Demographic and Socioeconomic Factors Influencing ADHD Diagnosis in Children and Adolescents: A Cross-Sectional Study

Background Attention deficit hyperactivity disorder (ADHD) is among the most commonly diagnosed psychiatric disorders in childhood, However, demographic and socioeconomic factors influencing diagnosis remain insufficiently explored. The aim was to examine associations between demographic factors (gender, month of birth, migration status, number of siblings) or socioeconomic variables (household income, residence type, school funding type) and ADHD diagnosis in children and adolescents. Methods Population-based case-control study nested in a cohort of individuals born between 1991 and 2011 and followed from 2007 to 2019 using linked health and educational records from Navarre, Spain. Incident ADHD cases were age-matched to three controls (1:3). Data were analyzed with multivariate conditional logistic regression Results Lower family income (< €18,000/year) was associated with a 23% increased risk of ADHD diagnosis (OR = 1.23, 95%CI: 1.16–1.31). Urban residence showed higher diagnostic rates compared to rural areas (OR = 0.88, 95%CI: 0.82–0.93 for rural). The month of birth significantly influenced diagnosis likelihood, with those born later in the year showing increased risk, peaking at a 69% higher risk in October-December (OR = 1.69, 95%CI: 1.55–1.83). Having ≥ 3 siblings reduced diagnosis likelihood by 18% compared to only children (OR = 0.82, 95%CI: 0.75–0.89). Migration status and school type interaction analysis revealed that migrant children in public schools had significantly lower ADHD diagnoses compared to non-migrant peers; this difference diminished in charter schools. Conclusion Socio-economic and demographic factors significantly affect ADHD diagnosis, highlighting disparities and potential diagnostic biases. Strategies to address these inequalities are essential for consistent ADHD diagnostic practices and equitable healthcare interventions.