ADHD News & Research

Income Levels Linked to Incidence of ADHD, Asthma, and Autism in Children

Kids are affected differently by mental and physical disorders, depending on their family’s income level.

February 14, 2017

From 2003 to 2012, rates of asthma, ADHD, and autism spectrum disorder (ASD) rose dramatically for children in the United States. Now, a new study charts the connection between each condition and income levels, finding that ADHD and asthma rates are closely linked to increased poverty levels — hitting poor children and the uninsured the hardest — while ASD affected wealthy families more.

The study, published in Pediatrics on February 13, used data from the National Survey of Children’s Health (NSCH), an in-depth nationwide survey conducted by the CDC three times between 2003 and 2012. The results indicated that between those years, asthma rates increased by 18 percent, ADHD rates increased by 44 percent, and ASD rates increased by a whopping 400 percent. But the distribution of those increases wasn’t equal across income levels.

For children living under the federal poverty level, asthma rates increased by 25.8 percent — compared to 13 percent for other children. Children living without insurance saw their asthma rates increase by 57.9 percent, while children with insurance only saw a 9 percent increase. ADHD rates showed similar patterns; children living in poverty had a 43.2 percent increase in ADHD rates, while counterparts at other income levels only had a 33.4 percent increase. Uninsured children saw an increase of 42.7 percent, compared to 37.5 percent for insured children.

ASD, on the other hand, increased dramatically — by 36 percent — for children in households with incomes 400 percent or higher above the federal poverty line. Children living below the poverty line saw only a 13.3 percent increase in the same time period. And ASD occurred more frequently in children with insurance, the report said; rates increased 50 percent for this group, but showed no increase at all for children living without insurance.

“It has been well established that having a family member with a disability increases one’s likelihood of being poor,” the authors write. “Potential reasons for this include increased out-of-pocket health care expenses and time off away from work due to caretaking. These associations have important implications on health care utilization and cost for children and families in poverty and suggest that many families are struggling financially to [take] care of their children with chronic medical conditions.” Doctors should keep these associations in mind when evaluating children for any of the three conditions examined, they conclude.

In an accompanying editorial, Dr. Bernard Dreyer, M.D., agreed that it’s long been known that poor children suffer from chronic health conditions more than their wealthy counterparts. He goes on to say, however, that the potential repeal of the Affordable Care Act currently being discussed makes the results of this study much more urgent.

“We in the AAP [American Academy of Pediatrics], and pediatricians throughout the country, urge Congress to take a ‘do no harm to children’ standard,” Dr. Dreyer writes. “Any changes in the ACA must not leave children worse off than they are today; there must be no structural changes to Medicaid; and CHIP must be reauthorized and strengthened. As described in the AAP Blueprint for Children, anything less will leave the most vulnerable children, who have an increased burden of chronic disease, without access to the essential, comprehensive health services they need to survive and thrive.”