Skip to main content

Advertisement

SpringerLink
Log in

The Association Between Socioeconomic Disadvantage and Attention Deficit/Hyperactivity Disorder (ADHD): A Systematic Review

  • Substantive/Theoretical Review
  • Published:
Child Psychiatry & Human Development Aims and scope Submit manuscript

Abstract

This systematic review examines associations between parental socioeconomic disadvantage and childhood attention deficit/hyperactivity disorder (ADHD). Socioeconomic status (SES) was measured by parental income, education, occupation and marital status. Results were mixed by measure of SES with no one aspect being differentially related to ADHD. 42 studies were included in the review, of which 35 found a significant univariate association between socioeconomic disadvantage and ADHD. Meta-analyses of dimensions of SES and their association with ADHD indicate that children in families of low SES are on average 1.85–2.21 more likely to have ADHD than their peers in high SES families. In spite of substantial between-study heterogeneity, there is evidence for an association between socioeconomic disadvantage and risk of ADHD measured in different ways. This is likely mediated by factors linked to low SES such as parental mental health and maternal smoking during pregnancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

ADHD:

Attention deficit/hyperactivity disorder

SES:

Socioeconomic status

References

  1. Polanczyk G, de Lima M, Horta B, Biederman J, Rohde L (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164(6):942–948

    Article  PubMed  Google Scholar 

  2. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders IV, Text Revision. American Psychiatric Association

  3. Cooper P (2001) Understanding AD/HD: a brief critical review of literature. Child Soc 15(5):387–395

    Article  Google Scholar 

  4. Galera C, Bouvard MP, Lagarde E, Michel G, Touchette E, Fombonne E et al (2012) Childhood attention problems and socioeconomic status in adulthood: 18-year follow-up. Br J Psychiatry 201(1):20–25

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sacker A, Schoon I, Bartley M (2002) Social inequality in educational achievement and psychosocial adjustment throughout childhood: magnitude and mechanisms. Soc Sci Med 55(5):863–880

    Article  PubMed  Google Scholar 

  6. Klein RG, Mannuzza S, Olazagasti MAR, Roizen E, Hutchison JA, Lashua EC et al (2012) Clinical and functional outcome of childhood attention-deficit/hyperactivity disorder 33 years later. Arch Gen Psychiatry 69(12):1295–1303

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bernfort L, Nordfeldt S, Persson J (2008) ADHD from a socio-economic perspective. Acta Paediatr 97(2):239–245

    Article  PubMed  Google Scholar 

  8. Russell G, Ford T, Rosenberg R, Kelly S (2013) The association of attention deficit hyperactivity disorder with socioeconomic disadvantage: alternative explanations and evidence. J Child Psychol Psychiatry 55(5):436–445

    Article  PubMed  PubMed Central  Google Scholar 

  9. Linnet KM, Dalsgaard S, Obel C, Wisborg K, Henriksen TB, Rodriguez A et al (2003) Maternal lifestyle factors in pregnancy risk of attention deficit hyperactivity disorder and associated behaviors: review of the current evidence. Am J Psychiatry 160(6):1028–1040

    Article  PubMed  Google Scholar 

  10. Thapar A, Fowler T, Rice F, Scourfield J, van den Bree M, Thomas H et al (2003) Maternal smoking during pregnancy and attention deficit hyperactivity disorder symptoms in offspring. Am J Psychiatry 160(11):1985–1989

    Article  PubMed  Google Scholar 

  11. Pheula GF, Rohde LA, Schmitz M (2011) Are family variables associated with ADHD, inattentive type? A case-control study in schools. Eur Child Adolesc Psychiatry 20(3):137–145

    Article  PubMed  Google Scholar 

  12. Kreppner JM, O’Connor TG, Rutter M (2001) Can inattention/overactivity be an institutional deprivation syndrome? J Abnorm Child Psychol 29(6):513–528

    Article  PubMed  Google Scholar 

  13. Mulligan A, Anney R, Butler L, O’Regan M, Richardson T, Tulewicz EM et al (2013) Home environment: association with hyperactivity/impulsivity in children with ADHD and their non-ADHD siblings. Child Care Health Dev 39(2):202–212

    Article  PubMed  PubMed Central  Google Scholar 

  14. McCann D, Barrett A, Cooper A, Crumpler D, Dalen L, Grimshaw K et al (2007) Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet 370(9598):1560–1567

    Article  PubMed  Google Scholar 

  15. Williams NM, Zaharieva I, Martin A, Langley K, Mantripragada K, Fossdal R et al (2010) Rare chromosomal deletions and duplications in attention-deficit hyperactivity disorder: a genome-wide analysis. Lancet 376(9750):1401–1408

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kahn RS, Khoury J, Nichols WC, Lanphear BP (2003) Role of dopamine transporter genotype and maternal prenatal smoking in childhood hyperactive-impulsive, inattentive, and oppositional behaviors. J Pediatr 143(1):104–110

    Article  PubMed  Google Scholar 

  17. Boe T, Overland S, Lundervold AJ, Hysing M (2012) Socioeconomic status and children’s mental health: results from the Bergen Child Study. Soc Psychiatry Psychiatr Epidemiol 47(10):1557–1566

    Article  PubMed  Google Scholar 

  18. Froehlich TE, Lanphear BP, Epstein JN, Barbaresi WJ, Katusic SK, Kahn RS (2007) Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Arch Pediatr Adolesc Med 161(9):857–864

    Article  PubMed  Google Scholar 

  19. Russell G, Rodgers L, Ukoumunne O, Ford T (2013) Prevalence of parent-reported ASD and ADHD in the UK: findings from the millennium cohort study. J Autism Dev Disord 44(1):31–40

    Article  Google Scholar 

  20. Bradley RH, Corwyn RF (2002) Socioeconomic status and child development. Annu Rev Psychol 53(1):371–399

    Article  PubMed  Google Scholar 

  21. Miech RA, Caspi A, Moffitt TE, Wright BRE, Silva PA (1999) Low socioeconomic status and mental disorders: a longitudinal study of selection and causation during young adulthood. Am J Sociol 104(4):1096–1131

    Article  Google Scholar 

  22. Scahill L, Schwab-Stone M, Merikangas KR, Leckman JF, Zhang H, Kasl S (1999) Psychosocial and clinical correlates of ADHD in a community sample of school-age children. J Am Acad Child Adolesc Psychiatry 38(8):976–984

    Article  PubMed  Google Scholar 

  23. Larsson H, Sariaslan A, Langstrom N, D’Onofrio B, Lichtenstein P (2013) Family income in early childhood and subsequent attention deficit/hyperactivity disorder: a quasi-experimental study. J Child Psychol Psychiatry 55(5):428–435

    Article  PubMed  PubMed Central  Google Scholar 

  24. Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M et al (2005) Socioeconomic status in health research: one size does not fit all. JAMA 294(22):2879–2888

    Article  PubMed  Google Scholar 

  25. Shavers VL (2007) Measurement of socioeconomic status in health disparities research. J Natl Med Assoc 99(9):1013

    PubMed  PubMed Central  Google Scholar 

  26. Conger RD, Donnellan MB (2007) An interactionist perspective on the socioeconomic context of human development. Annu Rev Psychol 58:175–199

    Article  PubMed  Google Scholar 

  27. Galobardes B, Lynch J, Smith GD (2007) Measuring socioeconomic position in health research. Br Med Bull 81(1):21–37

    Article  PubMed  Google Scholar 

  28. Miech RA, Hauser RM (2001) Socioeconomic status and health at midlife: a comparison of educational attainment with occupation-based indicators. Ann Epidemiol 11(2):75–84

    Article  PubMed  Google Scholar 

  29. Mackenbach JP (2012) The persistence of health inequalities in modern welfare states: the explanation of a paradox. Soc Sci Med 75(4):761–769

    Article  PubMed  Google Scholar 

  30. Reiss F (2013) Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Soc Sci Med 90:24–31

    Article  PubMed  Google Scholar 

  31. Graham H (2002) Building an inter-disciplinary science of health inequalities: the example of lifecourse research. Soc Sci Med 55(11):2005–2016

    Article  PubMed  Google Scholar 

  32. Taylor E, Rogers JW (2005) Practitioner review: early adversity and developmental disorders. J Child Psychol Psychiatry 46(5):451–467

    Article  PubMed  Google Scholar 

  33. von Stumm S, Deary IJ, Kivimaki M, Jokela M, Clark H, Batty GD (2011) Childhood behavior problems and health at midlife: 35-year follow-up of a Scottish birth cohort. J Child Psychol Psychiatry 52(9):992–1001

    Article  Google Scholar 

  34. Kiernan KE, Mensah FK (2009) Poverty, maternal depression, family status and children’s cognitive and behavioural development in early childhood: a longitudinal study. J Social Policy 38(04):569–588

    Article  Google Scholar 

  35. Hausner E, Waffenschmidt S, Kaiser T, Simon M (2012) Routine development of objectively derived search strategies. Syst Rev 1(1):1–10

    Article  Google Scholar 

  36. Koster J (2004) PubMed PubReMiner: a tool for PubMed query building and literature mining. http://hgserver2.amc.nl/cgi-bin/miner/miner2.cgi

  37. Reuters Thomson (2011) Endnote X5. Thomson Reuters, New York

    Google Scholar 

  38. StataCorp (2013) Stata statistical software: release 13. StataCorp LP, College Station

    Google Scholar 

  39. de Oliveira Pires T, da Silva CMFP, de Assis SG (2013) Association between family environment and attention deficit hyperactivity disorder in children–mothers’ and teachers’ views. BMC Psychiatry 13(1):1–9

    Article  Google Scholar 

  40. Li S, Jin X, Yan C, Wu S, Jiang F, Shen X (2009) Sleep problems in chinese school-aged children with a parent-reported history of ADHD. J Atten Disord 13(1):18–26

    Article  PubMed  Google Scholar 

  41. Lingineni RK, Biswas S, Ahmad N, Jackson BE, Bae S, Singh KP (2012) Factors associated with attention deficit/hyperactivity disorder among US children: results from a national survey. BMC Pediatr 12(1):50

    Article  PubMed  PubMed Central  Google Scholar 

  42. Graetz BW, Sawyer MG, Hazell PL, Arney F, Baghurst P (2001) Validity of DSM-IV ADHD subtypes in a nationally representative sample of Australian Children and Adolescents. J Am Acad Child Adolesc Psychiatry 40(12):1410–1417

    Article  PubMed  Google Scholar 

  43. Khamis V (2006) Family environment and parenting as predictors of attention-deficit and hyperactivity among Palestinian Children. Journal of Social Service Research 32(4):99–116

    Article  Google Scholar 

  44. Duric NS, Elgen I (2011) Characteristics of Norwegian children suffering from ADHD symptoms: ADHD and primary health care. Psychiatry Res 188(3):402–405

    Article  PubMed  Google Scholar 

  45. Franz M, Lensche H, Schmitz N (2003) Psychological distress and socioeconomic status in single mothers and their children in a German city. Soc Psychiatry Psychiatr Epidemiol 38(2):59–68

    Article  PubMed  Google Scholar 

  46. Sagiv SK, Epstein JN, Bellinger DC, Korrick SA (2013) Pre- and postnatal risk factors for ADHD in a nonclinical pediatric population. J Atten Disord 17(1):47–57

    Article  PubMed  Google Scholar 

  47. Yoshimasu K, Kiyohara C, Minami T, Yoshikawa N, Kihira S, Toyonaga K et al (2009) Maternal smoking during pregnancy and offspring attention-deficit/hyperactivity disorder: a case-control study in Japan. Atten Defic Hyperact Disord 1(2):223–231

    Article  PubMed  Google Scholar 

  48. De Ridder A, De Graeve D (2007) Children with ADHD in Flanders: profile of consumption of health care, school attainments and impact on the household. [Dutch]Kinderen met ADHD in Vlaanderen: Profiel van zorgconsumptie, schoolresultaten en impact op het gezin. Tijdschrift voor Geneeskunde 63(11):525–531

    Article  Google Scholar 

  49. Schneider H, Eisenberg D (2006) Who receives a diagnosis of attention-deficit/hyperactivity disorder in the United States elementary school population? Pediatrics 117(4):e601–e609

    Article  PubMed  Google Scholar 

  50. Dopfner M, Breuer D, Wille DPN, Erhart M, Ravens-Sieberer U (2008) How often do children meet ICD-10/DSM-IV criteria of attention deficit-/hyperactivity disorder and hyperkinetic disorder? Parent-based prevalence rates in a national sample—results of the BELLA study. Eur Child Adolesc Psychiatry 17(Suppl 1):59–70

    Article  PubMed  Google Scholar 

  51. Cornejo JW, Osio O, Sanchez Y, Carrizosa J, Sanchez G, Grisales H et al (2005) Prevalence of attention deficit hyperactivity disorder in Colombian children and teenagers. Rev Neurol 40(12):716–722

    PubMed  Google Scholar 

  52. Ornoy A (2003) The impact of intrauterine exposure versus postnatal environment in neurodevelopmental toxicity: long-term neurobehavioral studies in children at risk for developmental disorders. Toxicol Lett 140–141:171–181

    Article  PubMed  Google Scholar 

  53. Counts CA, Nigg JT, Stawicki JA, Rappley MD, Von Eye A (2005) Family adversity in DSM-IV ADHD combined and inattentive subtypes and associated disruptive behavior problems. J Am Acad Child Adolesc Psychiatry 44(7):690–698

    Article  PubMed  Google Scholar 

  54. Flouri E, Buchanan A, Tan JP, Griggs J, Attar-Schwartz S (2010) Adverse life events, area socio-economic disadvantage, and adolescent psychopathology: the role of closeness to grandparents in moderating the effect of contextual stress. Stress 13(5):402–412

    Article  PubMed  Google Scholar 

  55. Biederman J, Faraone SV, Monuteaux MC (2002) Differential effect of environmental adversity by gender: Rutter’s index of adversity in a group of boys and girls with and without ADHD. Am J Psychiatry 159(9):1556–1562

    Article  PubMed  Google Scholar 

  56. Andres MA, Catala MA, Gomez-Beneyto M (1999) Prevalence, comorbidity, risk factors and service utilisation of disruptive behaviour disorders in a community sample of children in Valencia (Spain). Soc Psychiatry Psychiatr Epidemiol 34(4):175–179

    Article  PubMed  Google Scholar 

  57. Ford T, Goodman R, Meltzer H (2004) The relative importance of child, family, school and neighbourhood correlates of childhood psychiatric disorder. Soc Psychiatry Psychiatr Epidemiol 39(6):487–496

    Article  PubMed  Google Scholar 

  58. Al Hamed JH, Taha AZ, Sabra AA, Bella H (2009) Attention deficit hyperactivity disorder (ADHD): is it a health problem among male primary school children. Bahrain Med Bull 30(2):67–71

    Google Scholar 

  59. Kotimaa AJ, Moilanen I, Taanila A, Ebeling H, Smalley SL, Mcgough J et al (2003) Maternal smoking and hyperactivity in 8-year-old children. J Am Acad Child Adolesc Psychiatry 42(7):826–833

    Article  PubMed  Google Scholar 

  60. Bener A, Al Qahtani R, Teebi AS, Bessisso M (2008) The prevalence of attention deficit hyperactivity symptoms in schoolchildren in a highly consanguineous community. Med Princ Pract 17(6):440–446

    Article  PubMed  Google Scholar 

  61. Wagner AI, Schmidt NL, Lemery-Chalfant K, Leavitt LA, Goldsmith HH (2009) The limited effects of obstetrical and neonatal complications on conduct and attention-deficit hyperactivity disorder symptoms in middle childhood. J Dev Behav Pediatr 30(3):217–225

    Article  PubMed  PubMed Central  Google Scholar 

  62. Anselmi L, Menezes A, Barros FC, Hallal PC, Araújo CL, Domingues MR et al (2010) Early determinants of attention and hyperactivity problems in adolescents: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study. Cad Saude Publica 26(10):1954–1962

    Article  PubMed  Google Scholar 

  63. Sciberras E, Ukoumunne OC, Efron D (2011) Predictors of parent-reported attention-deficit/hyperactivity disorder in children aged 6–7 years: a national longitudinal study. J Abnorm Child Psychol 39(7):1025–1034

    Article  PubMed  Google Scholar 

  64. Getahun D, Jacobsen SJ, Fassett MJ, Chen W, Demissie K, Rhoads GG (2013) Recent trends in childhood attention-deficit/hyperactivity disorder. JAMA Pediatr 167(3):282–288

    Article  PubMed  Google Scholar 

  65. McLaughlin KA, Sheridan MA, Winter W, Fox NA, Zeanah CH, Nelson CA (2014) Widespread reductions in cortical thickness following severe early-life deprivation: a neurodevelopmental pathway to attention-deficit/hyperactivity disorder. Biol Psychiatry 76(8):629–638

    Article  PubMed  PubMed Central  Google Scholar 

  66. Evans GW, Li D, Whipple SS (2013) Cumulative risk and child development. Psychol Bull 139(6):1342

    Article  PubMed  Google Scholar 

  67. Lemstra M, Neudorf C, D’arcy C, Kunst A, Warren LM, Bennett NR (2008) A systematic review of depressed mood and anxiety by SES in youth aged 10–15 years. Can J Public Health 99(2):125–129

  68. Piotrowska PJ, Stride CB, Croft SE, Rowe R (2015) Socioeconomic status and antisocial behaviour among children and adolescents: a systematic review and meta-analysis. Clin Psychol Rev 35:47–55

    Article  PubMed  Google Scholar 

  69. Durkin MS, Maenner MJ, Meaney FJ, Levy SE, DiGuiseppi C, Nicholas JS et al (2010) Socioeconomic inequality in the prevalence of autism spectrum disorder: evidence from a US cross-sectional study. PLoS ONE 5(7):e11551

    Article  PubMed  PubMed Central  Google Scholar 

  70. Thapar A, Rice F, Hay D, Boivin J, Langley K, van den Bree M et al (2009) Prenatal smoking might not cause attention-deficit/hyperactivity disorder: evidence from a novel design. Biol Psychiatry 66(8):722–727

    Article  PubMed  PubMed Central  Google Scholar 

  71. Lindblad F, Hjern A (2010) ADHD after fetal exposure to maternal smoking. Nicotine Tob Res 12(4):408–415

    Article  PubMed  Google Scholar 

  72. Ellis B, Nigg J (2009) Parenting practices and attention-deficit/hyperactivity disorder: new findings suggest partial specificity of effects. J Am Acad Child Adolesc Psychiatry 48(2):146–154

    Article  PubMed  PubMed Central  Google Scholar 

  73. Kiernan KE, Huerta MC (2008) Economic deprivation, maternal depression, parenting and children’s cognitive and emotional development in early childhood. Br J Sociol 59(4):783–806

    Article  PubMed  Google Scholar 

  74. Tippett N, Wolke D (2014) Socioeconomic status and bullying: a meta-analysis. Am J Public Health 104(6):e48–e59

    Article  PubMed  Google Scholar 

  75. Holmberg K, Hjern A (2008) Bullying and attention-deficit–hyperactivity disorder in 10-year-olds in a Swedish community. Dev Med Child Neurol 50(2):134–138

    Article  PubMed  Google Scholar 

  76. Webb E (2013) Poverty, maltreatment and attention deficit hyperactivity disorder. Arch Dis Child 98(6):397–400

    Article  PubMed  Google Scholar 

  77. Rutter M, Andersen-Wood L, Beckett C, Bredenkamp D, Castle J, Groothues C et al (1999) Quasi-autistic patterns following severe early global privation. J Child Psychol Psychiatry 40(4):537–549

    Article  PubMed  Google Scholar 

  78. Young S (2000) ADHD children grown up: an empirical review. Couns Psychol Q 13(2):191–200

    Article  Google Scholar 

  79. Skoglund C, Chen Q, Lichtenstein P, Larsson H (2014) Familial confounding of the association between maternal smoking during pregnancy and ADHD in offspring. J Child Psychol Psychiatry 55(1):61–68

    Article  PubMed  PubMed Central  Google Scholar 

  80. Hjern A, Weitoft GR, Lindblad F (2010) Social adversity predicts ADHD-medication in school children—a national cohort study. Acta Paediatr 99(6):920–924

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank the Evidence Synthesis Team of the University of Exeter Medical School for their support and assistance, and Dr Obioha Ukoumunne for his advice on meta-analysis. This research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Author information

Authors and Affiliations

  1. Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, EX1 2LU, UK

    Abigail Emma Russell & Tamsin Ford

  2. Department of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK

    Rebecca Williams

  3. ESRC Centre for Genomics in Society (Egenis) and Institute of Health Research, University of Exeter Medical School, Exeter, UK

    Ginny Russell

Authors
  1. Abigail Emma Russell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tamsin Ford
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rebecca Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ginny Russell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Abigail Emma Russell.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Russell, A.E., Ford, T., Williams, R. et al. The Association Between Socioeconomic Disadvantage and Attention Deficit/Hyperactivity Disorder (ADHD): A Systematic Review. Child Psychiatry Hum Dev 47, 440–458 (2016). https://doi.org/10.1007/s10578-015-0578-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10578-015-0578-3

Keywords

Search

Navigation