Black girls with ADHD often remain undiagnosed because their symptoms are mischaracterized.
Black girls’ symptoms frequently mischaracterized; trust also issue
Miché Aaron has long been a high achiever. The 29-year-old is in her third year of a planetary sciences doctoral program at Johns Hopkins University, where she researches minerals found on Mars. But last year, Aaron was barely keeping it together — missing classes, struggling to explain that she understood the required material. Her academic adviser warned that if she didn’t get professional help, she would fail.
“I simply thought I was a lazy student and I needed to try harder,” Aaron said.
Then she was diagnosed with attention deficit hyperactivity disorder, and it all made sense.
For many Black women like Aaron, finally having that answer comes with both relief and grief after years of suffering and being misunderstood. Already subject to unique discrimination at the intersection of gender and race, Black girls with ADHD often remain undiagnosed because their symptoms are mischaracterized. Signs of inattentiveness or impulsivity, two main features of the disorder, could be mistaken for laziness or defiance. And the longer these girls aren’t diagnosed and treated, the more their problems are likely to worsen as they grow into adults.
While the 2016 National Survey of Children’s Health showed that 6.1 million children ages 2-17 in the United States have received a diagnosis for ADHD at some point, millions more adults are estimated to have it, too.
ADHD doesn’t discriminate by gender or race, but white boys are still more likely to be diagnosed and treated than anyone else. Experts and advocates say this leads to an inequity in care that hurts girls of any background and children of color of any gender.
Over the past few decades, mental health experts and researchers have started to understand how ADHD manifests differently depending on gender, as girls with the condition tend to seem more inattentive and forgetful while boys tend to seem more hyperactive and disruptive. The reasons Black children and ethnic minorities are overlooked include racial bias in schools, lack of access to care and distrust of educators and health providers based on past discrimination.
Paul Morgan, director of the Center for Educational Disparities Research at
Penn State, is the lead author of multiple studies showing that the disparities in school start early. By kindergarten, Black children in the U.S. are 70 percent less likely to receive an ADHD diagnosis than otherwise similar white children.
A 2016 study found that by 10th grade, white children are nearly twice as likely to receive a diagnosis for ADHD as Black children. Lead author Dr. Tumaini Rucker Coker, head of general pediatrics at Seattle Children’s Hospital and a top researcher at its Center for Child Health, Behavior and Development, said that while her study didn’t look at underdiagnosis of Black girls, federal Education Department data shows telling signs of racial and gender discrimination in diagnosing ADHD: Black girls are six times as likely to be suspended from school as white girls.
Behavior as common as talking back in class could have wildly different consequences depending on how it’s interpreted, Coker explained. For Black girls, it’s often viewed as “intimidation” of a teacher.
“When there’s ‘bad behavior’ and you’re a white girl, you get all the benefit of the doubt,” Coker said. “On the opposite spectrum, you get zero benefit of the doubt as a Black girl.”
Over time, studies have shown that ADHD, especially in girls, can lead to increased rates of anxiety and depression, risky behavior, drug use, self-harm and suicide attempts. Researchers and therapists said they are especially worried about those undiagnosed or undertreated.
Being diagnosed and treated, on the other hand, has many upsides. Medication and therapy, and even behavioral training for parents of patients, have proved to be highly effective in managing ADHD. However, access to such resources depends not only on a diagnosis, but trust and buy-in from families.
René Brooks, who lives outside Gettysburg, Pennsylvania, was diagnosed three times — twice as a child, when her school tested her without parental permission. Her mother rejected the idea of her daughter, who is Black, being labeled, distrusting a system she feared wanted to “drug up minority children.”
The third time Brooks was diagnosed, she was 25 and on the brink of losing her job because she couldn’t keep up with the workload. After starting medication, 18 years after her first diagnosis, she said her brain felt like it “switched on,” and she was able to be more productive than she ever imagined possible.
She started a blog called “Black Girl, Lost Keys,” which educates and empowers Black women with ADHD, and created Unicorn Squad, Black People of Marginalized Genders With ADHD, a private support group on Facebook with more than 2,200 members.
Aaron said finding the Facebook group and talking with other Black women with ADHD during the weekly virtual meetings made it easier to accept her diagnosis. They also commiserate about the all-too-common racialized slights known as microaggressions that she and others face — whether it’s being dismissed for showing emotion as an “angry Black woman” or being doubted at pharmacies when trying to fill prescriptions for stimulants that treat ADHD under the assumption they’re addicts trying to misuse the controlled substances.
Coker and Morgan agreed that culturally and linguistically sensitive screenings are key to getting more people diagnosed. Also critical: culturally relevant groups like the Unicorn Squad.
“When you start receiving treatment, the biggest impact is to your self-esteem, because you’re no longer concerned that you’re just lazy, or that you’re just unmotivated,” said Brooks. “You know this is a problem, and problems have solutions, whereas character flaws do not.”