BACKGROUND: Studies have found negative associations between socioeconomic position and attention deficit/hyperactivity disorder (ADHD), but it remains unclear if this association is causal. The aim of this study was to determine the extent to which the association between family income in early childhood and subsequent ADHD depends on measured and unmeasured selection factors. METHODS: A total of 811,803 individuals born in Sweden between 1992 and 2000 were included in this nationwide population-based cohort study. Diagnosis of ADHD was assessed via the Swedish national Patient Register and the Swedish Prescribed Drug Register. Annual family income during offspring's first 5 years in life was collected prospectively from the Swedish Integrated Database for Labour Market Research and divided into quartiles by (lower) family disposable income. We predicted ADHD from family income while controlling for covariates and also comparing differently exposed cousins and siblings to control for unmeasured familial confounding. RESULTS: The crude analyses suggested that children exposed to lower income levels were at increased risk for ADHD (HRQ uartile1 = 2.52; 95% CI, 2.42-2.63; HRQ uartile2 = 1.52; 95% CI, 1.45-1.58; HRQ uartile3 = 1.20; 95% CI, 1.14-1.15). This dose-dependent association decreased after adjustment for measured covariates (HRQ uartile1 = 2.09; 95% CI, 2.00-2.19; HRQ uartile2 = 1.36; 95% CI, 1.30-1.42; HRQ uartile3 = 1.13; 95% CI, 1.08-1.18). Although the association was attenuated in cousin comparisons (HRQ uartile1 = 1.61; 95% CI, 1.40-1.84; HRQ uartile2 = 1.28; 95% CI, 1.12-1.45; HRQ uartile3 = 1.14; 95% CI, 1.01-1.28) and sibling comparison models (HRQ uartile1 = 1.37; 95% CI, 1.07-1.75; HRQ uartile2 = 1.37; 95% CI, 1.12-1.68; HRQ uartile3 = 1.23; 95% CI, 1.04-1.45), it remained statistically significant across all levels of decreased disposable family income. CONCLUSIONS: Our results indicated that low family income in early childhood was associated with increased likelihood of ADHD. The link remained even after controlling for unmeasured selection factors, highlighting family income in early childhood as a marker of causal factors for ADHD.
BACKGROUND: Studies have found negative associations between socioeconomic position and attention deficit/hyperactivity disorder (ADHD), but it remains unclear if this association is causal. The aim of this study was to determine the extent to which the association between family income in early childhood and subsequent ADHD depends on measured and unmeasured selection factors. METHODS: A total of 811,803 individuals born in Sweden between 1992 and 2000 were included in this nationwide population-based cohort study. Diagnosis of ADHD was assessed via the Swedish national Patient Register and the Swedish Prescribed Drug Register. Annual family income during offspring's first 5 years in life was collected prospectively from the Swedish Integrated Database for Labour Market Research and divided into quartiles by (lower) family disposable income. We predicted ADHD from family income while controlling for covariates and also comparing differently exposed cousins and siblings to control for unmeasured familial confounding. RESULTS: The crude analyses suggested that children exposed to lower income levels were at increased risk for ADHD (HRQ uartile1 = 2.52; 95% CI, 2.42-2.63; HRQ uartile2 = 1.52; 95% CI, 1.45-1.58; HRQ uartile3 = 1.20; 95% CI, 1.14-1.15). This dose-dependent association decreased after adjustment for measured covariates (HRQ uartile1 = 2.09; 95% CI, 2.00-2.19; HRQ uartile2 = 1.36; 95% CI, 1.30-1.42; HRQ uartile3 = 1.13; 95% CI, 1.08-1.18). Although the association was attenuated in cousin comparisons (HRQ uartile1 = 1.61; 95% CI, 1.40-1.84; HRQ uartile2 = 1.28; 95% CI, 1.12-1.45; HRQ uartile3 = 1.14; 95% CI, 1.01-1.28) and sibling comparison models (HRQ uartile1 = 1.37; 95% CI, 1.07-1.75; HRQ uartile2 = 1.37; 95% CI, 1.12-1.68; HRQ uartile3 = 1.23; 95% CI, 1.04-1.45), it remained statistically significant across all levels of decreased disposable family income. CONCLUSIONS: Our results indicated that low family income in early childhood was associated with increased likelihood of ADHD. The link remained even after controlling for unmeasured selection factors, highlighting family income in early childhood as a marker of causal factors for ADHD.
Authors: F Xavier Castellanos; Edmund J S Sonuga-Barke; Michael P Milham; Rosemary Tannock Journal: Trends Cogn Sci Date: 2006-02-07 Impact factor: 20.229
Authors: Brian M D'Onofrio; Jackson A Goodnight; Carol A Van Hulle; Joseph Lee Rodgers; Paul J Rathouz; Irwin D Waldman; Benjamin B Lahey Journal: J Abnorm Child Psychol Date: 2009-04
Authors: Tomas Larson; Henrik Anckarsäter; Carina Gillberg; Ola Ståhlberg; Eva Carlström; Björn Kadesjö; Maria Råstam; Paul Lichtenstein; Christopher Gillberg Journal: BMC Psychiatry Date: 2010-01-07 Impact factor: 3.630
Authors: Jennifer E Enns; Jason R Randall; Mark Smith; Dan Chateau; Carole Taylor; Marni Brownell; James M Bolton; Elaine Burland; Alan Katz; Laurence Y Katz; Nathan C Nickel Journal: Can J Psychiatry Date: 2017-02-01 Impact factor: 4.356
Authors: Frances M Cronin; Ricardo Segurado; Fionnuala M McAuliffe; Cecily C Kelleher; Richard E Tremblay Journal: Eur Child Adolesc Psychiatry Date: 2016-05-31 Impact factor: 4.785
Authors: Andrew S Rowland; Betty J Skipper; David L Rabiner; Fares Qeadan; Richard A Campbell; A Jack Naftel; David M Umbach Journal: J Child Psychol Psychiatry Date: 2017-08-12 Impact factor: 8.982
Authors: Lindsay L Miller; Hanna C Gustafsson; Jessica Tipsord; Minkyoung Song; Elizabeth Nousen; Nathan Dieckmann; Joel T Nigg Journal: J Abnorm Child Psychol Date: 2018-07
Authors: Erik Pettersson; Arvid Sjölander; Catarina Almqvist; Henrik Anckarsäter; Brian M D'Onofrio; Paul Lichtenstein; Henrik Larsson Journal: J Child Psychol Psychiatry Date: 2014-07-15 Impact factor: 8.982
Authors: Xin Zhao; Timothy F Page; Amy R Altszuler; William E Pelham; Heidi Kipp; Elizabeth M Gnagy; Stefany Coxe; Nicole K Schatz; Brittany M Merrill; Fiona L Macphee; William E Pelham Journal: J Abnorm Child Psychol Date: 2019-08