Diagnosis Of ADHD More Difficult To Obtain For These Women

As the first child in a family of six, Chidera Ochuagu was parentified from a very young age. This did nothing to protect her from Attention Deficit Hyperactive Disorder (ADHD), even now that she is 25.

A neurological development disorder, ADHD affects how people see and interact with the world, causing misalignments and problems in their personal and professional lives. 

One of the most prominent symptoms of ADHD in Chidera’s childhood was always being on the noisemaker list in school, and this action caused her to be constantly monitored and forced to behave a certain way due to the expectations placed on her both as a girl and as the eldest child in her family. 

Constantly feeling restless, excessively talking, obsessive use of social media, easily losing interest in things, and racing thoughts are common in people with ADHD. 

“I can’t remember if I was hyperactive because even if I was, it was shunned out of me,” she told HumAngle. 

Research has shown that girls with ADHD hardly show symptoms such as impulsivity and hyperactivity like their male counterparts. They are, however, more likely to show inattentiveness symptoms such as struggling to manage time, misplacing or forgetting things constantly, struggling with listening and getting easily distracted, and sometimes hyper-focusing on tasks or things they find interesting, according to Help Guide, an independent mental health website. 

Sometimes, girls may exhibit symptoms such as impulsive shopping, risky sexual behaviour, interrupting people when they are speaking –especially on their subject of interest – and making impulsive remarks that may put a strain on their relationships with others. 

In her teen years, Chidera struggled badly with forgetfulness and intense mood swings. Her mother used to say she was probably possessed, especially when she stayed by herself or got irritable, and it affected her relationship with those around her.

Many Nigerians tend to have the misconception that mental disorders or illnesses have spiritual or supernatural causes, such as divine punishments, witchcraft, sorcery and dark magic. This leads to more stigma and decreases the rate at which people seek help for their conditions. 

“I would forget the food on the fire when I was cooking. At one point, I was living with family friends, and they yelled at me a lot. One time, I even got hit.” 

Sometimes, Chidera believes she runs on autopilot mode, and she struggles with meeting up to her daily expectations. She struggles with focusing on things that need to be done, such as reading, and she feels it is becoming worse with time.

“My education is being affected, and I struggle to set goals for my life like other people.” Even when she makes lists or sets goals, it doesn’t motivate her to move or act. Sometimes, Chidera picks up extra jobs to supplement her education, but she struggles to keep them, and it ends up affecting her income. 

She also tends to forget to eat or spend a long time contemplating what to eat until it’s too late. “I once went for 10 hours without drinking water, and I didn’t notice till my head started aching.” This forgetfulness and procrastination affect her physical health as well. 

Going against the grain

The worst social implication for Chidera is being perceived as lazy. “More than half of the time, I struggle to clean my house, and sometimes people make judgments and assumptions.” 

But Chidera could see clear differences between her and the boys who behaved similarly throughout her life. 

“I noticed boys are allowed to be rough and hyperactive, which is not a grace that is extended to girls. Also, boys are allowed to keep dirty spaces, but girls are held to higher standards of cleanliness, while boys are allowed to opt out of chores.”

“I believe boys have it a lot easier when it comes to societal expectations.” 

Chidera constantly feels different and out of place. “I feel like people don’t understand me, and I feel like they can’t relate to me. It feels like we are very different human beings sharing the same planet.” This leads her to withdraw even more from social settings and avoid noise, except with selected friends. 

“People sometimes get turned off since I live my life the way I want to live it, instead of following social expectations. My opinion is often considered different, wayward and sometimes even like abominations because I don’t ascribe to general social beliefs.” 

She started following online therapists and content creators with ADHD on social media, and she joined an online group of neurodivergent people. Someone in the group had discovered her posts about her experiences on Facebook in 2023 and encouraged her to join.  

“It was awesome because I thought there was something wrong with me. But knowing I am not alone in this helped me so much.” 

The community‘s shared experiences made Chidera proud and more accepting of herself. She saw herself through the lenses of her strengths – empathetic, being able to understand people and being very justice-centered in the way she approaches the world. 

“I am undiagnosed because I don’t have access to diagnosis. The healthcare system and my lack of resources make it difficult to even start.” 

But Chidera is not alone in her struggles. 

Before she was a 21-year-old National Youth Service Corp member serving in Ibadan,  southwestern Nigeria, Tomiwa Ajijola was a bright and bubbly girl with a short attention span. She would read a lot and get so hyper-fixated on her books until the people around her complained about it. 

A Nigerian study on ADHD shows that 8.7 per cent of 1112 students sampled aged 7-12 struggled with ADHD with an average male-to-female ratio of 2:1. 

The symptoms of ADHD as defined by the Diagnostic and Statistical Manual of Mental Disorders more accurately described boys than it did girls. 

Tomiwa’s life has been riddled with ADHD symptoms for as long as she can remember. Now, as an adult, she struggles with a short attention span, bad time management,  forgetfulness, including important things like tests and assignments, mixing up dates, names and faces, procrastination, impulsiveness and emotional deregulation. 

Tomiwa understands that her symptoms will be lifelong, “Sometimes, I feel like my brain takes ‘out of sight is out of mind very seriously.’ I would say I will do something but will immediately forget, and that affects my relationships with people, especially with my mother, friends, and coworkers.”

Tomiwa struggles with emotional regulation, and she feels she constantly has to be on her toes to check her symptoms. Unfortunately, people blame her a lot when these symptoms shine through, not understanding she has little control over how her symptoms choose to manifest. 

“I have a very bad relationship with time. I am trying to work on it, but I still struggle badly with time management.” And this affects her life in many ways. She struggles to write and ends up procrastinating even on important issues. 

Even though she is a social butterfly who makes friends easily, she struggles with keeping these new relationships. She forgets to reply and struggles to reach out, and sometimes she feels like her brain looks for dopamine in ‘crazy ways.’

“My attention span is really short, and I get bored and tired really easily, which means I struggle with following through with things.” 

The search for answers:

“Growing up, I thought I was special. I knew I wasn’t like other people,” Tomiwa said.

When she first came across ADHD, she didn’t think it was something that affected Nigerian children. But an incident pushed her to probe harder and she found out she ticked many of the boxes. That was when she decided to find a community. “I knew I needed to find a community so I can find people that can relate to my struggles and experiences and it’s helping me so much.” 

But it was her indecisiveness that made her probe deeper into her symptoms. Once, someone accused her of being the worst person to go to the market with. This was after struggling to make a decision on what to buy and ending up with the worst choice. She realised how badly she struggled with things that came easily to others, and she didn’t know how to explain that the environment was too overwhelming for her.

“It is hard getting any place that will diagnose me in Oyo State. I once found a doctor, but he treated me like I was insane after explaining my symptoms. Finding a medical personnel that will understand is hard, but I plan on getting diagnosed later this year in Lagos.” Another reason for her lack of diagnosis is getting the resources and opportunity to go to Lagos. 

“I wish society would extend an olive branch to people struggling with ADHD. I believe we usually have to do things at different paces than a typical neurotypical person because our brains are wired differently.” 

A much-needed diagnosis

Mirabel Andrews’* diagnosis came alongside an autistic diagnosis when the psychologist she had started seeing for her anxiety and depression noticed the ADHD symptoms.  

Anxiety and other affective disorders tend to be common in girls with ADHD. Those struggling with this condition are more likely to experience generalised anxiety disorder and some other specific phobias than boys with the same condition.

And that was the answer that she needed for certain symptoms that weren’t fully explained by anxiety, depression, or suspected autism. As a child, especially in secondary school, Mirabel struggled with school. Her attention span was quite short, and her teachers struggled to understand her symptoms. 

A study published in 2009 has shown that one of the reasons for the gender gap in ADHD diagnosis is the inability of teachers to refer ADHD girls for treatment, and even when they are referred, medication is not often used as a treatment option for them as it is for boys. 

According to a psychiatrist at the Federal Neuropsychiatric Hospital Kaduna, North West Nigeria, Dr Fatima Aliyu Baba, “Some of the biggest reasons for the misdiagnosis and under-diagnosis of conditions like ADHD in girls is rooted in the inability of some  existing psychiatric doctors to think outside the box of more common conditions like depression and anxiety. Also, cultural norms that force girls to mask their symptoms, encouraged by the mental health stigma among medical practitioners and the general public, make it harder to get this diagnosis.”

“I fluctuate between being inattentive and hyper-focused. I can’t focus at all for some tasks, but for others, I get completely absorbed in it and can’t stop.” 

She also used to be hyperactive as a child; she would find herself running up and down without any real goal. But this has gotten better for her as she grew older. 

Mirabel also currently still struggles with time blindness. “I have no real sense of timing. I tend to be either really late or super early to compensate.” 

She also struggles with her memory and the sense of object permanence – a symptom of the condition which makes it difficult to remember tasks, people or activities when she can’t physically see them. 

 “Unless something is literally where I can see it at all times, I simply forget that it exists.” 

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Name with asterisks was changed to protect the subject’s identity.