Peer-reviewed article
Family socioeconomic status and attention-deficit/hyperactivity disorder symptoms in preschool children: a cross-sectional study of 21,366 parent-child dyads in Yan'an, western China.
Jiali Du, Man Bai, Jieqiong Liu, Jie Mi, Yan Wang ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how family socioeconomic status relates to attention-deficit/hyperactivity disorder (ADHD) symptoms in over 21,000 preschool children in western China. Researchers found that children from higher-income families with more educated parents showed fewer ADHD symptoms, and the relationship was consistent across different income groups. The findings suggest that socioeconomic resources matter for early childhood mental health in China.
Key points
- Each increase in family socioeconomic status corresponded to a 0.17-point decrease in ADHD symptom scores
- Higher socioeconomic status reduced the odds of elevated ADHD symptoms by 27% per standard deviation increase
- A clear dose-response relationship was observed across socioeconomic status tertiles
- Associations remained consistent across all subgroups tested, with no significant differences by child age or sex
- Findings were robust across multiple analytical approaches including multiple imputation and restricted cubic spline analyses
Limitations
This is a cross-sectional study, so it cannot establish whether socioeconomic status causes lower ADHD symptoms or whether other factors explain the relationship. The study measures ADHD symptoms through parent report only, which may be subject to bias.
Abstract
BACKGROUND: Socioeconomic status (SES) is a well-established determinant of child mental health, yet evidence from large preschool populations in western China remains scarce. This study examined the association between family SES and attention-deficit/hyperactivity disorder (ADHD) symptoms in preschool children. METHODS: We conducted a cross-sectional survey among 21,366 parent-child dyads recruited from 189 public kindergartens in a western Chinese city using stratified cluster sampling. A composite family SES index was derived from parental occupation, education, and household income through principal component analysis. Child ADHD symptoms were measured using the Strengths and Difficulties Questionnaire (SDQ) hyperactivity/inattention subscale. Survey-weighted linear and logistic regression models adjusted for child age, sex, preterm birth, parental smoking and alcohol use, respondent role, and respondent age, with cluster-robust standard errors accounting for kindergarten-level clustering. RESULTS: Higher family SES was significantly associated with lower ADHD symptom scores. In the fully adjusted linear model, each 1-SD increase in SES corresponded to a 0.17-point decrease in the SDQ hyperactivity/inattention score (95% CI: -0.18 to -0.15, P < 0.001). Logistic regression showed a 27% reduction in the odds of elevated ADHD symptoms per 1-SD increase in SES (OR = 0.73, 95% CI: 0.64 to 0.84, P < 0.001). A clear dose-response relationship emerged across SES tertiles (P for trend < 0.001). Stratified analyses demonstrated consistent associations across all subgroups, with no significant effect modification after Bonferroni correction. Multiple imputation and restricted cubic spline analyses confirmed the robustness of these findings. CONCLUSIONS: Higher family SES is associated with lower ADHD symptom levels in preschool children from western China, with a clear dose-response relationship. These findings underscore the importance of socioeconomic resources in early childhood mental health and may inform the development of targeted intervention strategies for low-SES families. Longitudinal studies are warranted to establish causality and elucidate underlying mechanisms.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- This is an observational study with no intervention; it examines the natural relationship between family socioeconomic status and ADHD symptoms
- Population
- 21,366 preschool children aged 3-6 years and their parents from 189 public kindergartens in Yan'an, western China
Key finding
Each 1-SD increase in composite family SES index associated with 0.17-point decrease in SDQ hyperactivity/inattention score (95% CI: -0.18 to -0.15, P < 0.001)