The Impact of Multilingualism and Immigration Background on Attention Difficulties and ADHD Diagnoses: Findings From a Large Cohort Study in Norway.

OBJECTIVE: This study aims to investigate the relationship between children's multilingualism, immigration background, and their attention difficulties, as well as the prevalence of ADHD diagnoses. METHODS: Questionnaire data on 70,102 children from the Norwegian Mother, Father and Child Cohort Study (MoBa), including parental ratings of attention difficulties (Child Behavior Checklist, Parent/Teacher Rating Scale for Disruptive Behavior Disorders) and multilingual language use, was linked with registry data from the Norwegian Patient Registry concerning ADHD diagnoses. RESULTS: Our findings indicate that multilingual children exhibited higher ratings of attention difficulties compared to their monolingual peers. However, the prevalence of ADHD diagnoses did not show significant differences based on multilingualism or parental language background. Nevertheless, there are indications that children with mothers from North Africa, the Middle East, Southeast Asia, East Asia, and Oceania may be at risk of being underdiagnosed for ADHD in Norway. In addition, girls whose mothers spoke a native language other than Norwegian were diagnosed with ADHD significantly later than girls with native Norwegian-speaking mothers. CONCLUSION: Our results raise concerns about the validity of parental questionnaires, such as the Child Behavior Checklist, in assessing attention difficulties across various cultural and linguistic backgrounds, as well as the overall quality of ADHD evaluations for these children. The delayed ADHD diagnoses among daughters of immigrant mothers highlight potential systemic inequalities within the Norwegian healthcare system, emphasizing the need for linguistically and culturally sensitive assessment tools to better support neurodiverse children from diverse backgrounds.