"The Way the System is Working Out, It's Not Working at All": Parent Perspectives on Social Determinants of Health and ADHD Symptoms in Preschoolers

Adverse social determinants of health (SDH) are associated with higher risk for ADHD and worse prognosis. Understanding the reason for this association is critical for planning interventions to reduce inequities in ADHD outcomes. To answer this question, we conducted a qualitative study with parents of preschoolers aged 3-5 years old with ADHD symptoms, recruited from a safety net hospital, to understand their perspectives on the relationship between SDH and ADHD symptoms. Nineteen parents (53% Black, 26% Latine, 16% White; median income $32,500) completed in-depth interviews, and the data was analyzed using thematic analysis. Parents described bidirectional relationships between three main themes: (1) unmet social needs, (2) child ADHD symptoms, and (3) parent stress. Our findings suggest that early intervention to address unmet social needs in the child's environment and support parent mental health could be tested to improve symptom trajectories in preschoolers with emerging ADHD.