People of color who have ADHD often carry a double burden: managing a neurodevelopmental condition while navigating a world shaped by racism. Racial trauma, microaggressions, and systemic violence place a constant cognitive and emotional load on BIPOC individuals with ADHD. Chronic stress can worsen ADHD symptoms such as distractibility, impulsivity, and emotional overwhelm.
State violence, white supremacy, and police brutality leave deep imprints on the nervous system. Constantly scanning for danger, processing the threat of discrimination, or witnessing harm to others creates ongoing stress that can amplify ADHD symptoms like overwhelm and dysregulation. This kind of chronic physiological stress doesn’t stay in the mind alone; it lives in the body, shaping how people breathe, sleep, and regulate emotions in everyday life.
Mental health care for neurodivergent people of color must be explicitly antiracist and culturally humble. Antiracist care recognizes how racism affects not just identity but physiology. At Sakura Counseling, we do not pathologize stress reactions to racist and harmful power structures and systems. Culturally humble care seeks to understand each person’s unique personal and cultural background and perspective.
Kirmayer (Kirmayer, 2012) writes about how cultural humility and cultural safety are an “an added critique of cultural competence.” This refers to mental health care providers’ understanding of cultural knowledge and respect and reception towards clients’ worldview, voice, and frameworks informing their realities. Clinicians hold a responsibility to acknowledge structural violence and provide “safe clinical encounters.” Cultural safety is “striving towards the absence of cultural bias and any form of racism” (Konidaris & Petrakis, 2025). Kirmayer [42] describes that “cultural safety ‘moves beyond the concept of cultural sensitivity to analyzing power imbalances, institutional discrimination, colonization and colonial relationships as they apply to health care (National Aboriginal Health Organisation, 2008, p. 3)’”.
Possessing humility, self-reflexivity, and an understanding of both culture and race and understanding of its dynamic impact on mental health, is a shared responsibility between culturally diverse communities and mental health clinicians. Jackson and Samuels (2011) write about cultural attunement in mental health care and social work practice with multicultural communities, stating that “Attunement requires one’s ‘cultural humility’ and awareness and acknowledgement of individual and group based experiences of pain and oppression (Hoskins, 1999).”
Clinicians hold a responsibility to engage in critical self-reflection and critical self-reflexive processes in their culturally attuned work with clients. Cultural safety is reliant upon therapist’s ability to center their clients’ values, self-efficacy, and self-determination. For BIPOC individuals and couples with ADHD, this means support that validates their experiences of racial trauma, honors their cultural strengths, and collaborates with them on tools that feel empowering rather than pathologizing or prescriptive. When care embraces both justice and neurodiversity, it helps people not just manage symptoms, but build resilience, safety, and connection in a world that still has a long way to go.
Sources
Dean R. The Myth of Cross-Cultural Competence. Fam. Soc. J. Contemp. Soc. Serv. 2001;82:623–630. doi: 10.1606/1044-3894.151.
Kirmayer L.J. Cultural competence and evidence-based practice in mental health: Epistemic communities and the politics of pluralism. Soc. Sci. Med. 2012;75:249–256. doi: 10.1016/j.socscimed.2012.03.018.
Kirmayer L.J. Rethinking cultural competence. Transcult. Psychiatry. 2012;49:149–164. doi: 10.1177/1363461512444673.
Konidaris M, Petrakis M. Cultural Humility Training in Mental Health Service Provision: A Scoping Review of the Foundational and Conceptual Literature. Healthcare (Basel). 2025 Jun 4;13(11):1342. doi: 10.3390/healthcare13111342. PMID: 40508955; PMCID: PMC12155312.
Hook J.N., Davis D.E., Owen J., Worthington E.L., Jr., Utsey S.O. Cultural Humility: Measuring Openness to Culturally Diverse Clients. J. Couns. Psychol. 2013;60:353–366. doi: 10.1037/a0032595.
Jackson K.F., Samuels G.M. Multiracial competence in social work: Recommendations for culturally attuned work with multiracial people. Soc. Work. 2011;56:235–245. doi: 10.1093/sw/56.3.235.
