Blog by Abigail Agyei
‘ADHD? …isn’t ADHD associated with disruptive and hyperactive schoolboys…that is not me … that is not my story, I have never seen anyone who looks like me with ADHD?’
This is what first came to mind when I read an article by the amazing mental health advocate Penny Belle in 2018 who shared her journey realising she had ADHD as an adult. I read her experience of her mind being on constant overload and feeling emotionally and physically wore out, and this was me.
In 2020, I decided to finally attempt to navigate the ADHD diagnosis process in the UK and received my official diagnosis in 2021. At 30 years old, it had finally been confirmed that I had been masking ADHD my whole life I felt such a mix of emotions getting these diagnoses feeling liberated and validated in my thoughts - but feeling frustrated, shame and resentment for how long everything had taken.
ADHD doesn’t discriminate by gender or race. Yet boys are more likely than girls to receive a formal diagnosis of ADHD. Black children in the United States are 70 percent less likely to receive an ADHD diagnosis than otherwise similar White children . Recent figures also showed that Black women made up the highest percentage of people aged over 16 to screen positive for ADHD in the UK.
My diagnoses really made me reflect and review my own experiences as a Black Woman with undiagnosed ADHD, along with researching and speaking to other Black Women about their experiences with ADHD. In doing this here are some of my thoughts on why Black Women are often misdiagnosed and underdiagnosed when it comes to ADHD and what more can be done to support Black girls and women with ADHD.
1. Adultification of Black Girls in Schools
Adultification bias is a form of racial prejudice where children of minority groups, typically Black children, are treated by adults as being more mature than they actually are. Figures obtained by the charity Agenda found Black girls are two times more likely to be excluded from school as white counterparts . In this report Black girls stated that they often not listened to and ignored. Often non-compliant behaviour may be viewed as a disruption and threat, rather than a sign of ADHD, meaning teachers may miss opportunity to support Black female students.
2. Fear of stigmatisation for Black families and communities
The relationships between Black communities and mental health and educations services can be fraught. I spoke to one woman who realised she had ADHD when getting a diagnosis for her son and she said initially it was implied to her that Black children do not have ADHD they have ‘behavioural problems’. Evidence in the Ethnic Inequalities In Healthcare Review by the NHS Race and Health Observatory also shows that Black children were 10 times more likely to be referred to Child and Adolescent Mental Health Services (CAMHS) via social services rather than their GP service, in comparison to White British children. Negative stereotypes and experiences like this can lead to distrust of education and health system with Black parents being fearful of their children being labelled and stigmatised as stupid or troublesome which means their struggles may be minimised and overlooked - meaning many may suffer in silence.
3. Twice as hard narrative
As a Black British Ghanaian Woman something I have heard that that I am sure many can relate to from immigrant families is the ‘work twice as hard’ narrative. The idea that we must work twice as hard to achieve half as much as our white counterparts. Often with this message drummed into our heads, I know for me I always felt that the reason I was failing things was just because I was simply that I was not pushing myself hard enough not that my brain worked differently.
4. Gaps addressing Black Women’s healthcare
Figures show that there is bias that exists in healthcare for Black women and there are gaps in addressing their needs. The NHS Observatory Review found evidence for Black Women of negative interactions, stereotyping, disrespect, discrimination and cultural insensitivity, leading to some ethnic minority women feeling ‘othered’, unwelcome, and poorly cared-for by health services.
I have been in community groups and heard Black women’s experiences of being denied referrals from their GPs as they were told their symptoms did not seem ‘severe enough’ and I have heard stories of Black Women having to deal with covert discrimination and microaggressions of the ‘angry black woman trope’ - when they did attempt to assert their position and explain their experiences and symptoms. These experiences highlight lack of cultural sensitivity practitioners often have in understanding Black women’s nuanced experiences and Black woman often having to really fight and advocate for themselves to be taken seriously.
5. Expectations and pressures placed on Black Women
Cultural pressures that society often demands of Black women can often make us experts at masking symptoms of ADHD which can eventually lead to burnout. I know for me I decided to pursue my ADHD diagnosis in the height of pandemic balancing my full-time role and my commitment supporting Black and Minority Communities over the pandemic and with the resurgence of the Black Live Matter Movement things began to feel unmanageable.
Black women face the pressures of the ‘Superwoman Schema’ (this was a finding from study done by as part of the African American Women's Heart and Health Study, which examined links between racism and health). Its aspects include feeling obligated to appear strong and suppress emotions; resistance to being vulnerable or dependent on others; determination to succeed; and feeling obligated which can heighten stress and make it difficult to consider, assess, and treat mental-health conditions. Similarly, Black Women are often culturally associated with strength, pressured to be “strong” in every single situation, even if it means putting themselves second as well as the expectation for us to be domesticated, the fixers and nurturers. So, a lot of Black women take on that pressure, which can lead to burnout and other mental-health challenges.
So how can we support and bring more awareness around ADHD in Black Girls and Women?
Educational and research into Black Women’s Needs
Educational, medical and psychological organisations should examine their policies and guidelines with an intersectional lens thinking about the needs of all marginalised groups including Black women. There needs to acknowledgment of the role that conscious and unconscious bias can play in identifying Black and racial minority women needs. There also needs to be funding in research studies that include Black and Racial minority girls and women with and without ADHD to understand the condition better.
Representation and Community
It is so important to normalise ADHD in Black Community to create safe spaces where people can see themselves and share their experiences I never thought of ADHD when I was struggling cause I never seen anyone who looked like me with it. Hearing how people who looked like them have support and are thriving in life is invaluable. Community groups like ADHD Babes (a support group to educate and empower Black women and non-binary people with ADHD.) has been a safe haven for me and seeing people like Rene Brooks and Rach Idowu share their experience with ADHD through their blogs has helped me deal with my own shame and stigma. We also need more practitioners from diverse backgrounds and for Black families and communities to see and relate to.
For the first time this year I saw ADHD on TV through the eyes of a Black girl - Waterloo road brilliantly told the story of Kelly Jo and how ADHD impacts her. She is often told she is ‘confrontational, aggressive, and disruptive.’ It showed the way her sensory overload, internal hyperactivity and emotional regulation differences spiralled as she was unsupported and not given the tools she needed. This portrayal on tv head me in tears, stories like Kelly Jo’’s is vital for reducing stigma and understanding of neurodiversity in communities that are often left behind in the diagnosis process.
There still a lot of work to be done to reduce stigma and to make sure Black Women with ADHD get to thrive instead of just survive but I am so proud and happy to be part of a community advocating for Black Girls and Women with ADHD to be seen and I am hopeful that the Black girls growing up now with ADHD will be learn to love their brains and the unique ways it works a lot sooner than I did.