As a teenager, Stephanie Ozuo constantly heard about her shortcomings. She was “late” and “disorganised”, “messy” and “rude”. She found A-levels hard to cope with and deferred her politics degree at university, as the pressure of organising her time, social life and studies flooded her racing mind.
In her twenties, on social media, she found herself oversharing about the daily struggle to “get herself together” – until a Twitter DM changed the diminished view of herself that she had held since childhood.
The stranger, another Black woman and a doctor – that they were the same sex and ethnicity is significant to Stephanie – suggested she may have undiagnosed ADHD (Attention Deficit Hyperactivity Disorder), placing her among thousands of British women silently struggling with a behavioural condition chronically under-recognised in girls.
“Growing up, I never would have thought I had a problem because I thought I was the problem,” says the 26-year-old London-based careers advisor who was diagnosed, two years ago, after acting on that message.
“Doctors, relatives, teachers, never saw a neurodivergent Black girl, they saw someone disorganised and flustered who didn’t apply herself. That message – from someone who saw below the surface – and my diagnosis transformed my life.”
ADHD causes inattentiveness, impulsiveness, low concentration and physical hyperactivity and is thought to affect 1.5 million British adults, although far fewer are formally diagnosed. In 2019, health watchdog NICE confirmed a problematic disparity in gender, acknowledging that women were more likely to remain untreated, miss out on referrals or receive incorrect mental health diagnoses, as the condition – and diagnostic screening – remains too associated with the traits of naughty, disruptive schoolboys.
One group of academics found that primary age girls were nine times less likely than boys to be diagnosed and treated, masking their symptoms into adulthood. The difference is three-fold in men and women, according to another study.
“Burnout, as an ADHD woman, is not episodic, it’s a continuous state of being,” Stephanie remembers. “I cried so many times in my GP’s office but was told I had anxiety or depression. It is like a wrecking ball.” She was ultimately told she would have to wait two years to see an NHS psychologist, but instead chose to pay £350 for private testing, allowing her to start medication. Other women report waits of five to seven years.
Female ADHD traits can include an inability to keep time, feeling hypersensitive to rejection, emotional dysregulation, trouble maintaining friendships, binge eating, overspending and experiencing imposter syndrome. Almost universally, women report cripplingly low self-esteem.
Raised in a Nigerian household, Stephanie says: “As a woman you’re supposed to be polite, organised, the peacemaker, the homemaker. We live under a patriarchy. If you put ADHD under that construct, it can make you a ‘bad woman’. Layer Black female identity into that – an African girl should be seen not heard, tidy, make her family proud – and shame became a huge part of my identity.”
While women often camouflage their symptoms through girlhood, many feel overwhelmed by them once they take on studies, work, relationships or motherhood. For some, the impact of their untreated condition can be debilitating. (Approximately a quarter of the prison population has ADHD, while sufferers are three times more likely to impulsively quit their job.)
Online forums, like UK Women with ADHD and ADHD Babes (for Black women and nonbinary people), have become a place of solace for tens of thousands of women working to make sense of their disorder. Campaigners believe better and more frequently collated figures by government would help to stem the gender divide in diagnosis.
Ana-Maria Butura, 24, who was diagnosed with the condition as a teenager, is a researcher at King’s College, London, working to improve testing for ADHD in girls and women. She explains: “Late diagnoses can seriously impact girls’ functionality and mental health. By the time they’re referred, it’s complicated by years of other problems. ADHD brains think about 10 different things at once, each leading to 10 more things. Rather than bouncing off walls, like boys, little girls find excuses for their traits, like asking to hand out worksheets or talking excessively, to adhere to societal expectations. In adulthood, women’s many roles mean they can no longer keep the plates spinning.”
Ana-Maria was picked up by mental health services, aged 15, after self-harming. A diagnosis followed but it took another five years for her to begin treatment. “I was born in Romania,” she explains. “Not being English, my parents didn’t know where to look for support. I had no self-esteem whatsoever. I was academic but had to run that extra mile to achieve. School reports always described a ‘very emotional little girl’. You know you are different but have this need to fit in. Not getting something right affected me a lot. I still find it hard to regulate anger and rejection.”
Existing ADHD research is predominantly based on boys. Ana-Maria says female diagnosis still has too much to do with luck. “It usually comes from a friend or family member talking about it, never from a professional or on TV. We want to level out the playing field. There’s still a massive stigma and that has to change.”
Kate Moryoussef was diagnosed, at 40, alongside her nine-year-old daughter, last year. She took the results of online tests and information about ADHD in women to her GP but was dismissed with anti-anxiety medication, which she never took. She remembers: “Once I started reading up on it, for my daughter, I saw those traits in me, too. I felt like a failure all the time. I’d put others on a pedestal while feeling frustrated at myself. As a student, I often had more to give but couldn’t concentrate or retain information and handed stuff in late. I would instantly lose interest in things and constant introspection made me exhausted and anxious. I had a realisation that I needed to help myself, or my brain would spiral out of control. A diagnosis has been the most validating thing ever.”
A wellness coach and mum-of-four, Kate also sought private diagnosis but opted against medication, preferring alternative therapies. She says: “There is treatment, medication, and counselling out there that can be life-changing, but society and professionals need to start joining the dots for women. We are conditioned to believe we should work, run a house, be hands-on mums, but there are bright, talented women, in all decades of life, overwhelmed and exhausted from society’s judgment. Being diagnosed gives you an explanation to work around. It unlocks your potential. I believe I can do things instead of discounting myself.”
Kate, Ana-Maria and Stephanie have all started working with other ADHD women in their professional lives, which comes as no coincidence. Stephanie explains, “I’m learning to work with my ADHD brain rather than fighting it. But, as women, we’re still advocating for ourselves. Institutionally, we need fresh conversations. There is a lost generation of women with ADHD who have not been able to fulfil their potential. The expectations we have on women and young girls have to change.”
From British Vogue
