Comparison of attention-deficit/hyperactivity disorder and socioeconomic status among school-going children
TL;DR
Almost one in ten children had ADHD, with a consistent gradient of higher prevalence among lower and lower-middle socioeconomic strata, and SES appeared to act alongside other familial and psychosocial factors rather than independently, supporting broader, multi-factorial intervention strategies.
Abstract
Background: Attention-deficit/hyperactivity disorder (ADHD) was a common neurodevelopmental disorder among school-going children, with Indian prevalence estimates ranging widely (5–25%) depending on setting and screening tools. Socioeconomic status (SES) had been proposed as a key determinant of ADHD risk, acting through chronic stress, reduced healthcare access and inconsistent parenting. To determine the prevalence of ADHD among school-going children aged 7–12 years and to examine its association with socioeconomic status. Methods: A cross-sectional study was conducted from April 2024 to October 2025 among 400 children aged 7–12 years, recruited from Government/Government-aided schools around Chidambaram (community-based) and a tertiary hospital paediatric OPD (hospital-based confirmation) using multistage cluster sampling. ADHD was screened using the Vanderbilt Assessment Scale (teacher-completed), with positive screens confirmed via CBCL evaluation and psychiatric assessment. SES was classified using a standard composite scale. Associations were assessed using chi-square testing and multivariate logistic regression (p<0.05 considered significant). Results: Overall ADHD prevalence was 11.0% (44/400), with a significant association found between ADHD and SES (p=0.041); prevalence rose as SES declined, from 6.3% in the upper class to 12.5% in the lower-middle and upper-lower classes. Adjusted odds remained elevated for lower-middle (AOR 1.72), upper-lower (AOR 1.65) and lower-class (AOR 1.58) children relative to the upper class but did not retain significance after adjustment for gender, family type and parental education. Conclusions: Approximately one in ten children had ADHD, with a consistent gradient of higher prevalence among lower and lower-middle socioeconomic strata. SES appeared to act alongside other familial and psychosocial factors rather than independently, supporting broader, multi-factorial intervention strategies.