ADHD is less likely to be diagnosed in black women, here’s why

According to a 2014 NHS report, black women constituted the highest percentage of people aged over 16 to screen positive for attention deficit hyperactivity disorder (ADHD). Black women as a demographic are very familiar with medical racism and this historical neglect is also present in the mental health sphere. 

An astounding deficit in the diagnostics for ADHD in black women became overwhelmingly evident in the course of research for this article. Of the 10 women I spoke to, only 2 have been diagnosed even though all 10 show the textbook symptoms of ADHD and have shown these symptoms for most of their lives.

In my communication with Eri, what she had described as “a particularly frenetic way I express myself” was apparent. She accidentally missed the first two questions on the list and proceeded to apologise to me profusely (needlessly) via mail and then on Twitter. Eri’s other symptoms are fidgeting, impulsivity, hyper fixation (but only for short periods), forgetfulness, short attention span, anxiety, etc. In her follow up reply after my gentle nudge about the two earlier questions, she says; “I’d like to add that skipping these first few questions is a bit of a manifestation. I remember seeing the questions. I don’t know how I just skipped them when I was answering.”

Another prominent symptom that was a constant among the interviewees was fixations. Eri says, “my friends find it hard to keep up with my fixations (because there’s practically a new one every month or so). They make fun of me for it, never failing to point out that I’ll have a new obsession soon. People I work for don’t understand how I work so well yet forget (or take no cognisance at all of) the smallest details. It confuses them because they’re aware I work well, but those little things I forget can be a bit of a bother. Certain people have made comments on my impulsivity. I know they mean well, but it sometimes comes off as condescending. I don’t like phone calls because I zone out of the conversations and people always think I just don’t care enough to listen. If I do manage to keep paying attention, I start to interrupt a lot because I can only process bits of information at a go and I want to reply as soon as I’m done processing that bit. Some people find this rude or offensive. I also hear a lot that I speak too fast when I’m excited.”

Lola’s response to my mail is charmingly haphazard too. Her symptoms range from textbook symptoms like hyperactivity, hyper fixation, and impulsiveness to an inability to consume entertainment because of what she calls a “non-existent attention span”. “Zero motivation or motivation that comes in full force and dies off quickly” and depression since childhood. 

For Sarah, the primary manifestation of her ADHD is procrastination. “I have been a procrastinator for as long as I can remember, it doesn’t help that I almost always eventually get work done right on the deadline or a bit before it. Once it comes to teamwork, it is not as bad because I know many people are depending on my contribution. But my family members find it hard to understand and think I’m a lazy person.” This accusation of laziness is one Itohan is also very familiar with. She says she gets hobbies very often and drops them as fast and people assume it’s because of laziness.

Despite all the indications that these women probably have ADHD, diagnosis is hard to acquire even though it will serve to heighten their quality of life. Eri says; “I have neither the time nor the money to pursue a diagnosis but think a diagnosis would really help, not just because of the treatment that will most likely follow, but also because I’ll finally stop beating myself up for doing things I’m not proud of. With a diagnosis, I’ll have concrete proof that I actually can’t help it and I’m not just problematic.”

Eniola was diagnosed when she left Nigeria for university in the US. “When I came to the US, in my freshman year, I attended a seminar where they talked about ADHD and I realised some of the symptoms mentioned were similar to things I have been experiencing. So, I reached out to someone about it and she advised me to try taking a learning assessment at the Counseling Office in my College. After being in denial for so long, I decided to take the assessment my second semester in Sophomore year, yeah took me long enough.”

“Most people I get to hang around are from the same country I’m from and we were not taught that things like this actually had a meaning nor we were enlightened on how to identify the manifestations of these types of disorders. So when I recently got diagnosed, I told my friends all about it, some were already knowledgeable after having more exposure to a different society and some were not, and I would say they are more enlightened now. Apart from this set of people, the other mix of people around me is Americans who know better and are pretty familiar with things like this and are more open to accommodate people with this disorder. This is because they grew up having the resources and were pretty much taught about disorders like this and had more opportunity to get diagnosed with this disorder at a younger age having known its manifestations.” Eniola is on ADHD medication now and, she says it helps; bar the characteristic side effects of mental health drugs. 

Like Eri and maybe even more so, Lola craves diagnosis. “I’m desperately trying to get a diagnosis; heavy on the desperately but I can’t afford it and it’s messing up my life; literally “wasting my life away”. I know I need to get a job to get money for diagnosis but I also need to be on medication to carry the job so it’s tough for me. Treatment will CHANGE my life totally, I’m 100% sure the day I get diagnosed and start treatment, it’ll turn my life around for the better. I’ll be so emotional when I do. Hopefully, all of that sorts itself soon.”

4 of the 10 women said, verbatim, that they have neither the time nor the money to pursue a diagnosis. The unfortunate truth is, there are not many mental health professionals accessible to black women, especially in Africa. There’s also the sad fact that mental illnesses are often trivialised or vilified by society. The stigma around these illnesses may also hamper access to diagnosis and treatment. Where the appropriate help is available, it typically costs a lot and is inaccessible. 

Aj also points out that until recently, white men were at the forefront of ADHD studies and so, there is little to no nuance in medical discussions about ADHD. Most of these women only began to suspect that their behaviour that had been attributed to laziness or other non-related things were actually manifestations of ADHD through a stream of informative tiktoks on the internet. 

According to Lorraine Collins, “Black women have been invisible in healthcare and that has left an imprint, so there was no safe place to really discuss ADHD. Why would you go to a place where you feel your language isn’t understood and you have to edit yourself?” The routine neglect of black women in medicine is a contributing factor to the difficulty in getting a diagnosis, not to talk of treatment.

For more information on the subject: https://www.refinery29.com/en-gb/black-women-adhd-diagnosis-uk https://www.ebony.com/health/mental-health/adhd-black-women-disorder/