As noted above, Aboriginal and Torres Strait Islander peoples have faced considerable adversities that stem from the legacies of colonisation. Aboriginal and Torres Strait Islander peoples currently experience higher rates of physical health issues and social and emotional wellbeing concerns than non-Indigenous Australians (ABS, 2017). Aboriginal children are around 30% more likely than non-Indigenous children to have a disability (DiGiacomo et al., 2013).
There has been limited research on ADHD in Aboriginal and Torres Strait Islander peoples, including epidemiological studies of prevalence. The WA Aboriginal Child Health Survey reported that Aboriginal children had a higher risk of clinically significant hyperactivity problems (15.8%) compared with 9.7% for non-Aboriginal children, with ADHD more common in boys than girls (Zubrick et al., 2004). This study used the Strengths and Difficulties Questionnaire (SDQ), which broadly measures emotional and behavioural problems and has a hyperactivity subscale commonly used to screen for ADHD.
The validity of using the SDQ in Aboriginal and Torres Strait Islander people has been explored in urban New South Wales. They found many questions were appropriate, but some were considered inappropriate, and some important areas of emotional and behavioural problems were not necessarily captured by the SDQ (Williamson et al., 2014; Williamson et al., 2010). Construct validity only reached ‘acceptable’ levels (Williamson et al., 2014). Given there is no single Aboriginal or Torres Strait Islander ‘group’ the generalisability of the SDQ beyond urban NSW is unclear and potentially may be different in rural and remote areas.
A study of a population of NSW imprisoned people identified that a higher proportion of Aboriginal prisoners were identified as having adult ADHD (31%) than non-Aboriginal adults (10%) (Moore, Sunjic, Kaye, Archer, & Indig, 2016a). Screening was conducted using the Adult ADHD Self-rating Scale (ASRS), and assessment using the Mini-International Neuropsychiatric Interview. The study authors proposed that the study findings may be invalid due to inappropriate screening and assessment measures adapted from Western Methods, and they noted the considerable lack of research in ADHD in this population. Notably, the rate of ADHD identified for non-Aboriginal adults was much lower than that reported in international studies of ADHD in prisoners (Young, Moss, Sedgwick, Fridman, & Hodgkins, 2015a), suggesting that the rate of identification of ADHD in Moore et al. may be somewhat lower than in other studies.
There is a lack of norms for ADHD symptom questionnaires and other tools commonly used for screening and assessment within most Aboriginal and Torres Strait Islander groups. We are not aware of any other psychometric studies of ADHD-specific questionnaires in Aboriginal and Torres Strait Islander peoples. We note the Westerman Aboriginal Symptom Checklist for Youth (WASC-Y) (13–17 years) is a culturally validated checklist for the mental health of Aboriginal youths (covering the domains of depression, suicidal behaviours, drug and alcohol use, impulsivity, anxiety and cultural resilience as a moderator of risk). Although some items from the WASC-Y may have utility as proxies for ADHD symptoms (for example, impulsivity, hyperactivity and agitation) (Little, 2007) we are not aware of any validation in samples of youths with ADHD. Therefore, the prevalence of ADHD in different Aboriginal and Torres Strait Islander communities remains unclear.
There is a considerable lack of research in this area to understand the true prevalence of ADHD in Aboriginal and Torres Strait Islander peoples. Specifically, targeted screening and assessment measures for ADHD in Aboriginal and Torres Strait Islander peoples need to be developed.