<p>The aim of this systematic review and meta-analysis is to estimate the overall prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) among Iranian elementary school children, with a particular focus on potential variations by gender and diagnostic tools. A systematic review of nine studies meeting eligibility criteria was conducted, including data from 9,138 children aged 6 to 12 years. The results indicate a pooled ADHDt prevalence of 11.2% (95% CI: 9.4–13.2%), with a significantly higher prevalence observed in boys (10.1%) compared to girls (7%). The choice of diagnostic instrument was also a source of variability in results, with the Conners’ Questionnaire indicating a prevalence of 10.9% and the CSI-4 Questionnaire yielding a prevalence of 12.1%. The study highlights notable heterogeneity across the studies (I² = 87.6%), influenced by differences in sample size, location and diagnostic methodology. These findings highlight the necessity for the standardization of diagnostic practices in order to enhance the accuracy and consistency of estimates regarding the prevalence of ADHD in Iran. Additional research should concentrate on the elucidation of the social and cultural determinants. This will enable a deeper comprehension of these elements and the interwoven relationship between culture, society, and child mental health.</p>