Cross-Country Differences in Parental Reporting of Symptoms of ADHD

Previous studies within the United States suggest there are cultural and contextual influences on how attention-deficit/hyperactivity disorder (ADHD) symptoms are perceived. If such influences operate within a single country, they are likely to also occur between countries. In the current study, we tested whether country differences in mean ADHD scores also reflect cultural and contextual differences, as opposed to actual etiological differences. The sample for the present study included 974 participants from four countries tested at two time points, the end of preschool and the end of second grade. Consistent with previous research, we found lower mean ADHD scores in Norway and Sweden in comparison with Australia and the United States, and we tested four explanations for these country differences: (a) genuine etiological differences, (b) slower introduction to formal academic skills in Norway and Sweden than in the United States and Australia that indicated a context difference, (c) underreporting tendency in Norway and Sweden, or (d) overreporting tendency in the United States and Australia. Either under- or overreporting would be examples of cultural differences in the perception of ADHD symptoms. Of these explanations, results of ADHD measurement equivalence tests across countries rejected the first three explanations and supported the fourth explanation: an overreporting tendency in the United States and Australia. These findings indicate that parental reporting of ADHD symptoms is more accurate in Norway and Sweden than in Australia and the United States, and, thus, have important clinical and educational implications for how parental reporting informs an ADHD diagnosis in these countries.