Parental education, ADHD in family and ADHD diagnosis incidence in Finnish children and adolescents

BACKGROUND: Lower parental education is linked to higher incidence of attention-deficit hyperactivity disorder (ADHD) diagnosis in offspring, as is having ADHD in family, but these associations are rarely studied together. We examined whether parental education predicts offspring ADHD diagnosis differently for children and adolescents with or without ADHD family members. METHODS: We used Finnish total population register-based data on individuals born between 1994-2003 with non-migrant background. We followed 228,247 boys and 217,866 girls for first ADHD diagnosis, measured from health care or medication registers, in childhood (4-12) and adolescence (13-17), and identified ADHD for biological parents or full siblings. We used Poisson regression to examine differences in diagnoses separately by offspring sex and age group. RESULTS: Preliminary results show that boys are more often diagnosed for ADHD in childhood and girls in adolescence, but incidence is higher for boys in both age groups. Among boys and girls without ADHD family members, lower parental education is associated with higher incidence in both childhood and adolescence. Among those with ADHD family members, lower parental education predicts higher incidence in childhood, but in adolescence the differences by parental education even out for boys, and for girls, higher parental education predicts higher incidence. CONCLUSIONS: While lower parental education predicts higher ADHD diagnosis incidence in general, for adolescents in ADHD families, higher parental education seems to increase the likelihood of getting diagnosed -particularly for girls. This suggests that adolescents in ADHD families with lower parental education may remain without ADHD diagnosis if they are not diagnosed as children. Support measures should be developed to ensure equal access to diagnosis and care irrespective of age, gender and family background. KEY MESSAGES: • Lower parental education predicts higher ADHD diagnosis incidence in general. Yet, adolescents in ADHD families with lower educated parents may remain underdiagnosed. • Support measures should be developed to guarantee equal access to ADHD diagnosis and care regardless of family background.