Social Determinants and Inequities in Childhood ADHD and Autism: A National Population-Based Study
Abstract:
Background: Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are among the most prevalent neurodevelopmental conditions in the United States, yet their distribution follows persistent social and structural inequities. Increasing evidence indicates that socioeconomic disadvantage, limited access to care, and neighborhood stressors influence diagnostic patterns. This study examined national prevalence estimates and as sessed how multiple social determinants independently shape the likelihood of ADHD and ASD among U.S. children. Methods: A cross-sectional analysis was conducted using six cycles of the National Survey of Children’s Health (2018–2023), comprising 205,480 children aged 3–17 years. Weighted prevalence estimates described demographic and socioeconomic patterns. Survey-weighted logistic regression models evaluated associations between household income, parental education, insurance status, food insecurity, and neighborhood context with parent-reported ADHD and ASD, adjusting for demographic and regional factors. Predicted probabilities illustrated socioeconomic gradi ents. Results: Nationally, 9.7% of children had ADHD, and 2.9% had ASD. Strong, graded social disparities were ob served. Children living below the federal poverty level had more than twice the odds of ADHD and significantly higher odds of ASD compared with children in high-income households. Low parental education, food insecurity, public insurance, and unsafe neighborhoods were independent predictors of both conditions. Predicted probabilities declined steadily with increasing household income. Conclusions: ADHD and ASD follow pronounced socioeconomic and environmental gradients, indicating that neu rodevelopmental risk is shaped by structural living conditions as well as individual factors. Addressing these ineq uities will require strengthening early screening, improving access to behavioral health services, and implementing policies that integrate social-risk assessment into r
