Although public health researchers often account for socio-economic factors when examining racial or ethnic disparities in health conditions like asthma, Morgan said, such analyses are rarely used in educational research. Yet Black, Hispanic and Native American children are much more likely to experience poverty in their families as well as in their neighborhoods. Poverty increases children’s risks for exposure to lead, environmental toxin, low birthweight, violence, and other factors related to disabilities.
“It is clearly important to establish whether U.S schools are biased in how they are identifying children with disabilities,” he said. “A standard way to do so is to contrast children who are similarly situated in factors materially relevant to having disabilities but who differ in their race, ethnicity or national origin. When you conduct those types of contrasts, you repeatedly find evidence for a completely different problem than what federal legislation and regulation attempts to address.”
“Among children who are similarly situated including those who are attending the same schools, you repeatedly find that children are white and English-speaking are more likely to be identified as having disabilities,” Morgan said. The finding has been replicated across different grades, in different datasets, using different types of methods and statistical controls. Morgan and his colleagues find that the disparities are large. For example, Black children have odds of being diagnosed with ADHD that are about 70% lower than similarly situated white children.
The reasons for the under-diagnosis of disabilities among children of color are not yet clear, Morgan said, but some hypothesized mechanisms include a lack of access to health insurance, dismissive healthcare providers who do not consider the child’s struggles as indicative of disability or who are not culturally sensitive, a lack of knowledge about disability within some marginalized communities, and potential concerns about stigma.
“There’s been a well-justified concern in some communities about the potential for stigma,” said Morgan. “Studies find that parents of children with disabilities living in historically marginalized communities report experiencing stigma.”
Many parents of color have experienced difficulties in getting their child appropriately evaluated and provided with services to which that child is entitled, Morgan said. The consequences of not being diagnosed and treated can be particularly damaging for women of color with ADHD, as reported in an article in The Washington Post that cites Morgan’s research indicating that by kindergarten, Black children in the United States are less likely to receive an ADHD diagnosis than otherwise similar white children. According to the Washington Post article, Black girls with ADHD often remain undiagnosed because the common symptoms of the disorder, such as inattentiveness or impulsivity, could be mistaken for laziness or defiance. As they grow into adults, it is increasingly likely that their symptoms will worsen if they are not diagnosed or treated.
“Over time, studies have shown that ADHD, especially in girls, can lead to increased rates of anxiety and depression, risky behavior, drug use, self-harm and suicide attempts,” the article states.
According to Morgan, under-identification of ADHD and other disabilities among minoritized students may be contributing to racial/ethnic achievement gaps and to the “school-to-prison pipeline,” a national trend wherein children are funneled out of public schools and into the juvenile and criminal justice systems.
Treatments for disabilities such as ADHD including medication are well-validated, Morgan said, and outcomes are generally better for children who receive treatments for their disabilities. There is evidence that children who receive services through special education programs tend to do better academically, he added, which should lessen the likelihood that the children are later involved in the criminal justice system.
“Having a disability and not being appropriately recognized and receiving services, you’re more likely to struggle,” Morgan said.
Addressing the problem of under-identification of disabilities is hindered by the fact that “identification disparities are not currently monitored for by the federal government in ways that account for other explanatory factors,” Morgan said. Possible solutions include monitoring using federally collected datasets such the National Assessment of Educational Progress or the U.S. Department of Education’s Civil Rights Data Collection as well as making sure that information about the signs, symptoms and available treatments for various disabilities are distributed equitably to all families.
“We could better monitor for the problem and make sure the ways we’re disseminating information about disability is accessible to all families, not just to those who are better resourced and more advantaged,” he said.
Morgan and his colleagues are continuing their work in the area of disability under-identification through a new project being funded by the U.S. Department of Education’s Institute of Education Sciences. One of the possibilities for future research is expanding their datasets — some of the data they have doesn’t start tracking the students until later in elementary school, while other datasets are limited to infants and toddlers with no records of what happens to the children after they begin kindergarten. Morgan said they “need more data that follows kids across a longer timeframe” as well as more qualitative studies that examine how families of color are experiencing special education during the evaluation and eligibility stages.
“Given increasing concerns about equity and social justice in U.S. schools, we need to make sure that all children with disabilities are able to access the treatments and services to which they are entitled regardless of their race, ethnicity, or national origin,” said Morgan.