{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:15:45Z","timestamp":1789146945892,"version":"build-2803163510"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:sec id=\"ab-yoi260011-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Early diagnosis of attention-deficit\/hyperactivity disorder (ADHD) is often recommended, but it is unknown whether age at diagnosis is associated with educational outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi260011-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To estimate whether age at ADHD diagnosis is associated with school performance, completed degrees, educational enrollment, and school dropout.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi260011-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>\n                      This population-based cohort study used national registry data for individuals born in Finland between January 1, 1990, and December 31, 1999, followed up until age 20 years. Individuals were born without a diagnosis of intellectual disability (\n                      <jats:italic toggle=\"yes\">International Statistical Classification of Diseases and Related Health Problems, Tenth Revision<\/jats:italic>\n                      [\n                      <jats:italic toggle=\"yes\">ICD-10<\/jats:italic>\n                      ] codes F70-F79). Analyses were conducted from May 2024 to December 2025.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi260011-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>\n                      Age at ADHD diagnosis, identified by the first clinical diagnosis (\n                      <jats:italic toggle=\"yes\">International Classification of Diseases, Ninth Revision<\/jats:italic>\n                      code 314;\n                      <jats:italic toggle=\"yes\">ICD-10<\/jats:italic>\n                      code F90; or medication purchase).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi260011-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Grade point average (GPA; range, 4 [failing] to 10 [excellent]) at the end of compulsory education (approximately 16 years of age), completed degrees in upper secondary education (vocational or academic), enrollment in tertiary education, and school dropout at age 20 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi260011-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study sample included 580\u202f132 individuals (51.2% male). Of these, 12\u202f208 males (2.1%) and 3753 females (0.7%) had a first ADHD diagnosis between ages 4 and 20 years: mean (SD) age for males was 11.3 (4.1) years and for females was 14.4 (4.6) years. ADHD diagnosis at any age was associated with worse educational outcomes and greater likelihood of vocational than academic upper secondary education. After adjusting for sociodemographic covariates, if a diagnosis was received by age 16 years, younger age was associated with higher GPA for males (range, 7.12 [95% CI, 6.99-7.26] at age 4 years to 6.52 [95% CI, 6.46-6.58] at age 16 years) and females (range, 7.64 [95% CI, 7.49-7.78] at age 6 years to 6.95 [95% CI, 6.82-7.07]) at age 12 years, higher probability of completing an academic upper secondary degree for males (range, 20.77% [95% CI, 15.41%-26.12%] at age 4 years to 5.29% [3.78%-6.80%] at age 15 years) and females (range, 31.04% [95% CI, 15.60%-46.47%] at age 4 years to 12.01% [95% CI, 7.80%-16.21%] at age 14 years), and lower probability of school dropout for males (range, 9.16% [95% CI, 4.89%-13.42%] at age 4 years to 29.52% [95% CI, 25.85%-33.19%] at age 16 years) and females (range, 9.57% [95% CI, 4.49%-14.65%] at age 6 years to 27.16% [95% CI, 19.75%-34.57%] at age 13 years). However, after educational track choices (ages 17-20 years), older age at diagnosis was associated with higher and more academic education.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi260011-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this cohort study, earlier age at ADHD diagnosis was associated with better school performance, more academic education, and lower school dropout rates than diagnoses closer to age 16 years. The findings suggest that individuals who are diagnosed closer to age 16 years could benefit from targeted support to prevent school dropout.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2026.0181","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T15:00:17Z","timestamp":1775660417000},"page":"620","source":"Crossref","is-referenced-by-count":2,"title":["Age at First Attention-Deficit\/Hyperactivity Disorder Diagnosis and Educational Outcomes"],"prefix":"10.1001","volume":"83","author":[{"given":"Lotta","family":"Volotinen","sequence":"first","affiliation":[{"name":"Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland"},{"name":"Max Planck\u2013University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Remes","sequence":"additional","affiliation":[{"name":"Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland"},{"name":"Max Planck\u2013University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pekka","family":"Martikainen","sequence":"additional","affiliation":[{"name":"Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland"},{"name":"Max Planck\u2013University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland"},{"name":"Max Planck Institute for Demographic Research, Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niina","family":"Mets\u00e4-Simola","sequence":"additional","affiliation":[{"name":"Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland"},{"name":"Max Planck\u2013University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"yoi260011r3","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1177\/1087054714566076","article-title":"Long-term outcomes of ADHD: academic achievement and performance.","volume":"24","author":"Arnold","year":"2020","journal-title":"J Atten Disord"},{"issue":"4","key":"yoi260011r4","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1016\/j.jaac.2018.11.014","article-title":"Attention-deficit\/hyperactivity disorder, school performance, and effect of medication.","volume":"58","author":"Jangmo","year":"2019","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"1","key":"yoi260011r5","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1186\/1741-7015-10-99","article-title":"A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment.","volume":"10","author":"Shaw","year":"2012","journal-title":"BMC Med"},{"issue":"1","key":"yoi260011r6","doi-asserted-by":"publisher","DOI":"10.1002\/jcv2.12064","article-title":"The ADHD deficit in school performance across sex and parental education: a prospective sibling-comparison register study of 344,152 Norwegian adolescents.","volume":"2","author":"Sunde","year":"2022","journal-title":"JCPP Adv"},{"issue":"3","key":"yoi260011r7","doi-asserted-by":"publisher","DOI":"10.1002\/jcv2.12239","article-title":"The diminishing association between adolescent mental disorders and educational performance from 2006-2019.","volume":"4","author":"Nordmo","year":"2024","journal-title":"JCPP Adv"},{"issue":"7","key":"yoi260011r8","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2017.0691","article-title":"Educational and health outcomes of children treated for attention-deficit\/hyperactivity disorder.","volume":"171","author":"Fleming","year":"2017","journal-title":"JAMA Pediatr"},{"key":"yoi260011r9","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/j.jpeds.2018.01.034","article-title":"The population impact of childhood health conditions on dropout from upper-secondary education.","volume":"196","author":"Mikkonen","year":"2018","journal-title":"J Pediatr"},{"issue":"3","key":"yoi260011r10","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1192\/bjp.2021.146","article-title":"Psychiatric disorders diagnosed in adolescence and subsequent long-term exclusion from education, employment or training: longitudinal national birth cohort study.","volume":"220","author":"Ringbom","year":"2022","journal-title":"Br J Psychiatry"},{"issue":"3","key":"yoi260011r11","first-page":"1146","article-title":"Early adolescent health problems, school performance, and upper secondary educational pathways: a counterfactual-based mediation analysis.","volume":"99","author":"Mikkonen","year":"2021","journal-title":"Soc Forces"},{"issue":"3","key":"yoi260011r12","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1007\/s10567-012-0117-8","article-title":"Does long-term medication use improve the academic outcomes of youth with attention-deficit\/hyperactivity disorder?","volume":"15","author":"Langberg","year":"2012","journal-title":"Clin Child Fam Psychol Rev"},{"key":"yoi260011r13","doi-asserted-by":"publisher","DOI":"10.1007\/s00787-025-02852-0","article-title":"Parental education level and ADHD diagnosis in childhood and adolescence: the moderating roles of gender, age, and family history of ADHD.","author":"Volotinen","year":"2025","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"2","key":"yoi260011r14","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1001\/jamapsychiatry.2019.3523","article-title":"Incidence rates and cumulative incidences of the full spectrum of diagnosed mental disorders in childhood and adolescence.","volume":"77","author":"Dalsgaard","year":"2020","journal-title":"JAMA Psychiatry"},{"issue":"6","key":"yoi260011r15","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1111\/jcpp.13920","article-title":"Time after time: failure to identify and support females with ADHD\u2014a Swedish population register study.","volume":"65","author":"Skoglund","year":"2024","journal-title":"J Child Psychol Psychiatry"},{"issue":"1","key":"yoi260011r16","doi-asserted-by":"publisher","DOI":"10.1002\/brb3.70253","article-title":"Increase in occurrence of attention deficit hyperactivity disorder differs by age group and gender-Finnish Nationwide Register Study.","volume":"15","author":"Westman","year":"2025","journal-title":"Brain Behav"},{"issue":"4","key":"yoi260011r17","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1089\/cap.2011.0064","article-title":"Age-specific prevalence, incidence of new diagnoses, and drug treatment of attention-deficit\/hyperactivity disorder in Germany.","volume":"22","author":"Lindemann","year":"2012","journal-title":"J Child Adolesc Psychopharmacol"},{"issue":"4","key":"yoi260011r18","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2023.512","article-title":"Attention-deficit hyperactivity disorder diagnoses and prescriptions in UK primary care, 2000-2018: population-based cohort study.","volume":"9","author":"McKechnie","year":"2023","journal-title":"BJPsych Open"},{"issue":"1","key":"yoi260011r19","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1186\/s12888-021-03547-x","article-title":"Time of onset and\/or diagnosis of ADHD in European children: a systematic review.","volume":"21","author":"Rocco","year":"2021","journal-title":"BMC Psychiatry"},{"issue":"1","key":"yoi260011r20","doi-asserted-by":"publisher","DOI":"10.1111\/desc.12721","article-title":"Sex differences in ADHD trajectories across childhood and adolescence.","volume":"22","author":"Murray","year":"2019","journal-title":"Dev Sci"},{"issue":"2","key":"yoi260011r21","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1016\/j.psc.2010.01.006","article-title":"Gender differences in attention-deficit\/hyperactivity disorder.","volume":"33","author":"Rucklidge","year":"2010","journal-title":"Psychiatr Clin North Am"},{"issue":"5","key":"yoi260011r22","doi-asserted-by":"publisher","first-page":"1469","DOI":"10.1007\/s00787-024-02590-9","article-title":"Individual child factors affecting the diagnosis of attention deficit hyperactivity disorder (ADHD) in children and adolescents: a systematic review.","volume":"34","author":"Tam","year":"2025","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"8","key":"yoi260011r23","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1007\/s00787-018-1129-9","article-title":"Sex-specific trajectories of ADHD symptoms from adolescence to young adulthood.","volume":"27","author":"Millenet","year":"2018","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"9596","key":"yoi260011r29","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"issue":"6","key":"yoi260011r30","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1097\/EDE.0b013e3181577511","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.","volume":"18","author":"Vandenbroucke","year":"2007","journal-title":"Epidemiology"},{"issue":"3","key":"yoi260011r31","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1093\/ije\/dyu029","article-title":"Estimating predicted probabilities from logistic regression: different methods correspond to different target populations.","volume":"43","author":"Muller","year":"2014","journal-title":"Int J Epidemiol"},{"key":"yoi260011r35","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1007\/s11121-022-01358-4","article-title":"All in the family? A systematic review and meta-analysis of parenting and family environment as risk factors for attention-deficit\/hyperactivity disorder (ADHD) in children.","volume":"25","author":"Claussen","year":"2024","journal-title":"Prev Sci"},{"issue":"1","key":"yoi260011r36","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1186\/s12888-014-0237-4","article-title":"The downward spiral of mental disorders and educational attainment: a systematic review on early school leaving.","volume":"14","author":"Esch","year":"2014","journal-title":"BMC Psychiatry"},{"key":"yoi260011r37","doi-asserted-by":"publisher","first-page":"168","DOI":"10.3389\/fpsyt.2015.00168","article-title":"Why the diagnosis of attention deficit hyperactivity disorder matters.","volume":"6","author":"Hamed","year":"2015","journal-title":"Front Psychiatry"},{"issue":"11","key":"yoi260011r38","doi-asserted-by":"publisher","first-page":"1486","DOI":"10.1177\/1049732312457468","article-title":"Advantages of an ADHD diagnosis in adulthood: evidence from online narratives.","volume":"22","author":"Fleischmann","year":"2012","journal-title":"Qual Health Res"},{"issue":"8","key":"yoi260011r39","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.1177\/10870547241246645","article-title":"Life gets better: important resilience factors when growing up with ADHD.","volume":"28","author":"Dangmann","year":"2024","journal-title":"J Atten Disord"},{"issue":"1-2","key":"yoi260011r40","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1177\/10497323231206936","article-title":"Stories of hope: young people\u2019s personal narratives about ADHD put into context of positive aspects.","volume":"34","author":"Gr\u00f8nneberg","year":"2024","journal-title":"Qual Health Res"},{"issue":"2","key":"yoi260011r41","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1080\/1034912X.2019.1596226","article-title":"Living with ADHD: a meta-synthesis review of qualitative research on children\u2019s experiences and understanding of their ADHD.","volume":"67","author":"Ringer","year":"2020","journal-title":"Int J Disabil Dev Educ"},{"issue":"6","key":"yoi260011r42","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.18204","article-title":"Attention-deficit\/hyperactivity disorder diagnoses in Finland during the COVID-19 pandemic.","volume":"7","author":"Auro","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"1","key":"yoi260011r43","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1089\/cap.2018.0095","article-title":"Prevalence and predictors of medication use in children with attention-deficit\/hyperactivity disorder: evidence from a community-based longitudinal study.","volume":"29","author":"Efron","year":"2019","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"yoi260011r1","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5TM)","author":"American Psychiatric Association","year":"2013","edition":"5th ed"},{"key":"yoi260011r2","unstructured":"World Health Organization. International Classification of Diseases, Eleventh Revision (ICD-11) for Morbidity and Mortality Statistics. 2019. Accessed May 15, 2025. https:\/\/icd.who.int\/browse\/2025-01\/mms\/en"},{"key":"yoi260011r24","unstructured":"Finlex. Statute Book of Finland 338\/2011. 2011. Accessed April 16, 2025. https:\/\/www.finlex.fi\/fi\/lainsaadanto\/saadoskokoelma\/2011\/338"},{"key":"yoi260011r25","unstructured":"Hakulinen-Viitanen? T, Hietanen-Peltola? M, Hastrup? A, Wallin? M, Pelkonen? M. Comprehensive health check-up\u2014instructions for maternity and child health clinics and school health care. 2012. Accessed November 30, 2025. https:\/\/www.julkari.fi\/handle\/10024\/90831"},{"key":"yoi260011r26","unstructured":"OECD. Education policy outlook in Finland. 2020. Accessed April 6, 2025. https:\/\/www.oecd.org\/en\/publications\/education-policy-outlook-in-finland_f162c72b-en.html"},{"key":"yoi260011r27","unstructured":"Finlex. Basic Education Act 628\/1998. 1998. Accessed April 15, 2025. https:\/\/www.finlex.fi\/fi\/lainsaadanto\/saadoskokoelma\/1998\/628"},{"key":"yoi260011r28","unstructured":"Finnish National Agency for Education. Finnish education system. Accessed May 16, 2025. https:\/\/www.oph.fi\/en\/education-system"},{"key":"yoi260011r32","unstructured":"The Finnish Medical Society Duodecim. Attention-deficit hyperactivity disorder: current care guidelines. 2025. Accessed November 30, 2025. http:\/\/www.kaypahoito.fi"},{"key":"yoi260011r33","unstructured":"National Institute for Health and Welfare THL. Prevalence of ADHD among children and adolescents in 2022: ADHD diagnoses are increasing steadily; gender and regional differences are quite large. Julkari. 2024. Accessed November 30, 2025. https:\/\/urn.fi\/URN:NBN:fi-fe202401183216"},{"key":"yoi260011r34","unstructured":"Hakulinen? T, Hietanen-Peltola? M, Vaara? S, Merikukka? M, Pelkonen? M; THL. Modern practices and long traditions in health clinics and school health care: service monitoring study 2016-2017. Julkari. 2018. Accessed November 24, 2025. https:\/\/www.julkari.fi\/handle\/10024\/137282"}],"container-title":["JAMA Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamapsychiatry\/articlepdf\/2847662\/jamapsychiatry_volotinen_2026_oi_260011_1779900161.36996.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T15:00:41Z","timestamp":1780498841000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamapsychiatry\/fullarticle\/2847662"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":43,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamapsychiatry.2026.0181","relation":{},"ISSN":["2168-622X"],"issn-type":[{"value":"2168-622X","type":"print"}],"subject":[],"published":{"date-parts":[[2026,6,1]]}}}