What question did this study set out to answer?

This research aims to clarify the association between ADHD symptoms and school grades using data from twins and siblings.

July 26, 2026Open Access

ADHD and Student Grades in Children from the ABCD Study®: A Twin and Siblings Study

LCLuís Fernando Silva Castro-de-AraujoThe University of Melbourne DZDaniel ZhouVirginia Commonwealth University MSMei‐Hsin SuVirginia Commonwealth University

Key Points

This research aims to clarify the association between ADHD symptoms and school grades using data from twins and siblings.
Analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study® on twins and siblings.
Assessed ADHD symptoms via the Child Behavior Checklist and school grades were caregiver-reported.
Applied Direction of Causation (DoC) and Mendelian randomization extensions to assess relationships.
DoC analysis showed a forward path estimate for ADHD-to-grades of -0.16 (95% CI [-0.26, -0.07]) and for grades-to-ADHD of -0.30 (95% CI [-0.63, -0.17]).
In MR-DoC2, the ADHD-to-grades path estimate was -0.31 (95% CI [-0.62, -0.11]), while grades-to-ADHD was estimated at -0.60 (95% CI [-1.20, 0.03]).
Sex-limitation tests revealed no significant moderation by sex.

Abstract

Abstract Attention-deficit/hyperactivity disorder (ADHD) symptoms are strongly associated with lower academic performance, yet the nature of this association remains uncertain. We analyzed data from twins and siblings in the Adolescent Brain Cognitive Development (ABCD) Study ® to examine the relationship between ADHD symptoms and school grades using genetically informed models. ADHD symptoms were assessed via the Child Behavior Checklist, and grades were caregiver-reported for the previous school year. Both phenotypes were modeled as ordinal variables. We applied Direction of Causation (DoC) and Mendelian randomization extensions (MR-DoC and MR-DoC2) incorporating polygenic risk scores for ADHD and educational attainment. DoC and MR-DoC comparisons did not distinguish directionality (e.g., DoC forward path estimate = − 0.16, 95% CI − 0.26, − 0.07; reverse path = − 0.30, 95% CI − 0.63, − 0.17). In MR-DoC2, estimates differed in precision: ADHD-to-grades path = − 0.31, 95% CI − 0.62, − 0.11; grades-to-ADHD path = − 0.60, 95% CI − 1.20, 0.03. Sex-limitation tests indicated no moderation by sex.

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