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Open Access Research article

Do inattention and hyperactivity symptoms equal scholastic impairment? evidence from three European cohorts

Alina Rodriguez12*, Marjo-Riitta Järvelin23, Carsten Obel45, Anja Taanila2, Jouko Miettunen8, Irma Moilanen7, Tine Brink Henriksen4, Katri Pietiläinen2, Hanna Ebeling7, Arto J Kotimaa27, Karen Markussen Linnet4 and Jørn Olsen56

Author Affiliations

1 Department of Psychology, Uppsala University, Sweden

2 Department of Public Health Science and General Practice, University of Oulu, Finland

3 Department of Epidemiology and Public Health, Imperial College London, London, UK

4 Deptartment of Pediatrics, Aarhus University Hospital, Skejby, Denmark

5 Danish Epidemiology Science Centre, Aarhus University, Denmark

6 Department of Epidemiology, School of Public Health, UCLA, Los Angeles, USA

7 Clinic of Child Psychiatry, University and University Hospital of Oulu, Finland

8 Department of Psychiatry, University and University Hospital of Oulu, Finland

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BMC Public Health 2007, 7:327  doi:10.1186/1471-2458-7-327

Published: 13 November 2007



Attention Deficit/Hyperactivity Disorder (ADHD) affects many children, adolescents, and adults and is associated with a number of impairments. Poor academic performance is related to ADHD in clinical samples. However, it is unclear to what extent core ADHD symptoms and scholastic impairment are related in non-referred school-aged children.


Data come from three population-based cohorts from Sweden, Denmark, and Finland, which are part of the Nordic Network on ADHD. The combined sample size was 13,087 children who were studied at ages 7–8 or 10–12 years. Teachers rated children on inattention and hyperactivity symptoms and reported children's scholastic performance on basic skills.


There was a significant association in all cohorts between core ADHD symptoms and scholastic impairment in reading, writing, and mathematics. Particularly, inattention was related to a two to tenfold increase in scholastic impairment. Prevalence of hyperactivity symptoms was similar across the three cohorts, but inattention was lowest among children from the Finnish cohort, after stratification on living conditions.


These results extend previous reports of scholastic impairment among children with clinically diagnosed ADHD to non-referred population samples from three European countries. Surveillance policies should be implemented in school systems to catch children in need of behavioral or scholastic support early.