In a recent study published in JCPP Advances, researchers examined the associations between neighborhood characteristics and symptoms of attention-deficit/hyperactivity disorder (ADHD) among children with developmental delays (DD) and autism.
Their findings indicate that autistic youth from poorer neighborhoods show more symptoms of ADHD, highlighting the need to improve and increase resources in these areas to reduce inequalities among children with this common neurodevelopmental condition.
Study: Examining the association of neighborhood conditions on attention-deficit/hyperactivity disorder symptoms in autistic youth using the child opportunity index 2.0. Image Credit: Studio Romantic/Shutterstock.com
Background
Researchers believe that between 40% and 70% of autistic children present with elevated ADHD symptoms, which may be linked to poorer treatment responses, higher functional impairment, and higher language, adaptive, social, and conduct-related deficits.
While the influence of genes on ADHD has been established, environmental factors are now thought to play a significant role, and studies have documented the relationship between symptoms of ADHD and family conflict, parenting style, parental distress, and socioeconomic status (SES) of the household and neighborhood.
Other neighborhood characteristics, such as fewer amenities, less green space, dilapidated housing, vandalism, and lack of safety and social support, may also have a role to play.
However, associations between neighborhood-level factors and symptoms of ADHD among children with DD or autism have not been studied.
About the study
Researchers used multidimensional metrics that included data on social, economic, health, environmental, and educational domains to investigate whether being exposed to poorer resources or conditions at the neighborhood level could be linked to symptoms of ADHD during adolescence or mid-childhood. These were used to calculate neighborhood opportunity scores.
They compared this relationship for autistic children, those with DD but not autism, and typically developing (TD) children.
Children participated in the Childhood Autism Risks from Genetics and the Environment (CHARGE) study and were first assessed when they were between two and five years old, with a follow-up between eight and twenty years old, when ADHD symptoms were evaluated based on the 58-point Aberrant Behavior Checklist (ABC).
Covariates included sex assigned at birth, gestational age during delivery, ethnicity, and race, family SES (including financial hardship and household education). The data were analyzed using linear regression models and analysis of variance (ANOVA).
Findings
The participants included 246 children with autism, 85 DD children, and 193 TD children. During the initial assessment, the participants were, on average, 3.8 years old; about 77% were male and 52% were White. Nearly one in five families reported financial hardship when their child was born.
On average, TD children were younger than autistic children at the time of enrolment, and the DD group had lower learning scores, lower birth age, and a higher proportion of females than the other groups.
Families in the TD group were less likely to report financial hardship. However, the groups were similar in terms of SES, demographic variables, and neighborhood opportunity scores.
Lower neighborhood opportunities were related to more symptoms of ADHD during adolescence or mid-childhood, particularly among autistic children, for whom lower economic and social opportunities predicted significantly higher symptoms of ADHD.
However, no significant differences were found for neighborhood-level environment and health factors. Accounting for ADHD symptoms during early childhood did not significantly alter the findings.
Overall, the study suggests that the availability of neighborhood resources during early childhood can impact the severity of ADHD symptoms later in life, especially for autistic children.
This emphasizes the importance of improving social and economic conditions in communities to reduce ADHD symptoms.
Conclusions
This study explores the link between poor neighborhood conditions at birth and ADHD symptoms during mid-childhood and adolescence, focusing on autistic youth and those with DD without autism.
The findings reveal that poorer neighborhood opportunities are associated with higher ADHD symptoms, particularly among autistic individuals, suggesting they may be more vulnerable to environmental factors.
The study underscores the importance of social and economic neighborhood resources, which significantly affect ADHD outcomes in autistic children.
The strengths of this research include a diverse sample, rigorous diagnostic criteria, and the measurement of validated neighborhood conditions.
However, limitations include reliance on parent-reported ADHD symptoms, potential biases, and not accounting for families moving or neighborhood changes. Additionally, the sample was relatively high in socioeconomic status, which may limit the generalizability of the findings.
While effective interventions exist to support children with ADHD and autism, individuals from poorer neighborhoods may have less access to these services and other opportunities.
The study highlights the need for further research to explore neighborhood effects across different developmental stages.
It suggests policy efforts to improve resources for neurodevelopmentally challenged children in underserved neighborhoods, potentially reducing long-term disparities in ADHD outcomes.
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