Social Determinants of Neurodevelopmental Disorders: Associations with ADHD and ASD Among U.S. Children

TL;DR

This study finds that social factors like income and neighborhood safety are linked to higher rates of ADHD and ASD in U.S. children.

Contribution

The study provides new national evidence on how social determinants are associated with ADHD, ASD, and their comorbidity in children.

Findings

Lower income, food insecurity, and unsafe neighborhoods are linked to higher odds of ADHD and ASD.

Comorbid ADHD and ASD are more common among socially disadvantaged children.

Non-Hispanic Black and Hispanic children have lower odds of ASD, suggesting diagnostic disparities.

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are prevalent neurodevelopmental conditions in childhood. Beyond biological factors, social and environmental conditions influence developmental experiences and pathways to diagnosis. Nationally representative studies examining multiple social determinants in relation to ADHD, ASD, and comorbidity across recent years remain limited. Methods: We analyzed pooled cross-sectional data from six cycles (2018–2023) of the U.S. National Survey of Children’s Health, including 205,480 children aged 3–17 years. Parent-reported, clinician-diagnosed current ADHD and ASD were the primary outcomes; comorbid ADHD and ASD were examined secondarily. Social determinants included household income relative to the federal poverty level, parental education, health insurance type, food insecurity, and caregiver-reported neighborhood safety. Survey-weighted prevalence estimates and logistic regression models accounted for the complex sampling design and adjusted for demographic, family, regional, and temporal factors. Results: The weighted prevalence of ADHD was 9.7% and ASD was 2.9%; 1.1% of children had comorbid ADHD and ASD. Lower household income, food insecurity, unsafe neighborhood conditions, and lower parental education were associated with higher adjusted odds of both conditions. Boys had substantially higher odds of ADHD and ASD. After adjustment, non-Hispanic Black and Hispanic children had lower odds of ASD than non-Hispanic White children, consistent with differential identification rather than lower underlying prevalence. Comorbidity was concentrated among socially disadvantaged children. Conclusions: ADHD and ASD are socially patterned across U.S. children. Integrating developmental screening with assessment of social risks may support more equitable identification and intervention.

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