Association of Food Insecurity and Attention-Deficit/Hyperactivity Disorder in Children: Insights from the National...

ADHD affects ∼10% of US children and carries substantial health burdens. Food insecurity, limited or uncertain access to adequate nutrition, affects many US households and is linked to adverse cognitive and behavioral outcomes. Clarifying whether food insecurity is associated with ADHD diagnosis could inform clinical assessment and policy.

We conducted a cross-sectional analysis of the National Survey of Children's Health (NSCH) 2016-2022, including children aged 3-17 years. The primary outcome was parent-reported ADHD diagnosis. Household food insecurity was categorized as: always able to afford nutritious meals; enough but not preferred foods; sometimes not enough food; and often not enough food. Multivariable logistic regression models were used to estimate associations in a nationally representative sample.

Among 232,571 children, 10.2% had an ADHD diagnosis. Food insecurity was more common among children with ADHD than those without ADHD (42.4% vs 30.5%; p<0.001), with a graded distribution across severity categories. In fully adjusted models, food insecurity demonstrated a dose-response association with ADHD. Compared with food-secure households, odds of ADHD were higher among children in households with enough but not preferred foods (OR 1.31, 95% CI 1.21-1.42), sometimes not enough food (OR 1.55, 95% CI 1.34-1.80), and often not enough food (OR 1.83, 95% CI 1.36-2.45).

Household food insecurity is associated with ADHD in US children. Incorporating food security assessment into ADHD evaluations and addressing nutritional instability may support more comprehensive clinical assessment and improve overall child well-being.