title: The association of attention deficit hyperactivity disorder with socioeconomic disadvantage: alternative explanations and evidence.
abstract: BACKGROUND
  Studies throughout Northern Europe, the United States and Australia have found an association between childhood attention deficit hyperactivity disorder (ADHD) and family socioeconomic disadvantage. We report further evidence for the association and review potential causal pathways that might explain the link.
  
  
  METHODS
  Secondary analysis of a UK birth cohort (the Millennium Cohort Study, N = 19,519) was used to model the association of ADHD with socioeconomic disadvantage and assess evidence for several potential explanatory pathways. The case definition of ADHD was a parent-report of whether ADHD had been identified by a medical doctor or health professional when children were 7 years old.
  
  
  RESULTS
  ADHD was associated with a range of indicators of social and economic disadvantage including poverty, housing tenure, maternal education, income, lone parenthood and younger motherhood. There was no evidence to suggest childhood ADHD was a causal factor of socioeconomic disadvantage: income did not decrease for parents of children with ADHD compared to controls over the 7-year study period. No clinical bias towards labelling ADHD in low SES groups was detected. There was evidence to suggest that parent attachment/family conflict mediated the relationship between ADHD and SES.
  
  
  CONCLUSIONS
  Although genetic and neurological determinants may be the primary predictors of difficulties with activity level and attention, aetiology appears to be influenced by socioeconomic situation.
authors.affiliation: ESRC Centre for Genomics in Society (Egenis) & Institute of Health Research, University of Exeter Medical School, Exeter, UK.
authors.forename: Ginny
authors.initials: G
authors.lastname: Russell
authors.forename: Tamsin
authors.initials: T
authors.lastname: Ford
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosenberg
authors.forename: Susan
authors.initials: S
authors.lastname: Kelly
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000209:etiology*; D016022:Case-Control Studies; D002648:Child; D004522:Educational Status; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data*; D012307:Risk Factors; D015406:Single Parent / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology
keywords: ADHD; child development; longitudinal studies; social class; sociocultural influence