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

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

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)951-963
Number of pages13
JournalJournal of Abnormal Child Psychology
Issue number5
StatePublished - Jul 1 2018


  • ADHD
  • Attention deficit hyperactivity disorder
  • Comorbidity
  • NSCH
  • SES
  • Social disadvantage
  • Socioeconomic status

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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