School readiness as a signal of attention-deficit hyperactivity disorder: a population-based cohort study highlighting structural inequalities

Objective Assess sociodemographic disparities in attention-deficit hyperactivity disorder (ADHD) diagnoses and determine whether England’s universal assessment of ‘school readiness’ could provide a signal for ADHD-related educational needs.

Design Population-based cohort study.

Setting Bradford, UK.

Method Education and health records were linked using the Connected Bradford database for individuals who completed their first year of compulsory schooling (age 4–5 years) between the 2006/2007 and 2018/2019 academic years (n=1 25 330). School readiness was indexed by the ‘good level of development’ threshold within the Early Years Foundation Stage Profile. Primary healthcare records were used to identify individuals with clinical codes recorded that indicate ADHD diagnosis. Regression analyses allowed controlling for covariates, including sex, ethnicity, free school meals receipt and local area deprivation.

Results Male and White British heritage individuals were more likely to have received a diagnosis for ADHD than females and those of South Asian heritage or other ethnicities, with the lowest diagnosis rates among South Asian girls. Those who attained a ‘good level of development’ were also less likely to have received a diagnosis for ADHD (attained: 1.0%; not attained: 2.6%, OR=0.40, 95% CI (0.35, 0.45)), even after controlling for covariates (OR=0.42, 95% CI (0.37, 0.48)).

Conclusions There are structural inequalities in ADHD diagnosis, particularly across sex and ethnicity. Universal school readiness assessments, such as the Early Years Foundation Stage Profile used in England, could act as a signal of ADHD-related educational needs and aid more equitable pathways for ADHD identification and support.