Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, impulsivity, and hyperactivity. It's categorized into three subtypes: inattentive, hyperactive-impulsive, and combined. These symptoms significantly disrupt a child's development, often persisting into adulthood. While extensively researched in Western contexts, understanding of ADHD in diverse cultural groups, particularly South Asians, is limited. The South Asian population in the USA is growing, yet research on mental health issues within this community, especially ADHD, remains scarce. Significant stigma surrounding mental illness in South Asian communities deters help-seeking and exacerbates disparities in mental health care. Systemic barriers, such as language difficulties and lack of culturally competent services, compound these challenges, leading to underdiagnosis and undertreatment. Parenting styles, influenced by cultural values and societal norms, play a crucial role in shaping the development and management of ADHD symptoms. South Asian families often balance emotional support with high expectations for academic and personal success, influenced by collectivist values and family honor. Patriarchal structures further shape parenting dynamics, with gendered expectations influencing children's treatment. Despite growing understanding of ADHD, research on how South Asian cultural, societal, and familial dynamics influence its diagnosis and management remains scarce. This review aims to explore the relationship between ADHD symptoms and parenting styles within South Asian families, examining how cultural stigma, societal expectations, and family dynamics influence ADHD's presentation, diagnosis, and management. The goal is to inform future interventions and clinical practices tailored to the unique needs of South Asian families.

This narrative review synthesizes existing research on ADHD and parenting styles within South Asian communities. It examines how cultural stigma, societal expectations, and family dynamics influence ADHD's presentation, diagnosis, and management. Key studies reviewed include investigations into the association between specific parenting styles (authoritarian, authoritative, permissive, uninvolved) and the manifestation of ADHD symptoms in children and adolescents of South Asian descent. The review also explores the prevalence of ADHD within South Asian populations, comparing rates to other ethnic groups, and analyzes the impact of cultural stigma on help-seeking behaviors. Studies investigating the effectiveness of culturally adapted interventions, such as parent skills training programs, are reviewed to assess the efficacy of culturally sensitive approaches to ADHD management within South Asian families.

This systematic review utilized PubMed and Google Scholar databases (April 15, 2024 – May 15, 2024) to identify peer-reviewed studies published in English between 2000 and 2024. The search included keywords such as "South Asian," "Asian," "South Asian children," "ethnicity," "mental illness," "mental health," "ADHD," "Attention Deficit Hyperactivity Disorder," "Parenting styles," and "PCIT (Parent-Child Interaction Therapy). Boolean operators ("AND" and "OR") were used to refine the search. The initial search yielded 133 articles, which were then narrowed to 39 articles after adding terms related to mental health and ADHD. Finally, 13 studies met the inclusion criteria, focusing on South Asian populations, addressing ADHD or its symptoms in relation to parenting styles, and being peer-reviewed articles published in English between 2000 and 2024. Exclusion criteria included non-peer-reviewed articles, opinion pieces, letters to the editor, studies unrelated to South Asians, ADHD, or parenting styles, articles with non-standardized diagnostic measures, or studies lacking sufficient methodological rigor. Duplicates were removed. Two reviewers independently screened titles and abstracts. Articles meeting inclusion criteria underwent full-text review. The final 13 studies comprised a range of study designs: one systematic review and meta-analysis, one retrospective cohort study, nine cross-sectional studies, one randomized pre-post intervention study, and one case-control study. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The iterative keyword search strategy was necessary due to the limited research specifically addressing ADHD and parenting styles within South Asian populations.

Several studies highlighted the association between specific parenting styles and ADHD symptoms in children and adolescents. Ellis and Nigg found that maternal inconsistent discipline was significantly associated with ADHD combined type, and paternal low involvement was associated with ADHD symptoms across subtypes. Moghaddam et al. revealed that parents of children with ADHD had significantly lower permissive parenting scores and significantly higher authoritarian parenting scores compared to a control group. Jones et al. found that academic adjustment declined in students with higher ADHD symptoms across different parenting styles. Yim's study showed a positive correlation between authoritative parenting and adherence to Asian cultural values in a South Asian sample from Hong Kong. Ho et al. found cultural differences in parental harshness and its association with child aggression, with South Asian Canadian families reporting less parental harshness compared to European Canadian counterparts. Stewart et al. found significant gender differences in perceptions of parental styles and their effects on academic achievement and psychosocial functioning in Bangladeshi adolescents. Saleem et al. showed that parental overprotectiveness was linked to poorer psychological functioning in Pakistani young adults. Regarding prevalence, Adams et al. found a lower prevalence of ADHD diagnosis and treatment among Asian youth compared to Caucasian youth in the USA. Dissanayake et al. showed significantly lower self-reported ADHD diagnosis among South Asians compared to Caucasian youth. Ranjan et al.'s meta-analysis estimated a lower prevalence of ADHD in South Asian countries compared to other regions. Shah et al. demonstrated that a culturally contextualized parent skills training intervention improved ADHD symptoms and academic performance in Indian children. Arora et al. found that South Asian college students held negative attitudes toward seeking professional help for mental illness. Cadet et al. identified several factors associated with ADHD symptoms in Indian children, including maternal knowledge of ADHD and willingness to seek professional help.

This review reveals a complex interplay between cultural factors, parenting styles, and ADHD manifestation within South Asian communities. While certain parenting styles, particularly authoritarian styles, may be prevalent, their precise impact on ADHD symptoms requires further investigation. The underdiagnosis and undertreatment of ADHD among South Asians are significantly impacted by cultural stigma and systemic barriers. The limited availability of culturally competent mental health services exacerbates these challenges. The findings highlight the need for culturally sensitive interventions, such as parent skills training programs that consider the specific values and dynamics of South Asian families. Future research should focus on longitudinal studies to establish causal relationships between parenting styles and ADHD trajectories, and incorporate diverse methodologies to capture a more nuanced understanding of the lived experiences of South Asian families affected by ADHD.

Research on ADHD within the South Asian population is limited. This review underscores the need to address the underdiagnosis and undertreatment of ADHD in this community, considering cultural stigmas, systemic barriers, and the influence of culturally specific parenting practices. Future research should focus on culturally tailored interventions, expanding representation in mental health research, and reducing stigma. Integrating cultural understanding into mental health practices is crucial for equitable and effective solutions for underserved populations.

This literature review has several limitations. The primary limitation is the scarcity of research specifically addressing the relationship between parenting styles and ADHD within South Asian communities. The review only considered published, peer-reviewed articles written in English, potentially excluding relevant studies in other languages. The heterogeneity of South Asian cultures and the varying contexts of the studies included may limit the generalizability of the findings. Many studies relied on self-reported data, introducing potential biases. The cross-sectional nature of many studies prevented conclusions about causality. Future research should address these limitations by including larger, more diverse samples, employing longitudinal designs, and utilizing diverse data collection methods.