ADHD parenting tips from a Black clinical psychologist

What should families of color know about ADHD? The hosts welcome Kristin Carothers, PhD, a Black clinical psychologist who specializes in working with families of kids who have ADHD and learning differences. 

“Dr. Kristin” shares why ADHD — and ADHD medication — often weigh heavy on the hearts of Black families. She gives practical tips on what to do if you think your child might have ADHD. And she offers strategies for families who don’t have resources or health insurance to get professional help. Dr. Kristin and the hosts also reflect on Black Lives Matter and her personal experience of being a Black doctor.

Websites and approaches discussed by Dr. Kristin in this episode:

• Child Mind Institute

• American Academy of Child and Adolescent Psychiatry

• Parent Child Interaction Therapy

• The Incredible Years

• Alan Kazdin Parenting Approach

Related resources

• ADHD fact sheet

• What I tell Black parents who worry about labels like ADHD for their child 

• How to get a free or low-cost evaluation for your child

Episode transcript

Julian: Welcome to "The Opportunity Gap," a podcast for families of kids of color who learn and think differently. We explore issues of privilege, race, and identity. And our goal is to help you advocate for your child. I'm Julian Saavedra.

Marissa: And I'm Marissa Wallace. Julian and I worked together for years as teachers in a public charter school in Philadelphia, where we saw opportunity gaps firsthand.

Julian: And we're both parents of kids of color. So this is personal to us.

Welcome back to the show. Hey, Marissa.

Marissa: Hey, Julian.

Julian: We're really hyped today because we have a very special guest here: Dr. Kristin Carothers, PhD. She's a graduate of Howard University and DePaul University. She's a clinical psychologist. That means she works directly with families of kids with learning and thinking differences, like dyslexia and ADHD. And in addition to working with families, she's also a professor of psychiatry at the Morehouse School of Medicine in Atlanta, Georgia. And she's worked with Understood on many different projects, including our Wunder app, which we're really proud of. So let's welcome Dr. Kristin to the show.

Marissa: Thank you. That's awesome. Dr. Kristin, welcome. It's so great to have you. Thank you for joining us.

Kristin: Thank you for having me. I'm really happy to be here today.

Marissa: Everyone has this idea of what ADHD is, but for those who are new to this, or maybe not new, but maybe just unsure and unclear of what it is, how do you explain that to families? How do you unpack what ADHD is for families?

Kristin: First thing I try to do when I'm explaining to families what ADHD is, is to let them know that it's a thinking difference that has a brain basis. So if we think about our brains and how they work and how we in a given day have to manage like multiple demands, right, so we've got a plan. We've got to organize. We have to respond to some things. We have to filter out information that we don't need to respond to.

And what happens with ADHD is that you can have difficulty meeting those demands for a number of different reasons. And so we call it a neurodevelopmental disorder. And so what that means is that there's a brain basis for it, but it also has many environmental components that play a role in symptoms and presentation. But when you go to see a clinical psychologist or a psychiatrist, or even a pediatrician, and they tell you, oh, your child may have ADHD, what they're talking about is attention-deficit hyperactivity disorder.

And in the past there was ADD or attention-deficit disorder. And there was thought there's a difference between ADD and ADHD, but now we only use the one umbrella, ADHD. And then there are three presentations under that umbrella. Sometimes parents will say, "The brother is ADHD. He can't be." And so what they might be talking about is differences in symptoms that they noticed, but that's because there are different presentations.

So the first presentation is the hyperactive impulsive presentation. Those are the kids who are talking all the time, jumping when they should be sitting, running, climbing in situations where it might be dangerous. We would say those are Energizer Bunnies. So that's the hyperactive impulsive type.

The next presentation is the inattentive presentation. And these are our kids who are maybe forgetful. They're losing things all the time. It's almost as if you tell them to do something, goes in one ear and out the other. If the hyperactive kids are like Energizer Bunnies, the inattentive kids are like my space cadets. So it was like, "Hey, come back to Earth. Bring it back. Where were you?"

Then we've got the third presentation, which is a combination, where kids present with symptoms of hyperactivity and impulsivity and also symptoms of inattention. So they've got like this gumbo going on, where they have a mix of the symptoms at any given time.

Marissa: That's super clear and really helpful. I've heard it before. I've never heard it explained so well, so thank you very much for that explanation. And I can like envision and see the students that I've worked with and the family members and people that I know and love. That is them.

Julian: So from your perspective, what is unique about ADHD specifically for people of color? And then, even more specifically, for Black families?

Kristin: I think a perfectly timed question. So I'm also Black, in predominantly Black settings, and wasn't even really introduced to the concept of ADHD until my high school years, when the setting that I was educated in was predominantly Black, but it became integrated with more white students. And at the time, what had happened was some students had been put out of their Catholic school and they were sent by their parents to their neighborhood school.

So it was an interesting community because it's a white community, but the school in the community was all Black and the community didn't send their kids. But once they came, we learned about, oh, people take medication during the day to help them focus. Well, we had never heard of that.

And so I'll disclose I was in high school in the late '90s, early 2000s. I didn't really know anybody who was on medication for ADHD or who had been diagnosed with ADHD. But I started to become aware that some of the kids who came to my school, that they were either diagnosed, that they had been on medication, that people would say things to them: "Did you take your meds today?" And I was like, "What is this?"

Why am I saying all that? I think from the perspective of Black people, if a kid was evaluated or diagnosed, it was sometimes parents might say, oh, you're letting the system label them. OK, so there's already this like cultural mistrust for us and especially parents of Black boys. So that if a school system or a teacher wanted to evaluate a kid who was a Black kid and they presented with symptoms, parents would become mistrustful, because we don't know — you can't trust what the government does.

You can't trust that label won't be applied to your kid and that label won't follow them through their life. And then they won't be able to get a good job and they might be fast-tracked for the prison system. So we have all of this like healthy cultural paranoia that I think impacts Black people historically and currently, when we think about ADHD and diagnosis.

I was talking with my mom today about a friend that I grew up with and, or a couple friends I grew up with, where in retrospect probably did have ADHD, but we were so afraid. Even family members were so afraid of the intervention, due to the labels, that the intervention did not happen.

And in hindsight, yes, maybe they did, but at the time it was not safe to be evaluated, get the label. Or we felt it was unsafe to medicate. So that's kind of my perspective when it comes to like how we're moving through this cultural acceptance of can ADHD be a disorder that doesn't necessarily mean we've got a label that's gonna follow us for life. We can get help, treatment for it.

Julian: I didn't hear about this until I went to college and it had been something that I just was floored by. I didn't realize that medication was a thing. I didn't realize that these symptoms were actually scientifically proven to be a disorder. I just thought it was kids couldn't sit still. And so it was a really eye-opening experience for me, specifically because I went to a primarily white institution for my college. And I had grown up in primarily Black settings, too. So going to that situation, it just, it opened my head up.

Given that this is both of our experiences, right, and I think people in our age group probably experienced similar things, do you see it changing? Do you see some of that being altered now?

Kristin: I definitely see a little bit more acceptance in the Black community for the fact that a kid's symptoms can be tied to this like brain basis. That is not because the kid is just bad or acting now. But I think where we're still on the border and on the fences around medication and mistrust around like institutions and medical doctors. I think that some of that is mistrust. And some of it is like lack of knowledge. So if a kid is diagnosed and prescribed medication, parents may think, "Well, I gave it to him that one day, but his stomach hurt. I didn't give it to him again." Or "We gave it to him one day or four week and it didn't work. So we didn't do it again." Or "Medication doesn't work" or "Therapy doesn't work." And so I think what's happening for us is there's a lack of education about what the evidence-based treatments are — the fact that there are different classes of medication for ADHD.

So because one medication doesn't work, it could be that the dose was too low. It could be that it's the wrong class of medication. It could be that the kid will respond better to a different medication. Or it could be that it's an environmental thing and that there needs to be an environmental intervention.

Not every child diagnosed with ADHD is going to take medication. Most of the work is going to be parent and teacher training to modify the environment. And so that's the biggest thing that I find that people don't know.

Julian: As a clinician specifically with what you do day to day, how do you go about treating and providing treatment? Is it a combination of advising the behavioral modifications? Is it subscribing medication like the parent side? Like what is it that you typically do?

Kristin: So I'm a clinical psychologist. And so I do not prescribe, I'm not an MD. So across the states, in most states, the only people who can prescribe medication are psychiatrists. So psychiatrists have gone to medical school. They are medical doctors. Or pediatricians, depending on the state, you, which you live. Some pediatricians are more comfortable with diagnosing and medicating, but most pediatricians will refer parents to a child and adolescent — a board-certified child and adolescent psychiatrist for medication management if that's something they should decide to do.

Evidence-based suggests that the fastest response is going to be to medication. Long-term, though, the longest-term effects are going to be with behavioral parent management training and school consultation. So what I do is behavioral parent management training and school consultation.

And so there are a couple of different models that, um, clinicians can be trained in. There are some individual, there are some group models, there's some individual models, parent intervention, that are all based on the same premise that the coercive cycle of interaction between parents and kids can drive or increase these impulsive behaviors. And that the environment has to be modified or shaped so that the kid receives lots of positive attention for on-task behaviors, thus increasing those behaviors.

And we try to actively ignore negative, attention-seeking behaviors as much as possible, and also set the kid up for an environment that's successful. So what I do is behavioral parent management training and school consultation.

Julian: Focusing on the positive reinforcement aspect of it. Gotcha.

Kristin: And you know what I'll say about that positive reinforcement thing is sometimes people are like, "Oh, well you want me to just praise my kid?

Just praise my kid? What about what they do something wrong?" It's not just about praising your kid. It's about getting them to understand that there are certain behaviors that you're going to be really specific about that you're going to help them to be aware of that they need to increase. And when they increase those behaviors, you're acknowledging it.

I also want to remind parents that we enjoy praise and we enjoy reinforcement when we do something well. So none of us shows up to our jobs for free. We enjoy getting a paycheck. We want that compensation. So there's nothing wrong with giving people feedback about positive behavior. That's how we work as human beings.

Marissa: Yeah, it's so necessary. It's just ingrained, right? And I'm listening and I'm thinking to myself, how do you start to get the buy-in?

Kristin: When I'm trying to like join with a family or a parent that might be resistant to the idea that their kid is presenting with these problems, is that I try to keep in mind that parents are the experts on their children. And so even though I may see this kid in a number of settings and notice things, at the end of the day, the parent really is the expert on their kid.

And so as much as I can find out from them: What do you notice at home when you tell them to do X, Y, or Z? How many times do you have to call before the person comes or addresses? Have you noticed that the kid is having difficulty breaking away from this, but then they're really super focused on this. You can’t get them to do homework, but you can get them to do this for hours. That actually has a name, and this is what it's called.

And so sometimes it's like parents have that "aha" moment because there are things that they thought of as maybe being a personality thing that might really be a symptom of ADHD. And I'm validating that they are having this experience at home. And it's likely a similar experience that teachers are having at school.

Julian: Parents, do y'all hear that? Do y'all hear Dr. Kristin talk about how you all are the experts with your own children? Just want to lift that up and that everybody out there listening, Dr. Kristin is validating the fact that you all are the ones that know your kids. And that's something that we've been talking about a lot with our podcasts since the beginning.

Marissa: And that is something that we need to continue to remind our families, because I think that is a key part that's missing a lot of times. And that's why students are often struggling in school, because they're — that parent piece is always, or there's assumptions that are made. And I think it's important that our parents know how valuable and important they are.

So then with that being said, Dr. Kristin, I'm curious, for some families who are trying to get help, however, they might not have access to some of the resources or they might not have the financial ability or the insurance. Or even just like you said, there might be a knowledge gap or something missing there. What tips or advice can you give to those families?

Kristin: This, this is a big issue, right? There aren't enough clinicians to do the work. Even if there are enough clinicians, some of them don't accept insurance. Even if they do accept insurance, they don't have any space. So what do you do as a parent?

I often refer family members, friends, potential clients to sources of evidence-based information that are online. So for instance, I had a family member who reached out a couple of weeks ago about a child who has ADHD. They had medication from a pediatrician, weren't able to follow through. I say first, step one, you're going to go to this website, Understood.org. And you're going to look at what are learning differences. Childmind.org. The American Academy of Child and Adolescent Psychiatry. These are websites that have evidence-based, accurate information that parents can access, right? It's not treatment, but at least it's information, so you know you're not alone.

The other thing that I recommend is that parents reach out to the academic medical centers in their community or the closest big city to where you are.

The reason I say this is because academic medical centers typically train child and adolescent psychiatrists. And if they also train clinical psychologists who are doctoral level or pre-doctoral level. If you don't have an academic medical center, do you have a university, a college where there's a doctoral program in clinical psychology, where there are programs for licensed clinical social workers.

Those universities, schools, often have community-based clinics where they provide services at a free or very reduced fee. And so the other thing I think is you check in with that pediatrician. You say to the pediatrician, "Hey, I need help. I need referrals."

And then the final thing I would say is you gotta be careful with what you watch and consume because you don't necessarily know how truthful it is. But often there are YouTube videos that are by like organizations like Understood and AACAP — American Academy of Child and Adolescent Psychiatry — that provide information about symptoms and what you might see. So the web, I think, while you're waiting to get treatment, use that as a resource.

Julian: You know, I guess the takeaway is that you don't have to feel like you're alone. You don't have to feel like nobody has not gone through this before. And you have to remember that as families with children, you have a right to the services that are needed, you have a legal right to get what is needed. And so don't ever feel like you have to take this on by yourself.

Marissa: And I think one thing that stood out that you were talking about, Dr.

Kristin, and I think is important for families and for educators to know too, is the piece of it that is so much the changing the environment. Because I know I've worked in schools with families where a lot of times there is a holdup with their pediatrician. There is a holdup in getting their medication refilled. And so that can't be the only answer. Yes, I understand that it's part of their management piece and part of what they need. However, it is also up to what we're doing. How are we developing our environment? How are we supporting them with what they need in so many other ways that are non-medication related?

Kristin: Yeah, I agree. The other thing that I was going to say in terms of resources that are like, based on that environmental piece, some of the evidence though, the websites for evidence-based interventions that we do that really do impact that environment or that parent child interaction. They'll have resources on their website about, OK, what can you say to your kid? How do you structure the environment? So one model is called parent child interaction therapy, PCIT. And if you Google PCIT and international, you can go to their website and they'll have a list this just for parents.

There's another model that's a group-based intervention called the Incredible Years. If go Google the Incredible Years program, you'll get to their page. And it'll say for parents, right?

Or the Alan Kazdin behavioral parent management approach, Google it. And there'll be books that come up for really good information that can help you to start it if you need tips about, OK, what do I do at home to get them on task for getting ready for school. What do I do at home to motivate them for getting through homework?

Julian: I would love to know, Dr. Kristin, um, and you know, I think about even my own children, just the experience of interacting with a Black doctor. What's that like for you and formulating that, that relationship and just what's it feel like to move into a family's home, and regardless of the race of the patient, just being a Black doctor, what is it like for you?

Kristin: Depending on the context in which I was in and the time, things have changed. So if I think back to graduate school, when I was coming from the South Side to work with families on like the near North Side who were in public housing and I clearly was not in public housing, it was I'm Black, I'm from Chicago. But economically I've had a very different experience. And so working with a Black parent, I remember the parent was talking about being in public housing. And I say, my family came from public housing too. And she said, but you all were fortunate enough to get out.

Then I go to New York and I'm in Washington Heights, and I'm working with parents who are undocumented. I'm working with parents whose children have to interpret for them. That I'm able to still build a really strong relationship because we have this consistency, but they had to teach me so much about the culture because I know nothing. And so I'm in a position where I have to learn about not just like that, there's a language difference, but there is a cultural difference.

And so, can I connect with them when I can't speak their language and I'm Black and I'm not Dominican? So there's that. Then I go to Child Mind, and the families that I worked with that were Black were like me, middle-class. But there were very few of them. And so almost exclusively, my clients, the clients that I worked with were white and affluent and almost, for the most part, I was always respected.

There were a couple of times where it was like, I knew that because I was Black, things were different. So there might be client that was supposed to come to me and then they didn't come to me. And I don't know why they didn't come or they didn't stick. And it's like, am I bad therapist? Or did I not stick because I was Black? Or is my rate of getting clients and keeping clients different? Because when you're on Park Avenue, people are looking at your diplomas, where you went to school, and they're looking at what you look like. We gotta be, we real about that. Just like they looking at that when they're in Atlanta and they say, I want a Black therapist.

And so with the whole Black Lives Matter movement and everything, it's been as a Black doctor who's around other doctors who aren't Black, it was like really important for me to let people know, like I am Black, like Black-Black. And so this movement is like my life. And so I need you to know that if you work with me, or if you're in spaces with me, and then I guess where it breaks down for families and kids is now, there will be some times where I'm working with Black families and there will be some things, and they're like, "I don't have to explain this to you cause you know what I'm talking about." And it might be like a, a family, like a, some family-level issue. It might even be something about a sorority or a fraternity. And they're like, but on the flip side, when I'm talking to my white patients about it, I'm like, you got to explain that to me. I don't know.

Julian: And I think that's the point of asking it, is that for our listeners, regardless of who they are in hearing the complexity of your experience and what it means to be a Black professional in this work, is important to hear. And it's also important to hear that it's not a uniform experience, but we all have different things that happen to us and different things that shape who we are. But it doesn't change our devotion to the work and our devotion to what we do and how we're uplifting people.

So I just, I love everything that you've shared with us today. I love everything that you've chosen to talk about in terms of the recommendations and, you know, your life story is inspirational on so many different levels. You you've hit the gamut.

Marissa: And just to piggyback off of what Julian saying, I think it's a breath of fresh air too, for us to listen and to hear. Because a lot of the conversations we have, sometimes we don't always have easy answers and not, and not that you gave easy answers, right? I do think though, that you gave a lot of applicable and a lot of tangible things for our listeners to connect with. And because of just the diversity within your experiences, that in itself makes you relatable. So thank you seriously, so much gratitude, Dr. Kristin.

Kristin: Thank you. And I just want to let families know, and parents. Like, this is hard work when you get this information. They're like, "Oh, my kid has ADHD. What now?" And even sometimes I feel like when my family comes to me, I'm like, oh, I'm failing my family. How am I sharing all this information with all these different resources and my family doesn't even know?

It's because it's like really hard work and it can be exhausting. And so you are not alone. And if you feel like you're tired or you just don't know where to start and it's overwhelmed, totally get it. But places like Understood — and I was going to Understood before I was even like any way affiliated with Understood.

Marissa: I remember in graduate school, right in graduate school. I was like, especially as a special educator. And it just was like, again, like, I felt like there wasn't often a lot of times besides like your textbooks, right? They were like, here's where you get the information. I was like, well, no, I need things that are a little more up-to-date websites.

Kristin: Yeah. The IEP Toolkit, like the Understood — the number of times that I've sent emails to parents, like just go to this website and read what it says. And here's the letter to request that like, here's a template, like this will walk you through it.

Julian: I, again, I just want to reiterate the pleasure that we have of having you join us, and we really appreciate everything you had to say, your time. But also for our listeners out there, let's help encourage more of our young people to be like Dr. Kristin. We need more of you out there. We need more of you to be out there doing this work from a place of authenticity.

Everything that you said comes from a place of realness and authenticity. Our families out there, really encourage people in your lives and community to find ways to do this type of work, because we need it, but find people that you can trust. That's really what it comes down to.

This has been "The Opportunity Gap," a part of the Understood Podcast Network. You can listen and subscribe to "The Opportunity Gap" on Apple, Spotify, or wherever you get your podcasts.

Marissa: If you found what you hear today valuable, please share the podcast. "The Opportunity Gap" is for you. We want to hear your voice. Go to u.org/opportunity gap to find resources from every episode. That's the letter U, as in Understood, dot O R G slash opportunity gap.

Julian: Do you have something you'd like to say about the issues we discussed on this podcast? Email us at opportunitygap@understood.org. We'd love to share and react to your thoughts about "The Opportunity Gap."

Marissa: As a nonprofit and social impact organization, Understood relies on the help of listeners like you to create podcasts like this one to reach and support more people in more places. We have an ambitious mission to shape the world for difference, and we welcome you to join us in achieving our goals. Learn more at understood.org/mission.

"The Opportunity Gap" is produced by Andrew Lee and Justin D. Wright, who also wrote our theme song. Laura Key is our editorial director at Understood.

Scott Cocchiere is our creative director. Seth Melnick and Briana Berry are our production directors.

Julian: Thanks again for listening.