ADHD-related mental health and school impairments across educational stages: sex-specific patterns in Japanese youth
- 1Institute of Education, Shinshu University
Abstract
Introduction: While ADHD-related challenges are well-documented internationally, understanding of how these manifest across educational stages and sexes remains limited. This study examined mental health symptoms and school functioning in Japanese children with and without ADHD across elementary, junior high, and senior high school.
Methods: In this comparative cross-sectional study, parents of 1,594 Japanese children (797 with ADHD, 797 without ADHD) aged 6–18 years completed questionnaires assessing ADHD symptoms (ADHD-RS-IV), depression (SMFQ), anxiety (SCAS), irritability (ARI), bullying victimization, academic achievement, and social support. Three-way ANOVAs examined interactions between ADHD status, child sex, and educational stage, with Cohen's d effect sizes calculated for group comparisons.
Results: Children with ADHD demonstrated significantly poorer outcomes across nearly all domains, except for teacher support, with effect sizes ranging from moderate to very large (d = 0.35–1.44). Contrary to expectations, the largest group difference for girls' depression emerged in elementary school (d = 1.44) rather than junior high school, and girls' anxiety differences were comparably large in elementary (d = 1.25) and junior high school (d = 1.30). Girls with ADHD showed consistently larger effect sizes than boys for depression (mean d: 1.14 vs. 0.84), anxiety (1.13 vs. 0.73), and irritability (1.32 vs. 0.90) across all stages. Significant ADHD × sex interactions emerged for depression, anxiety, and irritability. Bullying victimization affected 31.0% of children with ADHD compared to 7.5% of non-ADHD children, with peak effects in elementary school. Academic difficulties showed the anticipated pattern of increasing impairment from elementary to junior high school, particularly for boys (d = 0.65 to 1.07).
Discussion: These findings reveal pronounced sex differences in ADHD-related mental health burden, with girls experiencing what may be a "hidden burden" of greater internalizing symptoms across development. The smaller group differences for internalizing symptoms in adolescence may partly reflect decreased parental awareness of adolescent internalizing symptoms. These results underscore the need for sex-specific, developmentally-informed interventions with particular attention to early identification and support for girls with ADHD who may be overlooked in clinical and educational settings.
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BibTeX
@article{takahashi2026adhdrelated,
title = {{ADHD-related mental health and school impairments across educational stages: sex-specific patterns in Japanese youth}},
author = {Fumito Takahashi},
journal = {Frontiers in Psychiatry},
year = {2026},
month = oct,
doi = {10.3389/fpsyt.2026.1736727},
url = {https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1736727/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - ADHD-related mental health and school impairments across educational stages: sex-specific patterns in Japanese youth
AU - Fumito Takahashi
PY - 2026
DA - 2026/10/22
JO - Frontiers in Psychiatry
DO - 10.3389/fpsyt.2026.1736727
UR - https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1736727/full
AB - Introduction: While ADHD-related challenges are well-documented internationally, understanding of how these manifest across educational stages and sexes remains limited. This study examined mental health symptoms and school functioning in Japanese children with and without ADHD across elementary, junior high, and senior high school. Methods: In this comparative cross-sectional study, parents of 1,594 Japanese children (797 with ADHD, 797 without ADHD) aged 6–18 years completed questionnaires assessing ADHD symptoms (ADHD-RS-IV), depression (SMFQ), anxiety (SCAS), irritability (ARI), bullying victimization, academic achievement, and social support. Three-way ANOVAs examined interactions between ADHD status, child sex, and educational stage, with Cohen's d effect sizes calculated for group comparisons. Results: Children with ADHD demonstrated significantly poorer outcomes across nearly all domains, except for teacher support, with effect sizes ranging from moderate to very large (d = 0.35–1.44). Contrary to expectations, the largest group difference for girls' depression emerged in elementary school (d = 1.44) rather than junior high school, and girls' anxiety differences were comparably large in elementary (d = 1.25) and junior high school (d = 1.30). Girls with ADHD showed consistently larger effect sizes than boys for depression (mean d: 1.14 vs. 0.84), anxiety (1.13 vs. 0.73), and irritability (1.32 vs. 0.90) across all stages. Significant ADHD × sex interactions emerged for depression, anxiety, and irritability. Bullying victimization affected 31.0% of children with ADHD compared to 7.5% of non-ADHD children, with peak effects in elementary school. Academic difficulties showed the anticipated pattern of increasing impairment from elementary to junior high school, particularly for boys (d = 0.65 to 1.07). Discussion: These findings reveal pronounced sex differences in ADHD-related mental health burden, with girls experiencing what may be a "hidden burden" of greater internalizing symptoms across development. The smaller group differences for internalizing symptoms in adolescence may partly reflect decreased parental awareness of adolescent internalizing symptoms. These results underscore the need for sex-specific, developmentally-informed interventions with particular attention to early identification and support for girls with ADHD who may be overlooked in clinical and educational settings.
SN - 1664-0640
ER -