ADHD in Racially and Ethnically Diverse Women: Understanding the Struggles and Seeking Holistic Support
Growing up as a woman from a racially and ethnically diverse background, my academic journey was filled with challenges that often went unnoticed. From primary to secondary school, I struggled with things that others seemed to manage easily. I was clumsy and frequently injured myself—I still carry the scars from those falls, some of which even resulted in losing consciousness. My handwriting was shocking, and I disliked writing essays, but in my culture, academic success was non-negotiable. My parents pushed me to attend extra tuition even on weekends, constantly comparing me to my more successful cousins. There was no room for struggle—only the relentless pursuit of academic excellence.
School Struggles: The Signs That Went Unseen
High school was especially difficult. I often found myself daydreaming in classes that didn’t capture my interest, like math and science. Sometimes, I would put my head on the desk and pretend to be sick just to escape the pressure. Subjects I enjoyed, like English, French literature, and German, provided a rare respite, but even in those classes, I felt the constant weight of expectations. One teacher remarked that I was full of potential if only I tried hard enough, a comment that stung and stuck with me. My parents often labeled me lazy or weak academically, adding to the feeling that I was never quite measuring up.
Most of my teachers didn’t pay much attention to my academic performance or behavior. Their focus was on the students who could keep up and were performing at or above standard; those of us who struggled were often left behind, unnoticed and unsupported. I almost had to repeat Year 11 equivalent and retake a math exam—a constant reminder of how I didn’t fit the mould.
The cultural pressure to excel academically overshadowed everything. There was no encouragement to participate in sports or other activities outside of studying. Skipping school and tuition became my only escape from the relentless focus on academics. Fear of punishment, including physical discipline, pushed me to try harder, even when I felt I was falling apart.
Friendships were another challenge. My relationships were short-lived and often felt superficial. My mother would tell me I had a best friend, but I have no recollection of this person. It was yet another area where I felt disconnected and misunderstood.
The Hidden Challenges in Adulthood
When I moved to Australia to study, new challenges quickly surfaced. Managing daily responsibilities like paying bills, balancing work, and attending university felt overwhelming, especially coming from a sheltered environment where family guided almost every aspect of life. The sudden need for self-direction was a shock, and tasks that seemed routine to others felt insurmountable to me.
I often ran late to my lectures and was sometimes locked out of the lecture room. On many occasions, I didn’t attend lectures at all—sometimes out of choice, especially if the subject didn’t capture my interest. However, for the subjects I truly enjoyed, I made an effort to be there and was even on time. Over the years, I’ve adapted by making sure I’m always early, often arriving about 30 minutes before any appointment. While this strategy helps me manage my time better, the waiting around can feel unbearable at times, adding a different kind of challenge to my day.
The Importance of a Holistic Approach and Differential Diagnosis
For women, especially those from diverse cultural backgrounds, ADHD often goes undiagnosed due to cultural expectations, misunderstandings, and the complex way symptoms present. A holistic approach to evaluation is crucial—one that looks beyond just the symptoms on a checklist and considers the whole person, including their cultural background, medical history, mental health, and personal experiences.
Women with ADHD frequently face unique challenges, such as mood disorders and hormonal influences that complicate their symptoms. Research shows that girls and young women with ADHD are at an increased risk of developing depression when using oral hormonal contraceptives compared with their unaffected peers (Lundin et al., 2023). These hormonal changes, along with other life stages like puberty, menstrual cycles, postpartum, and menopause, can muddy the waters by increasing vulnerability to mood fluctuations and depressive episodes. For instance, periods of hormonal change during menopause can increase the risk of depression (Freemen, 2010), yet the connection between ADHD and mood disorders like premenstrual dysphoric disorder (PMDD), postpartum depression (PPD), and menopausal depression is still under-researched.
A holistic evaluation also involves a differential diagnosis—ruling out other conditions that may overlap with ADHD, such as anxiety and depression, which are more prevalent and often more severe in women with ADHD compared to men (Solberg et al., 2018). Studies show that women with ADHD tend to experience depression earlier, with longer episodes and higher rates of suicidality than those without ADHD (Fuller-Thomson et al., 2016). Since ADHD symptoms often begin before depression, the presence of ADHD can significantly increase the risk of developing mood disorders later on (Kessler et al., 2005). Additionally, ADHD can worsen these mood-related conditions, such as during pregnancy, where women with ADHD symptoms have a higher risk of depression (Jones et al., 2018).
These overlapping conditions make a thorough assessment critical. To pinpoint the age of onset and distinguish ADHD from other possibilities, evaluations often include reviewing school reports and gathering input from close relatives or parents who can shed light on early behaviours and challenges. By carefully considering all these factors, healthcare providers can offer a more accurate diagnosis and tailor support plans that address the unique needs of each woman, ensuring that no aspect of their experience is overlooked.
Understanding how ADHD interacts with hormonal changes, mood disorders, and cultural expectations allows for a clearer path to the right support—one that truly considers the complexities of living with ADHD as a woman.
Shared Experiences: Beyond Cultural Boundaries
While my experiences are deeply rooted in cultural expectations, many women, including those from European descent, may find similarities in their own stories. ADHD in women often presents differently from the typical hyperactive behaviours associated with men and boys, leading to missed diagnoses. The quiet struggles, the internal battles, and the coping mechanisms like daydreaming are universal experiences that transcend race and culture.
Taking Action: Seeking the Right Support
If you see some of your experiences reflected here, consider exploring the next step with an evaluation. This process is not about finding flaws but about gaining a clearer understanding of yourself. A holistic and culturally sensitive approach to ADHD evaluation ensures that your unique experiences and background are valued.
At my clinic, we provide a compassionate and welcoming environment where you can feel seen and understood. Our evaluations take into account all aspects of your life, aiming to provide a thorough and accurate diagnosis. Don’t let past experiences or concerns about stigma stand in your way. Reach out when you feel ready, and take a step towards gaining insight, understanding, and the support you deserve on your journey with ADHD.
Book List:
1. “Women with Attention Deficit Disorder” by Sari Solden
2. “The Queen of Distraction: How Women with ADHD Can Conquer Chaos, Find Focus, and Get More Done” by Terry Matlen
3. “A Radical Guide for Women with ADHD: Embrace Neurodiversity, Live Boldly, and Break Through Barriers” by Sari Solden and Michelle Frank
4. “Understanding Women with ADHD: How They Feel and Why They Do What They Do” by Kathleen Nadeau and Patricia Quinn
5. “ADHD According to Zoë: The Real Deal on Relationships, Finding Your Focus, and Finding Your Keys” by Zoë Kessler
6. “Your Life Can Be Better, Using Strategies for Adult ADD/ADHD” by Douglas A. Puryear
7. “Driven to Distraction (Revised): Recognizing and Coping with Attention Deficit Disorder” by Edward M. Hallowell and John J. Ratey
8. “The ADHD Effect on Marriage: Understand and Rebuild Your Relationship in Six Steps” by Melissa Orlov
Online Resources:
Black Girl Lost Keys - A blog and resource hub specifically for Black women with ADHD, offering articles, support groups, and coaching services.
ADDA (Attention Deficit Disorder Association) - Offers resources, webinars, and support groups for adults with ADHD, including specific groups for women and people of colour.
CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) - Provides information, resources, and support for individuals with ADHD, including a section dedicated to women and minorities.
The Kaleidoscope Society - An online community and resource centre for women with ADHD, focusing on empowerment and support.
ADHD Women’s Wellbeing - A podcast and resource platform focusing on the wellbeing of women with ADHD, including episodes and resources for women of colour.
Dr. Russell Barkley - A clinical psychologist and ADHD expert who provides a range of online resources, including research articles, webinars, and books.