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Social Determinants of Neurodevelopmental Disorders: Associations with ADHD and ASD Among U.S. Children

Chinedu Izuchi1, Chika N Onwuameze2, Godwin Akuta3

  • 1Avera Hospitals, 132 N Dakota Ave, Sioux Falls, SD 57104, USA.

Children (Basel, Switzerland)
|January 28, 2026
PubMed

Insights

Social and environmental factors significantly impact Attention-deficit/hyperactivity disorder (ADHD) and Autism Spectrum Disorder (ASD) diagnoses in children. Disadvantaged children face higher risks for these neurodevelopmental conditions and their comorbidity.

Area of Science:

  • Pediatric neurodevelopmental disorders
  • Social epidemiology
  • Child health disparities

Background:

  • Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are common childhood neurodevelopmental conditions.
  • Social and environmental factors, alongside biological ones, shape developmental trajectories and diagnostic pathways.
  • Limited recent national data exist on multiple social determinants affecting ADHD, ASD, and their comorbidity.

Purpose of the Study:

  • To examine the associations between social determinants and the prevalence of ADHD, ASD, and comorbid ADHD/ASD in U.S. children.
  • To identify disparities in diagnosis related to socioeconomic status, neighborhood conditions, and race/ethnicity.

Main Methods:

  • Analysis of pooled cross-sectional data from the U.S. National Survey of Children's Health (2018-2023) involving 205,480 children (ages 3-17).
  • Parent-reported, clinician-diagnosed ADHD and ASD as primary outcomes; comorbidity examined secondarily.
  • Social determinants included household income, parental education, food insecurity, neighborhood safety, and insurance type. Survey-weighted logistic regression adjusted for covariates.

Main Results:

  • Weighted prevalence: ADHD 9.7%, ASD 2.9%, comorbid ADHD/ASD 1.1%.
  • Lower income, food insecurity, unsafe neighborhoods, and lower parental education were linked to increased odds of ADHD and ASD.
  • Boys showed higher odds for both conditions. Non-Hispanic Black and Hispanic children had lower ASD odds than non-Hispanic White children, suggesting identification bias. Comorbidity was higher in socially disadvantaged groups.

Conclusions:

  • ADHD and ASD prevalence patterns are influenced by social factors in U.S. children.
  • Findings highlight significant social disparities in the identification and diagnosis of these neurodevelopmental conditions.
  • Integrating social risk assessments into developmental screening can promote more equitable identification and intervention strategies.

Keywords:
National Survey of Children’s Healthattention-deficit/hyperactivity disorder (ADHD)autism spectrum disorder (ASD)comorbiditydiagnostic disparitieshealth equityneighborhood contextsocial determinants of healthsocioeconomic gradients

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