While mental disorders are known to be two to four times higher in homeless school-age children compared to housed children, Attention-Deficit/Hyperactivity Disorder (ADHD) has received surprisingly little focus.
A team of researchers sought to change this by conducting the first comprehensive systematic review and meta-analysis to determine the true scope of ADHD among this vulnerable population.
This thorough investigation—akin to an extensive deep-sea trawl of medical literature—pulled together data from 13 studies involving 2,878 homeless youths, all aged 19 and under.
The goal was not only to pin down the prevalence but also to uncover what factors might influence it.
Key Points
- Almost one-quarter of homeless children and adolescents (22.8%) have Attention-Deficit/Hyperactivity Disorder (ADHD).
- This rate is significantly higher than the approximate 6% global consensus for non-homeless children and adolescents.
- The prevalence of ADHD is more than three times higher in homeless adolescents ( > 12 years) at 43.1% compared to children (< 12 years) at 13.1%.
- The connection between ADHD and homelessness appears to be a two-way street, where ADHD may increase the risk of homelessness, and homelessness can worsen ADHD symptoms.
The Alarming Prevalence of ADHD
The key finding of the meta-analysis is stark: the pooled prevalence of ADHD among homeless children and adolescents is 22.8%.
This means almost one in four homeless youths may have difficulty with the inattention, hyperactivity, and impulsivity characteristic of the disorder.
For perspective, the global consensus for the general population of children and adolescents is around 5.9%.
The heightened rate in the homeless population aligns with other data showing a significantly increased prevalence of developmental and psychiatric disorders in this group.
The vast difference suggests a clear and concerning association between experiencing homelessness and having ADHD, pointing to a particular vulnerability to housing insecurity.
The Age Divide: Why Adolescents Face a Higher Risk
The study identified a critical factor influencing the prevalence: age.
- The prevalence of ADHD was found to be dramatically higher in adolescents with a mean age of 12 years or older, at 43.1%.
- In contrast, children with a mean age under 12 years had a prevalence of 13.1%.
This nearly three-and-a-half-fold difference contrasts with studies of non-homeless populations, where ADHD prevalence is sometimes higher in younger children.
A closer look at the data suggests a potential explanation: in the reviewed studies, children were typically homeless with their families, often due to economic hardship.
Adolescents, however, were usually homeless alone. The causes for their homelessness were often different, involving factors like:
- Behavioral or psychiatric problems in a parent.
- Emotional, physical, or sexual abuse.
- The adolescent’s own substance use disorder.
This suggests that having ADHD, especially when compounded by co-occurring issues like conduct or substance use disorders, might act as a significant vulnerability factor, increasing the likelihood of leaving home and becoming an isolated homeless individual.
The Vicious Cycle of ADHD and Housing Insecurity
The relationship between ADHD and homelessness appears to be a classic “chicken and the egg” scenario, a complex feedback loop.
- ADHD as a Precursor: Childhood ADHD is known to be a risk factor for adult difficulties, and a previous 33-year cohort study found a significant risk of homelessness among males with childhood ADHD.
- Homelessness as an Exacerbator: Conversely, the immense stress, trauma, and lack of structure inherent to homelessness can trigger or intensify symptoms that mimic ADHD, such as inattention and impulsivity.
The researchers highlight a major challenge in diagnosis: many studies used screening tools rather than comprehensive clinical evaluations—the gold standard for a correct diagnosis.
Since substance use disorder is also highly prevalent in this group, and its symptoms can overlap with ADHD, there is a risk of both misdiagnosis and missed diagnosis.
Why It Matters: Breaking the Cycle
This meta-analysis delivers an urgent message: ADHD is a massive, yet often invisible, factor in the crisis of youth homelessness.
The high rate of the disorder, which is manageable with pharmacological and behavioral interventions, presents a crucial point for intervention.
For the general public, this highlights how mental health issues are deeply intertwined with social instability.
It reminds us that ADHD is not just a classroom distraction, but, if left untreated, can contribute to a devastating “cascade of malfunction” leading to chronic instability.
For clinicians and policymakers, the takeaway is clear:
- Prioritize Stability First: Comprehensive care must start with fundamental needs, like secure housing—perhaps through a Housing First approach—and educational re-integration, to create a stable foundation before conducting an ADHD evaluation.
- Diagnose and Treat: Given the high prevalence and the availability of effective treatments, diagnosing and managing ADHD must be a critical next step. Evidence suggests treatment can improve long-term outcomes and may even protect against complications like substance use disorders.
The path to breaking the cycle of homelessness for these vulnerable youths is through tailored interventions that address their complex mental health needs, starting with the surprising reality of their high risk for ADHD.
Reference
Denis, C., Boucaud-Maitre, D., Brunelin, J., Jurek, L., Vallet, W., & Demily, C. (2025). Prevalence of attention deficit hyperactivity disorder in homeless children and adolescents: A systematic review and meta-analysis. Dialogues in Clinical Neuroscience, 27(1), 86–97. https://doi.org/10.1080/19585969.2025.2486355
