The current study examines racial differences in the management of Attention Deficit Hyperactivity Disorder (ADHD) among Black adolescents. This study also examines Black adults' reflection upon adolescent symptoms of ADHD. Drawing on literature from racial/ethnic disparities in diagnosis and treatment of ADHD, health care service utilization, health behaviors, structural racism and medicalization, this study examines the health behavior and health care utilization practices of Black people, analyzing the avenues through which racism structures the management of symptoms. This study also explores the ways in which management of adolescent symptoms of ADHD shape Black adults' self-management of symptoms in adulthood. To investigate such ideas data from the National Comorbidity Survey- Adolescent Supplement (NCS-A) and the Parent Self-Administered Questionnaire (PSA-Q) were analyzed to offer a descriptive picture of differences in management and treatment of adolescent ADHD symptoms. Ten interviews were conducted with Black adults to offer depth to reported interpersonal causes of racial differences in management and treatment and assist in placing such causes within a framework of structural racism. Interview questions focused on participant's articulation of the socio-political landscape in which adolescent symptoms of ADHD were experienced. Additional questions targeted processes around parent's management of symptoms, the school systems management of symptoms, participant's relationships to medical care providers and avenues to treatment. Quantitative findings suggest there are racial differences present in the management of adolescent ADHD and qualitative findings offer that these differences are reflective of a structural system of power and privilege that shapes Black people's engagement with and access to care for symptoms of ADHD. This research contributes to existent knowledge about reported racial differences in management of symptoms of ADHD, and has implications for the ways in which literature approaches racial disparities in diagnosis and treatment of ADHD among Black adolescents.