Peer-reviewed article
Academic achievement and socio-demographic differences in ADHD diagnosis: a population-based study of Swedish compulsory school pupils.
Högberg B ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how socio-demographic differences in ADHD diagnosis among Swedish school children change when academic achievement is considered. Using data from over 296,000 pupils graduating from compulsory school, researchers found that boys, children from lower socio-economic backgrounds, and native-born children were more frequently diagnosed with ADHD. However, when academic achievement was taken into account, these patterns shifted significantly, suggesting that some groups face barriers to diagnosis despite having comparable academic impairment.
Key points
- Before adjusting for academic achievement, boys had higher ADHD diagnosis rates than girls, and pupils with tertiary-educated parents had lower rates than those with compulsory-educated parents
- Adjustment for achievement reduced the gender gap by approximately two-thirds and reversed the socio-economic status gradient
- When accounting for differential timing of diagnosis, the gender gap reversed, with girls showing higher probability of ADHD diagnosis than boys
- Immigrant pupils had substantially lower ADHD diagnosis probability than native pupils, a gap that slightly widened after adjustment for achievement
- The findings suggest some groups face barriers to ADHD diagnosis even when their academic impairment is comparable to more frequently diagnosed groups
Limitations
This is a cross-sectional study using register data, so it cannot establish causality or fully explain the mechanisms behind diagnostic disparities. The study is limited to Swedish school pupils and may not generalize to other countries with different healthcare systems or diagnostic practices.
Abstract
Background Attention-deficit/hyperactivity disorder (ADHD) is more commonly diagnosed among boys, children with lower socio-economic status (SES), and native-born compared with immigrant children. ADHD can strongly impair academic achievement, and impaired academic functioning can also trigger diagnostic referral. The aim of this paper was to investigate how socio-demographic differences in ADHD diagnosis change when differences in academic achievement are taken into account. Methods Population-based cross-sectional study using linked national registers, comprising 296,380 pupils graduating from Swedish compulsory school (grade 9, age 16) between 2015 and 2017. ADHD was defined using specialist diagnoses and dispensed ADHD medication. Academic achievement was measured by compulsory school-leaving grades. Logistic regression models were estimated with and without adjustment for achievement, and estimates were transformed into marginal effects and predicted probabilities. Results Before adjustment for achievement, boys had a higher probability of ADHD diagnosis than girls, pupils with tertiary-educated parents had a lower probability than those with compulsory-educated parents, and immigrant pupils had substantially lower probability than native pupils. Adjustment for achievement reduced the gender gap by approximately two thirds, reversed the SES gradient such that pupils with tertiary-educated parents had the highest probability, and slightly widened the native-immigrant gap. When accounting for differential timing of diagnosis, the gender gap even reversed, with a higher probability among girls than among boys. Conclusions The findings underscore the need to consider academic achievement when interpreting socio-demographic patterns in ADHD diagnosis, and suggest that some groups may face barriers to diagnosis even when their level of academic impairment is comparable to that of more frequently diagnosed groups.