I spent my childhood in tony private schools that touted their ability to give students individualized care and attention. The privileged education was wonderful, but my grade reports and parent-teacher conferences were always the same: Ashley is intelligent and engaging, but her assignments are late, her organizational skills need work, and her grades aren’t where they should be.
My teachers knew something was off, but they didn’t have the resources or training to suspect that I had attention-deficit/hyperactivity disorder (ADHD) — a chronic condition that includes persistent problems such as difficulty paying attention, hyperactivity, and impulsive behavior. Instead, I was seen as a slacker with potential that I might never fulfill.
When you think of ADHD, you probably don’t imagine a black woman.
Most conversation about ADHD is focused on white boys, and white children are more likely to be diagnosed with ADHD than nonwhite ones. Boys are nearly twice as likely to be diagnosed with ADHD than girls, even though boys and girls likely suffer from ADHD in equal numbers.
It’s not that white boys actually have ADHD in greater numbers. Instead, there seems to be a bias in diagnosis. For example, black boys displaying potential ADHD symptoms are frequently seen as troublemakers instead of kids who need help. This pairs up with racial bias in the medical field, where, according to Scientific American, black patients receive a lower quality of care compared to white patients. Given this, it’s unsurprising that ADHD diagnoses in black patients are lacking.
There’s also a significant gender gap in ADHD diagnoses. In fact, an estimated 4 million women — nearly 75 percent of women with ADHD — don’t know they have it. The gender gap is likely because of the different ways in which ADHD presents in boys and girls. According to Dr. Doreen Zarfati, a psychiatrist in New York City who specializes in ADHD, boys tend to exhibit more overt signs of hyperactivity and impulsivity, while girls’ symptoms are more subtle. Girls might, for example, sit in class and pretend they’re paying attention as the information goes right over their heads. Then they resist speaking up or asking for help, she says.
While increased awareness probably led to the 55 percent rise in ADHD diagnoses for girls between 2003 and 2011, there is a “lost generation” of women whose symptoms weren’t caught during their adolescent years.
It’s easy to see why a black woman like myself who’s exhibited ADHD symptoms since childhood wasn’t on anyone’s radar. As with many other issues that lie at the intersection of race and gender, black women don’t seem to exist.
These stats are uncomfortably familiar. I was a college senior when I was diagnosed with ADHD. While I was relieved to get an explanation for my chronic procrastination, difficulty focusing, and perpetual lateness, I couldn’t help but feel bitter for what might have been had I been diagnosed as a child.
Zarfati says that the key to spotting ADHD in girls and women starts with giving information to educators as part of routine training; they can then pass on what they learn to parents. And early diagnosis is critical, because ADHD can trigger anxiety, depression, low self-esteem, and a feeling of failure, especially for girls and women, writes Dr. Patricia Quinn in her book 100 Questions and Answers About Attention Deficit Hyperactivity Disorder. According to Quinn and other studies, girls with ADHD are also at a higher risk for self-injury, addiction, and eating disorders.
ADHD is sometimes mistaken for a childhood affliction, but in truth it can get worse with age. Adulthood brings on a whole host of additional responsibilities. In the workplace, you might miss deadlines, “space out” and miss critical information, or show up late because you struggle to keep a schedule. You might not be able to control the impulse to tweet all day, or you could sidetrack meetings or procrastinate. If you haven’t been diagnosed and given a treatment plan, the workplace can seem nearly impossible.
While some employees might be given the benefit of the doubt, there’s a racial disparity there, too: Studies show that black employees are under more scrutiny than their white colleagues. This can lead to poorer performance reviews, lower wages, and higher chances of unemployment. (“You have to be twice as good” is practically a black proverb, passed down through bracing pep talks, reminding us that we can’t afford to make as many mistakes as our non-black counterparts.) This is an inseparable part of my reality as a young, black professional woman with ADHD. Trying to work in way that seems “normal” while living up to an impossibly high double standard isn’t a recipe for success.
Even the treatment for ADHD (there’s no cure) can make life at work tricky. Most doctors recommend pairing medication with cognitive behavioral therapy, a type of psychotherapy that can help you change your behavior. But that might result in a person with ADHD using unorthodox work methods that make them stick out. And there’s so much stigma around ADHD that Zarfati, for example, doesn’t recommend telling your boss you have it, even though it’s protected under the Americans With Disabilities Act.
Because here is the critical misconception: My ADHD doesn’t make me unable to do my work. It just makes it hard for me to do my work in a way that looks like how everyone else does their work.
Staying quiet is a catch-22: I want to do my part to end the stigma, but speaking up hasn’t helped me get accommodations like schedule changes or policy adjustments. And no matter how hard my employers have tried to understand, it’s really difficult to talk about ADHD with somebody who doesn’t have it or isn’t an expert. Our workplace is one-size-fits-all, with its cubicles, inflexible schedule, and punishing hours. There simply isn’t room for neurodiversity in such a rigid environment.
I don’t know whether the working world will change to become more flexible, even though it’s badly needed — and not just for people with ADHD. If anything, employers, like teachers, should receive more training and information about neurodiversity. Awareness might sound like such an empty word, but it’s everything. It’s the difference between hating yourself for being different and thriving in life and at work.