Understanding What Affects an ADHD Diagnosis in Children: What Every International Family Should Know

If you're an international parent living in the Netherlands and navigating concerns about your child's attention, behaviour, or learning differences, you're not alone. One of the most commonly raised concerns in school and home settings is Attention Deficit Hyperactivity Disorder (ADHD) — a neurodevelopmental condition that can significantly impact a child's day-to-day life if left undiagnosed or misunderstood.

A recent systematic review published in 2025 in European Child & Adolescent Psychiatry by Tam, Taechameekietichai, and Allen sheds important light on the many individual child factors that can influence whether a child receives a timely and accurate ADHD diagnosis.

Here’s what international families in the Netherlands need to know.

Why ADHD Diagnosis Isn’t Always Straightforward

ADHD is not just about being "hyper" or "distracted." It presents in different ways — some children may be restless and impulsive, others more dreamy and inattentive. The study reviewed 41 international research articlesand found that 16 different child-related factors can influence whether — and how quickly — ADHD is identified in children and adolescents.

Understanding these factors can empower parents to advocate for proper assessments and avoid misdiagnosis or delays.

16 Child Factors That May Affect ADHD Diagnosis

Here are the key child-related factors identified in the review:

1. ADHD Subtype – Children with the inattentive type (quiet, daydreamy) are more likely to be overlooked compared to those with hyperactive symptoms.

2. Symptom Severity – More visible or disruptive behaviours often lead to quicker referrals, while subtle symptoms may be missed.

3. Comorbid Mental Health Conditions – Conditions like anxiety, depression, or autism can mask or complicate the ADHD picture.

4. Behaviour Problems – Externalising behaviours (e.g., aggression, defiance) may trigger attention from teachers or caregivers sooner.

5. Internalising Symptoms – Children who are anxious, withdrawn, or sad may have their ADHD missed or misattributed.

6. Functional Impairment – The degree to which a child’s daily life is affected plays a big role in whether ADHD is recognised.

7. Social and Cognitive Functioning – Difficulties with peers or learning may signal ADHD, but they can also be linked to other challenges.

8. Physical Health – Health conditions or sleep problems can sometimes mimic or obscure ADHD symptoms.

9. Gender – Girls are less likely to be diagnosed promptly, often because their symptoms are less overt.

10. Age – Younger children may be misjudged as "immature" rather than considered for ADHD assessment.

11. Relative Age in Class – Children born later in the school year (and therefore younger than peers) are more often seen as inattentive or impulsive, which can lead to misdiagnosis or over-diagnosis.

12. Race/Ethnicity – In studies (mostly from the US), Black and Latinx children were less likely to receive a timely diagnosis. While ethnicity plays out differently in the Netherlands, cultural and linguistic differences may similarly complicate the path to diagnosis for international families.

13. Socioeconomic Status (SES) – Children from lower SES backgrounds may face barriers in accessing mental health services.

14. Health Insurance Coverage – In countries where this applies, lack of coverage can delay access to diagnostic services. While the Dutch system is more inclusive, insurance type can still influence the availability of certain services.

15. Urban vs Rural Residence – Access to services differs by location; in the Netherlands, urban areas typically offer faster access to child mental health professionals.

16. Family Structure – Children in non-traditional or high-stress family environments may be flagged sooner due to additional behavioural concerns — or may be overlooked if other family needs take priority.

What This Means for Families Living Abroad

For international families in the Netherlands, several of these factors are especially important to consider:

• Cultural Expectations: Behaviours considered "normal" in one culture may raise concern in another. Teachers or health professionals unfamiliar with your background may interpret behaviour differently.

• Language and Communication: If your child is learning Dutch as a second language, inattentiveness or restlessness may be attributed to language barriers rather than an underlying condition.

• Navigating the Dutch Health System: While the Netherlands has a strong healthcare system, understanding how to access psychological support — especially in English or another language — can be challenging without guidance.

Tips for International Parents Concerned About ADHD

1. Track Behaviours Across Settings: Note whether your child shows signs of inattention or hyperactivity at home, school, and in social settings.

2. Talk to Teachers: Dutch schools play a crucial role in referring children for ADHD assessments. Share your concerns clearly and regularly.

3. Be Aware of Biases: If your child is younger for their grade, a girl, or speaks another language at home, ensure these factors are not the sole explanation for their behaviour.

4. Seek Multicultural Understanding: Choose mental health professionals familiar with working with international families and diverse backgrounds.

5. Know Your Rights: In the Netherlands, children are entitled to support through the Jeugdgezondheidszorg (Youth Health Services) and school-based care teams (Zorgteams). Don't hesitate to ask your school or GP for help navigating this.

We're Here to Help

At Baumgarten Child Psychology and More, we specialise in supporting international families living in the Netherlands. We understand that seeking help in a new country, in a different language, and across cultures can be overwhelming.

Our team offers multilingual assessments, parent consultations, and guidance through the diagnostic process — with a special focus on nuanced conditions like ADHD.

If you're concerned about your child's focus, impulsivity, or school performance, don't wait. Early understanding leads to better outcomes.

📍 Contact us today to learn more about ADHD evaluations and support for international families in the Netherlands.