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Is the Association of ADHD with Socio-Economic Disadvantage Explained by Child Comorbid Externalizing Problems or Parent ADHD?

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Abstract

It has been unclear whether an associations of child ADHD with socio-economic disadvantage (SES) could be accounted for by (a) parental ADHD explaining both low SES and child ADHD, and/or (b) the joint overlap of ODD or CD with low SES and ADHD. Study 1 used a community-recruited case-control sample with detailed evaluation of SES indicators, child ADHD, child externalizing, and parent ADHD symptoms (n = 931 children, 521 ADHD, 577 boys, 354 girls) in a path modeling analysis with latent variables. Study 2 evaluated ADHD and externalizing behavior in a regression model using a poverty index for SES, in 70,927 children (48.2% female) aged 5–17 years from the US 2011–2012 National Survey of Children’s Health (NSCH). In Study 1, lower SES was related to the ADHD latent variable, β = −.18, p < .001; 95%CI [−.25,-.12]. This effect held when parent ADHD and child ODD and CD were in the model, β = −.11, p < .01, 95% CI [−.09,-.03], equivalent to OR = 1.50, 95% CI[1.12–2.04]). In Study 2, these results replicated. Adjusting only for age and sex, children from families who were below 200% of the federal poverty line were more likely to have moderate or severe ADHD than no ADHD, versus children above that line, OR = 2.13, 95% CI[1.79,2.54], p < .001. The effect held after adjusting for disruptive/externalizing problems, OR = 1.61, p < .01, 95%CI [1.32,1.96]. The effect size for comparable models was similar across both studies, lending higher confidence to the results. It is concluded that the SES association with child ADHD is not explained by artifact and requires a mechanistic explanation.

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Notes

  1. A potential confound in the Nam-Powers-Boyd system is that it scores an occupation score = “0” for a range of reasons. In our sample, the breakdown was as follows: Unemployed (n = 23), plus n = 54 others that might be debatable: active military (n = 1), retired (n = 7), disabled (n = 5), students (n = 22), homemaker (n = 19). In a robustness analysis, we recoded these n = 54 scores that as missing. We repeated this for all the models (with slight change in N as reported below). Results were essentially unchanged and conclusions remained the same. We therefore report the results with the code as recommended (Nam and Boyd 2004). The robustness results are available on request.

  2. In a path model, a hypothesized bidirectional effect gets two straight arrows, one pointing in each direction. However, models containing bidirectional effects can only be estimated given strong assumptions and other variables (or instruments) that cause each of the two variables involved in the bidirectional effect; therefore, we did not consider them viable here.

  3. To obtain fit statistics for an SEM with a dichotomous outcome variable requires the robust weighted least squares estimator. We ran all of our models using both the robust weighted least squares and robust maximum likelihood estimators and received nearly identical results. We present the results using the robust weighted least squares estimator so that the reader has sufficient information to assess model fit.

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Funding

This work was funded by NIMH grant R37–59105 (Nigg, PI).

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  1. Department of Psychiatry, Oregon Health & Science University, Portland, OR, 97239, USA

    Lindsay L. Miller, Hanna C. Gustafsson, Jessica Tipsord, Minkyoung Song, Elizabeth Nousen, Nathan Dieckmann & Joel T. Nigg

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Miller, L.L., Gustafsson, H.C., Tipsord, J. et al. Is the Association of ADHD with Socio-Economic Disadvantage Explained by Child Comorbid Externalizing Problems or Parent ADHD?. J Abnorm Child Psychol 46, 951–963 (2018). https://doi.org/10.1007/s10802-017-0356-8

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