ADHD diagnosis gap for girls from immigrant backgrounds
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Girls from multilingual and immigrant families could be missing out on ADHD support, according to new research from the University of East Anglia. ADHD is already known to be underrecognized in girls, whose symptoms are often less externally visible than those seen in boys. But a major new study suggests that language and cultural factors could further delay diagnosis, causing girls to miss out on vital support during some of the most important years of their education.
The study, published in the Journal of Attention Disorders, involved more than 70,000 children in Norway from a large population-based cohort study.
The team says its findings raise important questions for the U.K.—where around 5.1 million people in England and Wales speak a main language other than English.
A growing issue for the U.K.
Dr. Maria Garraffa, from UEA's School of Health Sciences, said, "ADHD represents a substantial demand on U.K. health services, with an estimated 741,000 children and young people aged between 5 and 24 living with ADHD in England alone.
"But many children still go undiagnosed, which can lead to struggles at school, poor mental health and problems with relationships.
"When children don't receive a timely diagnosis, they miss out on targeted support, guidance and treatment that can help them manage their symptoms.
"We wanted to better understand which children might be slipping through the net, particularly focusing on children from multilingual and immigrant families.
"We studied children in Norway and found that girls whose mothers spoke a language other than Norwegian were diagnosed with ADHD significantly later than other girls.
"This raises concerns that language, cultural and immigration-related factors may be creating barriers to timely diagnosis.
"Our work highlights the need to investigate whether similar inequalities exist in Britain, particularly among girls from culturally and linguistically diverse families."
How the research happened
The study was led by Dr. Köder at the University of Oslo in collaboration with UEA. The team analyzed data from 70,102 children and linked parental reports of attention difficulties with official ADHD diagnoses recorded in Norway's health care system.
Garraffa said, "We found that multilingual children were more likely to be rated by parents as having more attention difficulties than monolingual children. However, they were no more likely to receive an ADHD diagnosis.
"We then went on to look at the timing of diagnoses and found that girls whose mothers spoke a language other than Norwegian were diagnosed almost two-and-a-half years later than girls with Norwegian-speaking parents.
"Among families where the mother had a non-Norwegian language background, the gap between boys and girls stretched to almost five years," she added.
Multiple barriers for girls with ADHD
The findings suggest that some girls may face multiple barriers to having their symptoms recognized and assessed, potentially delaying access to treatment and support.
The team also found that some children from immigrant backgrounds were potentially being underdiagnosed—with ADHD diagnosis rates significantly lower among children whose mothers came from parts of North Africa, the Middle East, Southeast Asia, East Asia and Oceania than among children with Norwegian-born mothers.
"Our work doesn't explain exactly why these disparities exist," said Garraffa. "But we believe that a combination of cultural, linguistic and health care system factors may be involved.
"Some parents may be less familiar with ADHD or less likely to seek help because of concerns about stigma. Others may encounter difficulties navigating health care services or communicating concerns through language barriers."
The researchers also suggest that commonly used assessment questionnaires may not work equally well across different cultural and linguistic groups. They say the implications are likely to extend beyond Norway.
Devastating consequences
Garraffa said, "Although health care systems differ between countries, our work highlights a potential inequality that deserves closer examination in nations with increasingly diverse populations, including the U.K.
"I would like to see more culturally sensitive assessment approaches to ensure that children from multilingual and immigrant families are not disadvantaged when seeking support for ADHD.
"Delayed diagnosis can have lasting consequences, affecting children's education, well-being and future opportunities long after symptoms first appear."
Publication details
Franziska Köder et al, The Impact of Multilingualism and Immigration Background on Attention Difficulties and ADHD Diagnoses: Findings From a Large Cohort Study in Norway, Journal of Attention Disorders (2026). DOI: 10.1177/10870547261478017
Journal information: Journal of Attention Disorders
Key medical concepts
Attention Deficit Hyperactivity Disorder
Clinical categories
PsychiatryPediatricsChildren's healthPsychology & Mental health Provided by University of East Anglia Who's behind this story?
Sadie Harley
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