Gendered school expectations and ADHD recognition in an Ultra-Orthodox Jewish community: a qualitative study of parents, educators, and therapists

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition that manifests differently in boys and girls, often leading to disparities in diagnosis and treatment. In the Ultra-Orthodox Jewish (UOJ) community, where gender-segregated education is the norm, these differences may be further influenced by cultural and educational expectations. This study explores how gendered educational environments impact the recognition and treatment of ADHD in UOJ schools. Methods: This qualitative descriptive study utilized a secondary analysis of previously collected focus group data. Four homogeneous focus groups were conducted (n = 25) with UOJ mothers and fathers of children with ADHD, educators, and occupational therapists. Conventional content analysis was used to identify key themes related to gender, ADHD recognition, school expectations, medication use, and parental advocacy. Results: Four central themes emerged: (1) Gatekeeping of recognition; (2) Institutional fit/misfit; (3) Pharmacological compliance vs. personality preservation; and (4) Gendered care work. Despite challenges reported, participants noted a growing awareness of ADHD and increased acceptance of accommodations in some UOJ schools. Conclusions: Findings highlight the complex interplay between gender, education, and ADHD recognition within a religiously structured community. While systemic barriers persist, evolving school practices and increased parental advocacy suggest gradual shifts toward more inclusive ADHD support. These insights underscore the need for culturally sensitive interventions, increased teacher training on ADHD, and expanded learning models to accommodate neurodiverse students. Future research should further explore gendered ADHD experiences in other religious and traditional educational settings.