Geographical variation in ADHD: Do diagnoses reflect symptom levels?
Open accessAbstract
Rates of ADHD diagnosis vary across regions in many countries. However, no prior study has investigated how much within-country geographic variation in ADHD diagnoses is explained by variation in ADHD symptom levels. We examine whether ADHD symptom levels explain variation in ADHD diagnoses among children and adolescents using nationwide survey and register data in Norway. Geographical variation in incidence of ADHD diagnosis was measured using Norwegian registry data from the child and adolescent mental health services for 2011-2016. Geographical variation in ADHD symptom levels in clinics' catchment areas was measured using data from the Norwegian mother, father and child cohort study for 2011-2016 (n = 39,850). Cross-sectional associations between ADHD symptom levels and the incidence of ADHD diagnoses were assessed with fractional response models. Geographical variation in ADHD diagnosis rates is much larger than what can be explained by geographical variation in ADHD symptoms levels. Treatment in the Norwegian child and adolescent mental health services is free, universally available upon referral, and practically without competition from the private sector. Factors beyond health care access and unequal symptom levels seem responsible for the geographical variation in ADHD diagnosis.
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Regional and cultural variations, differing mental health awareness, healthcare access, and social stigma modulate reported prevalence rates of adult ADHD.
“Regional and cultural variations, differing mental health awareness, healthcare access, and social stigma further modulate reported prevalence rates”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [20]
The Introduction and Discussion report geographic variation in ADHD diagnosis and suggest that local diagnostic practices may contribute to it. The study concerns children and adolescents in Norway, not adult ADHD prevalence. It does not establish cultural variation, social stigma, or differences in healthcare access as drivers; the Abstract notes that care is freely available and suggests factors beyond access explain the variation. (LLM, conf=0.88)
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- Authors
- Widding-Havneraas, T., Markussen, S., Elwert, F., Lyhmann, I., Bjelland, I., Halmøy, A., Chaulagain, A., Ystrom, E., Mykletun, A., & Zachrisson, H. D.
- Affiliations
- Ragnar Frisch Centre for Economic Research (NO)
- University of Wisconsin–Madison (US)
- Haukeland University Hospital (NO)
- Norwegian Institute of Public Health (NO)
- University of Oslo (NO)
- ORCID
- Venue
- European Child & Adolescent Psychiatry
- Published
- 2022-05-18
- Volume
- 32
- Issue
- 9
- Pages
- 1795-1803
- ISSN
- 1018-8827 (ISSN-L)
- 1435-165X
- PMC
- PMC10460326
- OpenAlex
- W4280524464
- Cited by
- 39
- References
- 29
- Citations by year
- 2026: 11 · 2025: 13 · 2024: 6 · 2023: 7 · 2022: 2
- FWCI
- 4.56
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- European Child & Adolescent Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Funders
- Helse Vest (912197)
- Norges Forskningsråd (288585/IAR)
- H2020 European Research Council (818425)
- University of Bergen
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- attention deficit hyperactivity disorder, regional variation, child and adolescent mental health services, health care access, unnecessary testing, universal health care, Norwegian Mother and Child Cohort Study, child and adolescent psychiatry
- MeSH terms
- Adolescent, Attention Deficit Disorder with Hyperactivity, Child, Cross-Sectional Studies, Female, Humans, Mothers, Norway, Surveys and Questionnaires, Cohort Studies
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