title: Socioeconomic Associations with ADHD: Findings from a Mediation Analysis.
abstract: BACKGROUND
  Children from disadvantaged socioeconomic backgrounds are at greater risk of a range of negative outcomes throughout their life course than their peers; however the specific mechanisms by which socioeconomic status relates to different health outcomes in childhood are as yet unclear.
  
  
  OBJECTIVE
  The current study investigates the relationship between socioeconomic disadvantage in childhood and attention deficit/hyperactivity disorder (ADHD), and investigates putative mediators of this association in a longitudinal population-based birth cohort in the UK.
  
  
  METHODS
  Data from the Avon Longitudinal Study of Parents and Children was used (n = 8,132) to explore the relationship between different measures of socioeconomic status at birth-3 years and their association with a diagnosis of ADHD at age 7. A multiple mediation model was utilised to examine factors occurring between these ages that may mediate the association.
  
  
  RESULTS
  Financial difficulties, housing tenure, maternal age at birth of child and marital status were significantly associated with an outcome of ADHD, such that families either living in financial difficulty, living in council housing, with younger or single mothers' were more likely to have a child with a research diagnosis of ADHD at age 7. Financial difficulties was the strongest predictor of ADHD (OR 2.23 95% CI 1.57-3.16). In the multiple mediation model, involvement in parenting at age 6 and presence of adversity at age 2-4 mediated 27.8% of the association.
  
  
  CONCLUSIONS
  Socioeconomic disadvantage, conceptualised as reported difficulty in affording basic necessities (e.g. heating, food) has both direct and indirect impacts on a child's risk of ADHD. Lower levels of parent involvement mediates this association, as does presence of adversity; with children exposed to adversity and those with less involved parents being at an increased risk of having ADHD. This study highlights the importance of home and environmental factors as small but important contributors toward the aetiology of ADHD.
authors.affiliation: Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom.
authors.forename: Abigail Emma
authors.initials: AE
authors.lastname: Russell
authors.affiliation: Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom.
authors.forename: Tamsin
authors.initials: T
authors.lastname: Ford
authors.affiliation: ESRC Centre for Genomics in Society (Egenis) & Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom.
authors.forename: Ginny
authors.initials: G
authors.lastname: Russell
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data; D015233:Models, Statistical; D009790:Occupations / Q000706:statistics & numerical data; D010290:Parents; D011247:Pregnancy; D012923:Social Class