present differently in Asian Americans?
Common signs of ADHD include:
Inability to sit still
Interrupting others during conversations
Fidgeting or moving around restlessly
Talking excessively
Struggling to pay attention or stay on task
Having trouble noticing details
Not following directions
Poor organizational skills
Forgetfulness
But given the cultural pressures discussed above, ADHD may present differently in Asian Americans. Many people believe that inattentive symptoms are more common than hyperactive symptoms in Asian Americans. But Nguyen disagrees.
“It’s not that inattentive symptoms are more common than hyperactive symptoms in Asian Americans,” Nguyen said. “It's more that strict expectations of being quiet and well-mannered can lead young Asian Americans to mask any hyperactive symptoms they do experience. This is especially true for young girls and women.”
Asian Americans with ADHD may:
Mask their symptoms to fit in
Turn down time with friends, hobbies, or activities outside school in order to keep up good grades
Be more inclined to seek out school tutoring instead of mental health support or therapy
Develop perfectionist tendencies, which can mask struggles in school and lead to diagnosis much later in life. Healthcare professionals may not consider that kids might have ADHD if their grades are good.
Develop other mental health issues — such as anxiety and depression — because their ADHD isn’t recognized or treated
Develop imposter syndrome, which is when someone feels like they don’t deserve their success or achievements
“The internal and external pressure to perform well can also mean that people with ADHD will experience a lot of stress as they try to hide or compensate for their ADHD symptoms,” Nguyen said.
What are some causes of ADHD in the Asian American community?
The causes of ADHD are still being studied. But research shows that ADHD can be inherited. You’re 2 to 8 times more likely to have ADHD if one of your first-degree relatives has it, too.
In addition to genetics, other risk factors may play a role in the development of ADHD:
Environment: Increased exposure to electronic media — such as TV and video games — may interfere with someone’s ability to focus on less stimulating tasks.
Diet: Consuming caffeine may be associated with increased risk of ADHD. Deficiencies in copper, folate/folic acid, iron, omega-3 fatty acid, or zinc are also linked with a higher risk of ADHD.
Life experiences: ADHD symptoms in healthy adults are associated with stressful life events.
Certain substances and chemicals: Higher exposure to materials, such as lead, manganese, polyfluoroalkyl chemicals (PFCs), and phthalates may be associated with increased risk of ADHD.
Can ethnicity affect ADHD?
There isn’t much research on how ethnicity affects ADHD risk, if at all. But one recent study suggests that there’s a difference in ADHD-associated genes between African American and white populations. This research suggests that the genetic risk may vary depending on ethnicity. And that there may be a genetic explanation for why the symptoms can vary among different ethnicities.
How to find culturally competent support for people with ADHD
ADHD isn’t preventable or curable. But there are still many options to help you manage and thrive with this condition. This includes both therapy and medication.
To work out the best treatment plan, it’s important to be open and honest with your mental health about your experience. Nguyen suggests discussing the “behind the scenes” of your academic and/or work performance. This includes things like what it’s like for you to:
Concentrate or focus
Plan ahead
Prioritize tasks or responsibilities
Manage your schedule
Remember important details or plans
“If you believe that you or your child may have ADHD, you may have to advocate strongly, as there are educators and healthcare professionals who believe that 'good' academic performance means that ADHD is not even a possibility,” Nguyen said.
Finding culturally competent mental health professionals and services can result in a more comfortable experience. Here are some tips for finding a culturally competent mental health professionals:
Contact healthcare providers with a similar cultural background to your own.
Ask for recommendations from people you trust.
Ask about a mental health professional’s experience, their familiarity with your cultural background, or cultural competence training.
Tell healthcare professionals about traditions and values that are important to you.
If you are Asian American and looking for resources on ADHD, diagnosis, and treatment, here are some organizations with an emphasis on serving the AANHPI community:
Discussing ADHD: What is it called in my language?
Outside of diagnosis, treatment, and therapy, it’s important to open up discussion surrounding ADHD with family and friends. Here’s how to refer to ADHD in some Asian languages:
Language | Term for ADHD |
注意力缺乏多动障碍 | |
주의력결핍과잉행동장애 | |
ちゅういけつじょたどうせいしょうがい | |
अटेंशन डेफिसिट हाइपरएक्टिविटी डिसऑर्डर | |
สมาธิสั้น | |
attention deficit hyperactivity disorder | |
rối loạn tăng động giảm chú ý |
A note that some of the above languages don’t have their own name for the condition. Instead, they have adapted the sounds of ‘attention-deficit hyperactivity disorder’ to their own language. Additionally, many languages may simply use the shorter term “ADHD”, taken from English.
The bottom line
Asian Amerians have the lowest rate of ADHD diagnosis and treatment than any other ethnic group in the United States. This may be partly due to the cultural and societal pressures that dissuade people from asking for help and getting a diagnosis. But diagnosis and treatment can make a big difference in the day-to-day challenges that come with ADHD.
If you or someone you care about may have ADHD, start with an honest conversation with a trusted healthcare professional. For many, this may mean finding a culturally competent healthcare professional who understands how ADHD can look and feel different in the Asian community.
Why trust our experts?
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