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Four Steps Towards Better Serving Black and Brown Girls and Women with ADHD

Imagine a person with ADHD

What image comes to mind when you imagine a person with ADHD? Even though a substantial proportion of girls1 and women2 are affected by ADHD, most people typically picture a hyperactive boy. Now, ask yourself: what is the race of the person you pictured? If you answered White, you are not alone. Historically, White children have been more likely to be diagnosed and treated for ADHD compared to racial and ethnic minority youth,3 and research suggests that racial disparities in diagnosis extend into adulthood.Being both female and a minority leads to even higher hurdles to getting properly diagnosed and treated for ADHD. And delays in diagnosis can have serious downstream consequences such as low self-esteem,5 anxiety,5 eating disorders6 and self-harm.7

Barriers to diagnosis and treatment for minority females with ADHD

A lack of understanding in how symptoms of ADHD present in girls and women can be particularly challenging for minority females. For example, boys with ADHD often show more disruptive behaviors, such as hyperactivity and impulsivity, while girls with ADHD are more likely to display inattentive symptoms.5 Inattentive symptoms are less apparent and often lead to girls and women with ADHD being labeled as “lazy,” “not smart” or “having a poor attitude.” 

Preconceived judgments and cultural differences can result in additional misinterpretation of ADHD behavior in minority girls. For example, Black children are more likely to be suspended than their White peers, and Black girls are five times more likely to report being expelled or suspended compared to White girls.8 Any non-compliant behavior may be viewed as a disruption and threat to the classroom, rather than a sign of the medical condition of ADHD, resulting in teachers missing the opportunity to recommend their Black female students for evaluation. 

Most research studying ADHD is among White children; females, particularly minority females, are often not included in research samples. When underrepresented groups of women and girls are not included in research studies, study results may not apply to them. As a result, racial minority women and girls can experience damaging misdiagnosis9 and delayed or inappropriate treatments. 

Previous negative experiences and mistrust of the health care system can also result in minority women being less likely to pursue care for mental and physical health conditions.10 The stigma associated with mental health and behavioral health disorders, as well as fear of addiction to medications, have also been found to be highly prevalent concerns in Black and Latino populations.11

Four ways to support racial and ethnic minority females living with ADHD 

The challenges facing minority females with ADHD are complex; addressing these issues will take changes at both the individual and systemic level. However, given the high risks associated with delayed diagnosis and treatment – in addition to the educational and health inequities already faced by minority populations – taking steps toward change is vital to ensuring that racial and ethnic minority girls and women get the support they need to reach their full, vibrant potential. 

Here are four steps that can be taken to reduce disparities and increase health equity for racial minority girls and women living with ADHD: 

  1. We must educate and engage in conversations with clinicians and educators about how ADHD presents in girls and women. We also need to have discussions about the role that conscious or unconscious racial bias plays in identifying and treating racial minority girls and women with ADHD. Continuing education series, workshops and conferences with dedicated sessions to these topics are needed to foster these conversations. 
  2. We need to partner with minority communities to increase awareness and understanding of ADHD in girls and women to reduce stigma and help break down barriers to treatment. Connecting with racial and ethnic minority communities by collaborating with trusted community organizations, such as churches, can be an effective way to build equitable partnerships. 
  3. We need more research with a focus on ADHD in racial minority girls and women. Using representative research samples will clarify the true impact of ADHD within these marginalized communities. Kollins12 stresses the importance of considering race and ethnicity when compiling the findings of research studies of children with mental health conditions, like ADHD. The reason for this is because researchers often generalize their findings, which do not always apply to racial and ethnic minorities, leading to further health inequities. Funding research studies that include racial minority girls and women with and without ADHD is critical to understanding the condition in this population.
  4. We need to get to the root of the issues. Schools, medical institutions and psychological practices should examine their current policies with a racial equity lens. Forming working groups and seeking feedback from Black and Brown females with ADHD can help to ensure that the lived experiences of racial and ethnic minority populations are being taken into account when developing guidelines and practices. 

ADHD in women has long been considered a “hidden disorder,”13 and this is especially true for racial and ethnic minorities. Increasing awareness about ADHD in this population – as well as working to reduce the systemic barriers that limit girls and women of color from getting properly identified as having ADHD – will help to ensure they obtain the resources and support they need to not only survive, but thrive.

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1 Pastor P, Reuben C, Duran C, Hawkins L. Association between diagnosed ADHD and selected characteristics among children aged 4-17 years: United States, 2011-2013. NCHS Data Brief. 2015;(201):201.

2 Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716-723. doi:10.1176/ajp.2006.163.4.716

Coker TR, Elliott MN, Toomey SL, et al. Racial and Ethnic Disparities in ADHD Diagnosis and Treatment. Pediatrics. 2016;138(3):e20160407. doi:10.1542/peds.2016-0407

4 Fairman KA, Peckham AM, Sclar DA. Diagnosis and Treatment of ADHD in the United States: Update by Gender and Race. J Atten Disord. 2020;24(1):10-19. doi:10.1177/1087054716688534

Young S, Adamo N, Ásgeirsdóttir BB, et al. Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry. 2020; 20(404):1-27.

6 Biederman J, Ball SW, Monuteaux MC, Surman CB, Johnson JL, Zeitlin S. Are girls with ADHD at risk for eating disorders? Results from a controlled, five-year prospective study. J Dev Behav Pediatr. 2007;28(4):302-307. doi:10.1097/DBP.0b013e3180327917

7 Meza JI, Owens EB, Hinshaw SP. Childhood predictors and moderators of lifetime risk of self-harm in girls with and without attention-deficit/hyperactivity disorder. Development and Psychopathology. 2020:1-17. doi:10.1017/S0954579420000553

Morris EW, Perry BL. Girls Behaving Badly? Race, Gender, and Subjective Evaluation in the Discipline of African American Girls. Sociology of Education. 2017;90(2):127-148. doi:10.1177/0038040717694876

9 Fadus MC, Ginsburg KR, Sobowale K, et al. Unconscious Bias and the Diagnosis of Disruptive Behavior Disorders and ADHD in African American and Hispanic Youth. Acad Psychiatry. 2020;44(1):95-102. doi:10.1007/s40596-019-01127-6

10 Kennedy BR, Mathis CC, Woods AK. African Americans and their distrust of the health care system: healthcare for diverse populations. J Cult Divers. 2007;14(2):56-60.

11 Olaniyan O, dosReis S, Garriett V, et al. Community perspectives of childhood behavioral problems and ADHD among African American parents. Ambulatory Pediatrics. 2007;7(3);226–231.

12 Kollins SH. Editorial: Is child mental health research structurally racist?. J Child Psychol Psychiatry. 2021;62(2):111-113. doi:10.1111/jcpp.13376

13 Quinn PO, Madhoo M. A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. Prim Care Companion CNS Disord. 2014;16(3):PCC.13r01596. doi:10.4088/PCC.13r01596