The Evidence Behind FOCUS · Sticky Brain Studio

Screening is a sorting process

Before any child gets a full ADHD evaluation, a chain of quieter decisions has already happened: a parent decided the behavior was worth mentioning, a teacher decided it was worth noting, a provider decided it was worth pursuing. Each of those is a gate. And the mental picture most of us carry of “what ADHD looks like,” a hyperactive and disruptive young boy, quietly decides who gets waved through each gate and who gets filtered out.

A screening funnel built around a narrow picture will filter along the lines that picture was narrow on: race, gender, language, and income. That filtering is the disparity.

What the research shows

Four patterns, each replicated across large studies and years of data.

Race and ethnicity

Children of color with the same symptoms are less likely to be recognized as having ADHD, and more likely to have the same behavior labeled as defiance instead.

~69%

lower odds of an ADHD diagnosis for Black children in a national K–8 cohort, after accounting for behavior and academics (Morgan et al., 2013)

1.6×

higher odds of a conduct-disorder label for Black vs. White patients. The same behavior, routed toward discipline (Williams et al., 2024)

Gender

Girls are more often quietly inattentive than visibly hyperactive, so they generate fewer referrals, and get identified years later.

23.5 vs 19.6

average age (years) at ADHD diagnosis for women vs. men, about a four-year gap (Skoglund et al., 2024)

~2:1

boys identified for every girl in childhood, largely a referral pattern rather than a true difference in how common ADHD is (DSM-5-TR, 2022)

Language and access

Families who can navigate an English-dominant, multi-step, often costly system are more likely to get through it. In one primary-care study, English-speaking children were more likely to be diagnosed even among children who screened positive for attention problems (Sikov et al., 2022). A thin concern history can mean an unaffected child, or a path that was hard to walk.

Everything else in the room

Anxiety, trauma, and chronic stress, including the stress of experiencing bias itself, can look like ADHD, hide ADHD, or sit alongside it (Randle et al., 2025; Faraone et al., 2021). A tool that cannot hold that question open will answer it by default, and the default tends to track who the child is.

It is not just ADHD. The same pattern shows up in autism, where Black children wait about three and a half years on average between a parent's first concern and a diagnosis (Constantino et al., 2020). The same holds in adults, where roughly 6% of U.S. adults now carry a current ADHD diagnosis, many identified only after a childhood system missed them (Staley et al., 2024).

Why the usual checklists cannot close the gap

Standardized rating scales such as Vanderbilt and Conners are good at what they were built for: turning observed behavior into a comparable score. But that design has three built-in blind spots. They are sharpest for the loud, disruptive presentation that is already getting noticed. They are only as fair as the person filling them out. And they compare every child to norms that may not fit them. Most of all, they never ask the clinician to reason about context: whether a report is shaped by bias, whether quietness is masking, whether a thin history reflects a hard-to-reach system. That reasoning is left to memory and time pressure, which is exactly where disparities grow.

What FOCUS does

FOCUS is what I built in response to the research above, and I am offering it as one option to test, not as the answer to what it describes. It is five questions, asked at the moment a screening decision is made. It is one aid among the tools you already use, not a replacement for any of them. It does not replace your rating scales, your clinical interview, or your judgment. It adds one layer they were never built to provide.

Function

What can this child not do, or do only at great cost, rather than how much do they disrupt a room?

Other conditions

What else could explain this picture, and what else might be present alongside it, before settling on one cause?

Consistency

Across home, school, and time, what is the pattern, and where it breaks, is that the situation, the observer, or who was able to report?

Unusual presentations

Does this child fail to look like ADHD because it is absent, or because it does not match the picture we were trained to expect?

Supports

Is the information thin because the child is unaffected, or because the path to this room was hard to walk?

FOCUS does not tell you what to conclude. It makes it harder to reach a conclusion without having considered the things the evidence says we most often skip, so the predictable omissions become deliberate choices instead of invisible defaults.

What we are honest about

FOCUS is a reasoning aid, not a diagnosis. It produces no score and no cutoff. It produces a better-formed question and a clearer next step.

It is new, and we say so. The framework is built directly on the published research summarized above, but the framework and its screening tool have not yet been formally validated. A staged validation program is underway, covering expert review, real-world usability testing, and a study of whether it narrows identification gaps. We will report what we find, either way.

It is also worth saying what five questions cannot do. FOCUS works on one narrow point in the chain, the moment a clinician is deciding what to make of a child. It does not reach the barriers that sit upstream of that moment: who has access to care, which families are believed when they raise a concern, how schools are resourced, and how long the waitlist runs. Those require different work. FOCUS is a small part of a larger effort, not a substitute for it.

Try FOCUS in your practice

The FOCUS Screener™ is free for clinicians and primary-care providers. I am offering it for you to try in your own practice and judge for yourself. Enter no identifying information. It is a reasoning aid, not a record. Print or transcribe the summary into your own documentation.

Open the free FOCUS Screener →

Explore more: additional neurodiversity-affirming resources for clinicians and families at stickybrainstudio.org.

SELECTED REFERENCES

Constantino, J. N., Abbacchi, A. M., Saulnier, C., et al. (2020). Timing of the diagnosis of autism in African American children. Pediatrics, 146(3), e20193629.
Danielson, M. L., Claussen, A. H., Bitsko, R. H., et al. (2024). ADHD prevalence among U.S. children and adolescents in 2022. Journal of Clinical Child & Adolescent Psychology, 53(3), 343–360.
Faraone, S. V., Banaschewski, T., Coghill, D., et al. (2021). The World Federation of ADHD International Consensus Statement. Neuroscience & Biobehavioral Reviews, 128, 789–818.
Morgan, P. L., Staff, J., Hillemeier, M. M., Farkas, G., & Maczuga, S. (2013). Racial and ethnic disparities in ADHD diagnosis from kindergarten to eighth grade. Pediatrics, 132(1), 85–93.
Randle, T. S., Miskovic, L. N., Grant O’Daniel, V. R., et al. (2025). Untangling the threads: Co-occurring OCD and ADHD symptoms for Black and/or Latiné youth. Children, 12(6), 674.
Sikov, J., Baul, T. D., Garg, A., et al. (2022). Linguistic inequities in ADHD diagnosis among school-age children screened for attention problems in primary care. Journal of Health Care for the Poor and Underserved, 33(3), 1632–1649.
Skoglund, C., Sundström Poromaa, I., Leksell, D., et al. (2024). Time after time: Failure to identify and support females with ADHD. Journal of Child Psychology and Psychiatry, 65(6), 832–844.
Staley, B. S., Robinson, L. R., Claussen, A. H., et al. (2024). ADHD diagnosis, treatment, and telehealth use in adults. MMWR, 73(40), 890–895.
Williams, A., Shalaby, R., & Sengupta, A. (2024). Large-scale analysis reveals racial disparities in the prevalence of ADHD and conduct disorders. Scientific Reports, 14, 25123.

Based on a working paper (Osademe, 2026) introducing the F-O-C-U-S framework. A full reference list accompanies the manuscript, which is in preparation.