How interactions between ADHD and schools affect educational achievement: a family-based genetically sensitive study

Rosa Cheesman; Espen M Eilertsen; Ziada Ayorech; Nicolai T Borgen; Ole A Andreassen; Henrik Larsson; Henrik Zachrisson; Fartein A Torvik; Eivind Ystrom

doi:10.1111/jcpp.13656

How interactions between ADHD and schools affect educational achievement: a family-based genetically sensitive study

J Child Psychol Psychiatry. 2022 Oct;63(10):1174-1185. doi: 10.1111/jcpp.13656. Epub 2022 Jul 4.

Authors

Rosa Cheesman¹, Espen M Eilertsen^{1

2}, Ziada Ayorech¹, Nicolai T Borgen³, Ole A Andreassen^{4

5}, Henrik Larsson^{6

7}, Henrik Zachrisson³, Fartein A Torvik^{1

2}, Eivind Ystrom^{1

8}

Affiliations

¹ PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway.
² Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
³ Department of Special Needs Education, University of Oslo, Oslo, Norway.
⁴ NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
⁵ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁶ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁷ School of Medical Sciences, Örebro University, Örebro, Sweden.
⁸ Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.

Abstract

Background: Children with ADHD tend to achieve less than their peers in school. It is unknown whether schools moderate this association. Nonrandom selection of children into schools related to variations in their ADHD risk poses a methodological problem.

Methods: We linked data on ADHD symptoms of inattention and hyperactivity and parent-child ADHD polygenic scores (PGS) from the Norwegian Mother, Father, and Child Cohort Study (MoBa) to achievement in standardised tests and school identifiers. We estimated interactions of schools with individual differences between students in inattention, hyperactivity, and ADHD-PGS using multilevel models with random slopes for ADHD effects on achievement over schools. In our PGS analyses, we adjust for parental selection of schools by adjusting for parental ADHD-PGS (a within-family PGS design). We then tested whether five school sociodemographic measures explained any interactions.

Results: Analysis of up to 23,598 students attending 2,579 schools revealed interactions between school and ADHD effects on achievement. The variability between schools in the effects of inattention, hyperactivity and within-family ADHD-PGS on achievement was 0.08, 0.07 and 0.05 SDs, respectively. For example, the average effect of inattention on achievement was β = -0.23 (SE = 0.009), but in 2.5% of schools with the weakest effects, the value was -0.07 or less. ADHD has a weaker effect on achievement in higher-performing schools. Schools make more of a difference to the achievements of students with higher levels of ADHD, explaining over four times as much variance in achievement for those with high versus average inattention symptoms. School sociodemographic measures could not explain the ADHD-by-school interactions.

Conclusions: Although ADHD symptoms and genetic risk tend to hinder achievement, schools where their effects are weaker do exist. Differences between schools in support for children with ADHD should be evened out.

Keywords: ADHD; gene-environment interaction; genetics; school; school performance.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Academic Success*
Attention Deficit Disorder with Hyperactivity* / diagnosis
Attention Deficit Disorder with Hyperactivity* / epidemiology
Attention Deficit Disorder with Hyperactivity* / genetics
Cohort Studies
Educational Status
Humans
Schools

Abstract

Publication types

MeSH terms

Grants and funding