Interactive Effects of Racism and Racial Centrality on ADHD Symptoms

Abstract

Objective:

Although race-related stress is associated with numerous mental health outcomes, no previous research has examined associations with ADHD symptoms. We examine how such associations differ in Black Americans based on racial identity to allow for more nuanced understandings of racial discrimination’s association with ADHD symptoms.

Methods:

This study asked a sample of Black Americans to answer questionnaires assessing race-related stress, ADHD symptoms, and racial centrality.

Results:

In predicting ADHD symptoms, we found a positive effect of race-related stress and a negative effect of centrality. At low levels of centrality, the association between ADHD symptoms and race-related stress was stronger than at mean and high levels of centrality. Through additional sub-group analyses we found the interaction effect not replicating in one of our conditions.

Conclusion:

These results suggest experiences of race-related stress and racial identity are important factors for consideration in the treatment of ADHD symptoms.

Keywords

ADHD race stress symptoms

Introduction

Race-related stress refers to the stress connected with the experiences of racism and prejudiced treatment due to one’s race and is encountered by individuals from racially marginalized groups in their daily lives (Harrell, 2000). Race-related stress can occur at various levels corresponding to structural (i.e., inequitable societal systems, institutions, and policies), cultural (i.e., cultural practices seen as more superior to others), individual (i.e., experienced on a personal level), and collective (i.e., group level) racism (Utsey & Ponterotto, 1996). Race-related stress can have deleterious impacts on Black Americans’ mental health, as evidenced by associations with worse psychological distress (Roach et al., 2023; Sibrava et al., 2019), including both anxiety and depression symptoms in youth (Priest et al., 2013), as well as adults (Lewis et al., 2015; Soto et al., 2011). Additionally, greater exposure to race-related stress is positively associated with a variety of other internalizing symptoms, such as emotional dysregulation and rumination (Roach et al., 2023).

Despite a large body of work examining psychological correlates of race-related stress, many of these studies have focused on mood symptoms such as depression and anxiety. For example, in Paradies’s et al. (2015) review, 70% of studies included either depression or anxiety as an outcome. Relatively less work has examined the association between race-related stress and symptoms of attention-deficit/hyperactivity disorder (ADHD). ADHD is a neurodevelopmental disorder that usually begins in childhood and can continue into adolescence and adulthood (American Psychiatric Association, 2013). It is characterized by persistent patterns of inattention, hyperactivity, and impulsivity that can interfere with daily functioning and development (Ryan et al., 2015). Individuals with ADHD may have difficulty sustaining attention which may significantly impact their daily life (Salomone et al., 2020). ADHD may often occur with other co-morbidities such as anxiety, depression, and substance abuse which can negatively impact overall emotional and physical wellbeing (Katzman et al., 2017). Because ADHD is associated with high impairment and is strongly linked to anxiety, depression, and emotional dysregulation, examining the impact of race-related stress on ADHD symptoms is imperative to further understand how this unique stressor can negatively impact Black Americans.

Prevalence of ADHD Among Black Americans

Although Black individuals are at a higher risk of ADHD, there is a lower rate of detection and diagnosis within this community (Cénat et al., 2021; Coker et al., 2016). There are also racial disparities in teachers’ reports of ADHD symptoms in Black children (Cénat et al., 2021; Coker et al., 2016). The differing perceptions of Black children’s behaviors compared with White children’s behaviors by non-Black teachers and educators may vary significantly (Moody, 2016). Black children are more likely to be diagnosed with oppositional-defiant disorder (ODD) for behaviors versus ADHD (Fadus et al., 2020). Because of the negative stereotypes associated with Black people being aggressive, violent, and loud (Woods-Jaeger et al., 2022), teachers may view these ADHD behaviors in Black children as normal and typical (Fadus et al., 2020) rather than as something that should be intervened upon. To address these issues in the literature, it is critical for there to be more empirical research on how ADHD is associated with environmental factors unique to Black individuals (i.e., race-related stress) as well as the potential role of culturally specific risk factors.

Racial Centrality’s Interaction with Race-Related Stress

While existing literature indicates that race-related stress negatively impacts Black Americans’ mental health (Williams, 2018), less is known about the degree to which buffering factors, such as racial identity, play a role in experiencing this stressor. Racial identity refers to the personal significance and meaning of race to one’s self-concept (Sellers et al., 1998). It is multifaceted and can be influenced by various factors, including cultural upbringing, personal experiences, and social interactions (Cross, 1991). Exploring the role of racial identity in race-related stress can help further our understanding of its impact on ADHD symptoms.

Racial centrality, or how central one’s Black identity is to their sense of self (Sellers et al., 1998), can negatively or positively influence individual’s experiences of race-related stress. Studies have found that low levels of racial centrality may by associated with race-related stress in Black Americans (Banks & Kohn-Wood, 2007). This may be due to individuals with low racial centrality seeking connections with people outside of their racial groups compared to those with high levels of racial centrality (Sellers & Shelton, 2003). This may lead individuals to feel more depleted and upset when they do experience racial discrimination, thus increasing the impacts of race-related stress (Banks et al., 2007; Jones & Neblett, 2017). On the contrary, other studies have found that high levels of racial centrality may increase race-related stress (Burrow & Ong, 2010; MacNear & Hunter, 2023; Sellers et al., 1998). One possible explanation for this is that individuals whose race is central to them may associate racism as a reason for daily negative encounters. In some social contexts, having a strong racial identity can lead to feelings of empowerment, but it can also lead to facing and being more aware of stressors related to racism which can negatively impact wellbeing (Yip et al., 2019). How strongly someone connects to their own racial identity may affect how they perceive the discrimination they are facing, thus increasing their race-related stress and, consequently, their mental health symptoms (MacNear et al., 2023; Sellers & Shelton, 2003). Due to individual differences, racial identity may have positive and negative effects which may contribute to disparate findings in racial identity research. Examining how racial centrality impacts the relationship between race-related stress and ADHD symptoms could provide a more nuanced understanding of the relationship between race-related stress and mental health symptoms.

Current Study

Although there is evidence that race-related stress is associated with numerous mental health outcomes (e.g., depression and anxiety) and that general stress is associated with more ADHD symptoms, no studies have examined the association between race-related stress and ADHD symptoms. Furthermore, no studies have examined whether a critical individual difference factor, racial centrality, influences the degree to which race-related stress is associated with ADHD symptomology. In the current study, we addressed these gaps in research by examining the main and interactive effects of racial centrality and race-related stress on ADHD symptoms in an adult population of Black Americans (see Figure 1). We hypothesized that race-related stress would be associated with higher ADHD symptoms in Black Americans. We also expected that racial centrality would have a significant interaction effect between race-related stress and ADHD symptoms.

Figure 1.

Illustration of the hypothesized relationships between ADHD symptoms, racial centrality, and race-related stress.

Methods

Participants

A total of 283 participants aged 18 to 77 years old (M = 35.4, SD = 12.062) began the study, with 253 participants completing the study. An a priori power analysis indicated that a sample size exceeding 210 would provide sufficient statistical power (>0.95) to detect a small-medium effect size (f = 0.25). Table 1 denotes the sample characteristics for the participants in this study. Approximately 40% of this study’s participants noted their highest grade of completion was graduation from college. There was only one participant within the study that did not complete high school. While the demographic data was collected from participants using open-ended questions, the data were coded into categories. Regarding gender, 49.5% of participants identified as women, 48.4% as men, and the remaining 2.1% as either non-binary or gender non-conforming. In addition, 17.3% of the participants in the study reported experiencing four or more symptoms of ADHD.

Table 1.

Sample Demographics.

Sample characteristics
n = 283	%	M	SD
Age (years)		35.41	12.06201
Gender^a
Woman	44
Man	43
Non-binary/gender non-conforming	1.4
Transgender	0.4
Did not answer	12.4
Education
Less than 12th grad	0.4
12th grade/high school graduate	10.8
GED	3.2
Some college or technical school	29
Technical school graduate	5
College graduate	40.6
Graduate school	11
Income
Chose not to answer	14.8
Less than $5,000	2.1
$5,000–$14,999	6.3
$15,000–$24,999	7.1
$25,000–$34,999	12
$35,000–$49,999	11
$50,000–$74,999	22.3
$75,000–$99,999	11.3
$100,000–$149,999	9.2
$150,000–$199,999	3.5
$200,000 or more	0.4
ADHD symptomology (%)
Four or more symptoms reported	17.3
Less than three symptoms reported	82.7

Responses for gender were provided via a short answer self-report, where participants could type in their gender, these were broken into the categories shown in Table 1.

Procedure

Participants were recruited on Prolific (2022), an online participant recruitment site as part of a larger, experimental study on race-related stress and rumination. Participants who indicated in a pre-study screening that they were Black and residing in the United States were able to view and access the study on the Prolific website. The study protocol was approved by the university’s IRB.

Informed consent was obtained from participants, and they were informed that they were able to decline participation at any point during the study. The study itself was programmed on the platform Inquisit. Participants received $15 through Prolific for completing the study.

Half of participants were administered a race-related measure at the start (followed by other study measures, including ADHD and racial identity, i.e., experimental condition). The other half of participants completed a non-race related stress measure followed by the other study measures, including race-related stress (i.e., control condition). Thus, for the purposes of our analyses, the main difference was the order in which the race-related stress measure was administered, with those in the experimental condition completing it at the start of the study and those in the control condition completing it at the end of the study.

Measures

ADHD Symptoms

The presence of ADHD symptoms within participants was measured using Part A of the Adult ADHD Self-Report Scale (ASRS-v1.1; Hines et al., 2012). This 6-item scale asks participants to rate how often they present certain symptoms associated with ADHD such as fidgeting or having problems remembering appointments. It was determined that the ASRSv1.1 is an effective tool for screening adult ADHD and is commonly used by physicians to aid in further evaluations (Hines et al., 2012). The original validation for the ASRSv1.1 showed an inconsistency-adjusted sensitivity of 1.0, meaning the measure is very good for identifying individuals with ADHD and a positive predictive value of 0.52 meaning that around half of the identified positives using this measure had ADHD. Notably, this measure was used to identify ADHD symptoms in participants rather than a diagnosis.

All items were rated on a 5-point Likert scale from 1 (Never) to 5 (Very Often). An example item from this scale is, “How often do you have problems remembering appointments or obligations?” For questions 1 to 3, one point was given for participants selecting “Sometimes,” “Often,” or “Very Often.” One point was awarded only for “Often” or “Very Often” for questions 4 to 6. Items within the questionnaire are either an indicator of inattentive ADHD symptomology or hyperactive/impulsive ADHD symptomology. Items 1, 2, 3, and 4 are indicative of inattentive type ADHD symptoms and items 5 and 6 are indicative of hyperactive type ADHD symptoms. The points received from each of the six questions were then added together for a participant’s total score, with a score of 4 or higher being indicative of high levels of ADHD symptomology within participants.

Race-Related Stress

Data regarding race-related stress experienced by participants was collected using the Index of Race-Related Stress (Utsey & Ponterotto, 1996), a 46-item scale. Within the original validation studies conducted, the IRRS showed good internal consistency estimates ranging from .79 to .87 for the measures’ four subscales (Utsey & Ponterotto, 1996).

Participants were asked whether they had various experiences with racial discrimination and then to specify how stressful or unpleasant these experiences were to them. Items were rated by participants on a 5-item Likert scale, with 0 being “This has never happened to me” and 4 being “This event happened, and I was extremely upset.” The total sum of the participants scores are calculated, with a higher score indicating more race-related stress.

Due to the nature of the study this data was pulled from, participants completed the Index of Race-Related Stress at different time points through the study, either before or following an experimental manipulation regarding race-related stress.

Racial Centrality

In order to examine the relationship between ADHD symptoms and certain aspects of a Black individual’s racial identity, participants were asked to complete the centrality subscale of the Multidimensional Inventory of Black Identity (MIBI; Sellers et al., 1998). This 8-item subscale assesses the degree to which being Black is central to an individual’s identity, (e.g., “Being Black is an important reflection of who I am”). Within the original validation sample, the MIBI was found to have internal consistency estimates ranging from .67 to .85 and was found to be positively associated with self-esteem, and negatively associated with imposter feelings (Sellers et al., 1997).

Each of the items presented for this measure were rated on 7-point Likert scale from 1 (Strongly Disagree) to 7 (Strongly Agree) with 4 serving as a neutral anchor. Three of the subscale’s items required reverse scoring due to the nature of the statements. Items were averaged to create a mean score, with higher scores indicating more endorsement of centrality within participants.

Data Analytic Plan

This study uses secondary analyses using data from an experimental study designed to better understand the consequences of rumination about race-related stressors. Preliminary analyses were conducted to determine the reliability scores (Cronbach’s α), ranges, means, and standard deviations of the variables (See Table 2). However, before collapsing across the two conditions, we wanted to perform due diligence in our analyses and thus started by completing a set of t-tests to see if there was an effect of condition on our primary outcomes. Regardless of the outcome of the t-test, we completed three sets of analyses. First, we conducted correlational and moderation analyses in the full sample. Second, we conducted correlational and moderation analyses only for those in the experimental condition (i.e., race-related stress measure completed first). Third, we conducted correlational and moderation analyses only for those in the control condition (i.e., race-related stress measure completed at the end).

Table 2.

Means, Standard Deviations, and Correlations of Primary Variables (n = 253).

Variable	Cronbach’s α	Range	M	SD	1	2	3
1. Race related stress	.96	0–167	69.56	39.59	—	.433^**
2. Racial centrality	.76	1–7	5.10	1.41		—	.019
3. ADHD symptoms	.82	0–6	1.76	1.70	.326^**		—

p < .05. **p < .01.

Results

An independent samples t-test was performed to evaluate whether there was a difference in race-related stress, racial centrality, and ADHD symptoms between the experimental and control conditions. For race-related stress, there was no significant difference between the experimental (M = 71.67, SD = 37.65) and control (M = 67.78, SD = 41.45) conditions, t(264) = 0.864, p = .128. For racial centrality, there was no significant difference between the experimental (M = 5.21, SD = 1.35) and the control (M = 5.01, SD = 1.47) conditions, t(251) = 1.08, p = .581. For ADHD symptoms, there was no significant difference between the experimental (M = 1.89, SD = 1.67) and control (M = 1.65, SD = 1.73) conditions, t(251) = 1.11, p = .663. These findings suggest that no significant differences emerged between the experimental and control groups for race-related stress, racial centrality, and ADHD symptoms. Nevertheless, for completeness and transparency we completed our correlational and regression analyses for the full sample, the experimental group, and the control group.

Correlational Analyses (Full Sample)

Our first aim was to examine whether there was a positive association between race-related stress and ADHD symptoms. As shown in Table 2, race-related stress was significantly associated with more ADHD symptoms (r = .33, p < .001). Racial centrality was significantly associated with race-related stress (r = .43, p < .001), but was not associated with ADHD symptoms (r = .019, p = .761).

Regression Analyses (Full Sample)

In a regression model with race-related stress, centrality, and their interaction predicting ADHD symptoms (as shown in Table 3), we found that race-related stress (B = 0.018, SE = 0.0028, p < .001) was significantly associated with ADHD symptoms, F(3, 248) = 13.28, MSE = 2.53, R² = .14, RSE = 1.59, p < .001, and significantly associated with racial centrality (B = −0.25, SE = 0.086, p < .01). The racial centrality by race-related stress interaction predicting ADHD symptoms was also significant (B = −0.0039, SE = 0.0019, p = .046). We conducted follow-up analyses on the conditional effects at different levels of the moderator (racial centrality). Follow-up analyses revealed that the association between race-related stress and ADHD symptoms was strongest at lower levels (1 − SD) of racial centrality (B = 0.02, SE = 0, p < .01). There was also a significant effect at mean levels (0) of racial centrality (B = 0.02, SE = 0, p < .01) and higher levels (1 + SD) of racial centrality (B = 0.01, SE = 0, p < .01). These results indicate that the association between race-related stress and ADHD symptoms is strongest for participants who report lower levels of racial centrality (see Figure 2).

Table 3.

Racial Centrality as a Moderator for Race Related Stress and ADHD Symptoms (n = 253).

Variable	B	SE	β	t	p	R ²
Outcome: ADHD						.14*
RRS	0.0177***	0.00284	.412	6.22	<.001
RC	−0.250**	0.0873	−.208	−2.92	.00391
RRS × RC	−0.00386*	0.00193	−.130	−2.01	.0458

Note. RRS = race-related stress; RC = racial centrality.

p < .05. **p < 01. ***p < .001.

Figure 2.

Racial centrality × race-related stress interaction predicting ADHD symptoms.

Correlation Analyses (Experimental Condition)

We further examined the association between race-related stress, racial centrality, and ADHD symptoms for people in the experimental condition. Following the same pattern as in the full sample (Table 4), race-related stress was significantly associated with more ADHD symptoms (r = .40, p < .01). Racial centrality was significantly associated with race-related stress (r = .47, p < .01), but was not associated with ADHD symptoms (r = .12, p = .200).

Table 4.

Means, Standard Deviations, and Correlations for Experimental Condition (n = 118).

Variable	Cronbach’s α	Range	M	SD	1	2	3
1. Race related stress	.96	0–167	71.67	37.65	—	.474**
2. Racial centrality	.76	1.75–7	5.2	1.35		—	.119
3. ADHD symptoms	.82	0–6	1.89	1.67	.395**		—

p < .05. **p < .01.

Regression Analyses (Experimental Condition)

In a regression model with race-related stress, centrality, and their interaction predicting ADHD symptoms in the experimental condition (as shown in Table 5), we found that race-related stress (B = 0.013, SE = 0.017, p < .001) was significantly associated with ADHD symptoms, F (3, 114) = 7.40, MSE = 2.39, R² = .16, RSE = 2.39, p < .001, but was not significantly associated with racial centrality (B = −0.17, SE = 0.203, p = .520). The racial centrality by race-related stress interaction predicting ADHD symptoms was also not significant (B = 0.0011, SE = 0.0030, p = .709).

Table 5.

Racial Centrality as a Moderator for Experimental Condition (n = 118).

Variable	B	SE	β	t	p	R ²
Outcome: ADHD						.16***
RRS	0.0134***	0.0168	.301	4.38	<.001
RC	−0.170	0.203	−.138	−0.646	.520
RRS × C	0.0011	0.0030	.168	0.374	.709

Note. RRS = race-related stress; RC = racial centrality.

p < .05. **p < .01. ***p < .001.

Correlation Analyses (Control Condition)

We further examined the association between race-related stress, racial centrality, and ADHD symptoms in the control condition. As shown in Table 6, race-related stress was significantly associated with more ADHD symptoms (r = .27, p < .01). Racial centrality was significantly associated with race-related stress (r = .40, p < .01), but was not associated with ADHD symptoms (r = −.067, p = .443).

Table 6.

Means, Standard Deviations, and Correlations for Control Condition (n = 135).

Variable	Cronbach’s α	Range	M	SD	1	2	3
1. Race related stress	.96	0–164	67.48	41.45	—	.397**
2. Racial centrality	.76	1–7	5.01	1.47		—	−.067
3. ADHD symptoms	.82	0–6	1.65	1.73	.267**		—

p < .05. **p < .01.

Regression Analyses (Control Condition)

In a regression model with race-related stress, centrality, and their interaction predicting ADHD symptoms (as shown in Table 7), we found that race-related stress (B = 0.016, SE = 0.0037, p < .001) was significantly associated with ADHD symptoms, F (3, 130) = 8.86, MSE = 2.55, R² = .17, RSE = 2.55, p < .001, and significantly associated with racial centrality (B = −0.39, SE = 0.113, p < .001). The racial centrality by race-related stress interaction predicting ADHD symptoms was also significant (B = −0.0080, SE = 0.0025, p < .01). We conducted follow-up analyses on the conditional effects at different levels of the moderator (racial centrality). Follow-up analyses revealed that the association between race-related stress and ADHD symptoms was strongest at lower levels (1 − SD) of racial centrality (B = 0.029, SE = 0, p < .001). There was also a significant effect at mean levels (0) of racial centrality (B = 0.015, SE = 0, p < .001), but not at higher levels (1 + SD) of racial centrality (B = 0.0046, SE = 0, p = .342).

Table 7.

Racial Centrality as a Moderator for Control Condition (n = 135).

Variable	B	SE	β	t	p	R ²
Outcome: ADHD						.17***
RRS	0.0164***	0.0037	.437	4.45	<.001
RC	−0.391***	0.113	1.35	−3.45	<.001
RRS × RC	−0.0080**	0.0025	−1.20	−3.18	.002

Note. RRS = race-related stress; RC = racial centrality.

p < .05. **p < .01. ***p < .001.

Discussion

Although there are numerous studies examining associations between race-related stress and mental health, none have examined its associations with ADHD symptoms. Further, studies on ADHD have only examined general stress and not race-related stress which is a particularly relevant type of stressor for Black Americans (Utsey & Ponterotto, 1996). Thus, to contribute to both race-related stress and ADHD research, this study sought to examine whether race-related stress was associated with ADHD symptoms and whether a critical aspect of racial identity played a moderating role in this association.

In line with our first hypothesis, race-related stress was positively associated with ADHD symptoms. While there are no studies examining associations between ADHD symptoms and race-related stress for direct comparison, these results are consistent with work documenting associations of perceived stress and ADHD (Combs et al., 2015; Miklósi et al., 2016). One possible explanation for the impact race-related stress has on increased ADHD symptoms may be due to the hypervigilance associated with this type of stressor. The concept of heightened vigilance (Williams et al., 1994) is an individual’s experience of a continuous heightened state of psychological arousal in an attempt to protect oneself from negative experiences in one’s immediate environment. This concept may play a significant part in the exacerbation of ADHD symptoms in Black Americans due to increased physical and psychological stress levels that are typically associated with racism (Katzman et al., 2017; Williams, 2018). However, research is currently limited regarding methods with which to assess vigilance in regard to racial discrimination, as well as how vigilance and the resulting stress may relate to ADHD symptoms.

Racial Centrality as a Moderator

In line with our second hypothesis, we found that racial centrality moderated the association between race-related stress and ADHD symptomology, such that the association between race-related stress and overall ADHD symptoms was strongest for participants who reported lower levels of racial centrality (i.e., those who place little importance on their race as part of their identity). Various studies have indicated that racial centrality can serve as a protective factor (Sellers & Shelton, 2003), acting as a buffer from the negative impacts of race-related stress on mental health experienced by Black Americans. It is possible that participants with lower levels of racial centrality had relatively less access to this protective factor, making them more susceptible to the negative effects of race-related stress on ADHD symptoms.

However, our analysis revealed that this significant interaction was only significant among participants in the control group, indicating that the race-related stress and racial centrality interaction effect depended on the order in which participants completed the race-related stress measure. This finding suggests that this effect is only for when IRRS is administered after the other measures. The lack of a statistically significant interaction effect within the experimental group may be due to a discrepancy in sample sizes between the experimental and control groups, with the experimental group containing less participants. Upon further analysis, it was found that the experimental condition (n = 118) only possessed 76% statistical power by itself, compared to the control condition (n = 135) which possessed 82% power, while the full sample (n = 253) possessed 98% power. This interaction effect could also emphasize the nuanced nature of the relationship between racial centrality and the moderating effects it may have on the impacts of race-related stress on ADHD symptoms.

Clinical Implications

Acknowledging the impact that race-related stress can have on ADHD symptoms could help clinicians make informed decisions on how to effectively treat Black Americans. Various studies have detailed that addressing race with clients can have a positive effect on treatment and therapy (Knox et al., 2003). Current intervention and treatment methods for race-related stress in Black individuals do not address the possible symptoms of ADHD which may be exacerbated by experiencing race-related stress (Coker et al., 2016). Thus, a clinician may be better able to treat a Black individual who exhibits ADHD symptoms and has experienced racism by identifying whether they have race-related stress, empathetically discussing how their experience impacts them, and exploring the importance of their racial identity to their wellbeing. A clinician’s awareness of the environmental factors that influence ADHD symptoms, which includes race-related stress, can help provide more comprehensive and effective treatments for Black Americans exhibiting these symptoms.

The results of this study may also aid in determining ways clinicians might work to reduce the impact of race-related stressors on Black Americans as a possible treatment for ADHD symptoms. Further research exploring the specific reasons why race-related stressors can increase ADHD symptoms, along with the influence of racial identity on these effects, may offer insights into the cognitive mechanisms affected by experiences of racial discrimination. With a deeper understanding of its mechanisms, researchers, clinicians, and educators can work together to provide viable solutions for lessening racism’s negative impacts. This type of research can also be instrumental in preventing the persistent issue of misdiagnosis of ADHD among Black Americans, as highlighted by numerous studies (Cénat et al., 2021; Coker et al., 2016).

One strategy that may be helpful for clinicians to consider due to the overlap in ADHD symptoms and race-related stress symptoms, is to approach treatment through a trauma-informed lens. A trauma-informed approach recognizes the impact of trauma and stress on individuals’ symptoms and creates an environment that fosters safety, wellness, and empowerment (Wilson et al., 2013). By incorporating culturally informed and trauma-informed principles into their practice, clinicians can better support Black Americans who may be experiencing both ADHD symptoms and race-related stress.

Study Limitations and Future Directions

Despite this study’s potential to inform future research, some limitations apply to the design of the study. Our use of an ADHD screening tool, rather than a diagnostic assessment, precludes the ability to generalize to individuals diagnosed with ADHD. Thus, the roles of race-related stress and racial identity in Black Americans who meet the criteria for ADHD remain unknown. Future studies would need to be conducted with a sample of participants who have received a clinical ADHD diagnosis (either self-reported as having received one or assessed by a clinician for the purpose of the study) to better account for this part of the population.

In addition to the online nature of the study limiting clinical diagnoses, the short version of the ASRS v1.1 was used to assess the presentation of ADHD symptoms within participants. Future studies looking at possible associations and interactions between these topics should utilize the full version of the ASRS—utilizing the subscales—in order to have a more detailed understanding of how race-related stress can affect the various aspects of ADHD symptomology. Moreover, the study’s design presents unique challenges that affect the interpretation of its results. Specifically, participants in each condition were instructed to undergo race-related stress assessments at different points during the study, resulting in varying outcomes in our analyses. This variability emphasizes the need for further investigation into how racial centrality influences the relationship between ADHD symptoms and race-related stress. These findings suggest that the influence of racial centrality moderating the negative effects of race-related stress and ADHD symptoms vary across different conditions. Future research endeavors should aim to uncover the underlying processes driving this interaction. This highlights the importance of considering contextual factors when interpreting our results.

Finally, the study only assessed participants’ symptoms and racial centrality at a single time point, rather than longitudinally. This limitation prevents the examination of potential changes in ADHD symptom presentation in relation to experiences of racial discrimination, particularly if participants’ levels of racial centrality were to vary over time. Each of these limitations should be considered when developing future studies regarding this topic.

Future Research

The results gained from this study may provide future researchers and clinicians with a better understanding on how stressors unique to Black Americans may exacerbate ADHD symptoms. The findings presented within this study should be replicated in independent samples of Black Americans in order to determine the consistency levels of the discovered associations and how they may function for the overall population of Black Americans impacted by both race-related stress and ADHD symptoms. In addition, the increased strength of the association between ADHD symptoms and race-related stress at lower levels of racial-centrality warrants additional investigation of how other aspects of the Black identity may be related to experiences with ADHD symptoms in Black Americans.

Conclusion

The results of this study indicate the significance of race-related stress and racial centrality in relation to ADHD symptoms in Black adults. In doing so, this study adds to our understanding of how these experiences specific to Black Americans may influence their ADHD symptomology. Further investigation in this area is warranted to enhance the field’s understanding of the experiences of Black individuals with ADHD symptoms and to inform interventions and treatments for this population.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Kaylee Boyd

Maryam Ware

Author Biographies

Kaylee Boyd is a senior undergraduate student at the University of Louisville majoring in psychology. She aims to pursue a MD/PhD program upon graduation, with an eventual specialization in neurosurgery. Her current research interests include exploring how race and experiences of racism influence the impacts of psychopathology in BIPOC youth.

Maryam Ware, BA, is a second year Clinical Psychology doctoral student at the University of Louisville. She graduated from Mount Holyoke College with a Bachelor of Arts in Neuroscience & Behavior with a minor in Psychology. Her current research interests include examining the mechanisms by which racism and its consequences impact development and using this knowledge to develop impactful interventions.

Yara Mekawi, PhD, is an assistant professor in the Department of Psychological and Brain Sciences at the University of Louisville. Dr. Mekawi earned her PhD in Clinical and Community Psychology at the University of Illinois at Urbana-Champaign. She focuses on examining racial discrimination and racial prejudice at the intersection of affect and cognition. Using interdisciplinary and multi-method approaches, she pursues three main lines of inquiry: (a) What are the cognitive and affective mechanisms through which race-related stress is associated with psychopathology in racially marginalized groups? (b) What are the cognitive and affective factors that maintain racially prejudiced behavior and attitudes among White individuals? and (c) What are the most effective strategies to reduce racial prejudice and ameliorate its effects on the mental health of individuals from racially marginalized groups?

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