Family income in early childhood and subsequent attention deficit/hyperactivity disorder: a quasi‐experimental study
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Background: Studies have found negative associations between socioeconomic position and attention deficit/hyperactivity disorder ( ADHD ), but it remains unclear if this association is causal. The aim of this study was to determine the extent to which the association between family income in early childhood and subsequent ADHD depends on measured and unmeasured selection factors. Methods: A total of 811,803 individuals born in Sweden between 1992 and 2000 were included in this nationwide population‐based cohort study. Diagnosis of ADHD was assessed via the Swedish national Patient Register and the Swedish Prescribed Drug Register. Annual family income during offspring's first 5 years in life was collected prospectively from the Swedish Integrated Database for Labour Market Research and divided into quartiles by (lower) family disposable income. We predicted ADHD from family income while controlling for covariates and also comparing differently exposed cousins and siblings to control for unmeasured familial confounding. Results: The crude analyses suggested that children exposed to lower income levels were at increased risk for ADHD ( HR Q uartile1 = 2.52; 95% CI , 2.42–2.63; HR Q uartile2 = 1.52; 95% CI , 1.45–1.58; HR Q uartile3 = 1.20; 95% CI , 1.14–1.15). This dose‐dependent association decreased after adjustment for measured covariates ( HR Q uartile1 = 2.09; 95% CI , 2.00–2.19; HR Q uartile2 = 1.36; 95% CI , 1.30–1.42; HR Q uartile3 = 1.13; 95% CI , 1.08–1.18). Although the association was attenuated in cousin comparisons ( HR Q uartile1 = 1.61; 95% CI , 1.40–1.84; HR Q uartile2 = 1.28; 95% CI , 1.12–1.45; HR Q uartile3 = 1.14; 95% CI , 1.01–1.28) and sibling comparison models ( HR Q uartile1 = 1.37; 95% CI , 1.07–1.75; HR Q uartile2 = 1.37; 95% CI , 1.12–1.68; HR Q uartile3 = 1.23; 95% CI , 1.04–1.45), it remained statistically significant across all levels of decreased disposable family income. Conclusions: Our results indicated that low family income in early childhood was associated with increased likelihood of ADHD . The link remained even after controlling for unmeasured selection factors, highlighting family income in early childhood as a marker of causal factors for ADHD .
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Low family income predicted an increased likelihood of ADHD in a Swedish population-based cohort study of 811,803 individuals.
“Larsson and colleagues 15 found that low family income predicted an increased likelihood of ADHD in a Swedish population-based cohort study of 811,803 indivi duals.”
From Attention-deficit/hyperactivity disorder (2015) · cites this paper as [15]
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(2002) · Cited by 13,211 · see citing works
The worldwide prevalence of ADHD: a systematic review and metaregression analysis
Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007) · American Journal of Psychiatry · doi:10.1176/ajp.2007.164.6.942 · Cited by 5,346 · see citing works
Molecular genetics of attention-deficit/hyperactivity disorder
Faraone, S. V., Perlis, R. H., Doyle, A. E., Smoller, J. W., Goralnick, J. J., Holmgren, M. A., & Sklar, P. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.11.024 · Cited by 2,357 · see citing works
An interactionist perspective on the socioeconomic context of human development
Conger, R. D., & Donnellan, M. B. (2007) · Annual Review of Psychology · doi:10.1146/annurev.psych.58.110405.085551 · Cited by 1,935 · see citing works
Angold, A., Costello, E. J., & Erkanli, A. (1999) · Journal of Child Psychology and Psychiatry · doi:10.1111/1469-7610.00424 · Cited by 1,872 · see citing works
Wettermark, B., Hammar, N., MichaelFored, C., Leimanis, A., Olausson, P. O., Bergman, U., Persson, I. R., Sundström, A., Westerholm, B., & Rosén, M. (2006) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.1294 · Cited by 1,867 · see citing works
Neuroscience of attention-deficit/hyperactivity disorder: the search for endophenotypes
Castellanos, F. X., & Tannock, R. (2002) · Nature Reviews Neuroscience · doi:10.1038/nrn896 · Cited by 1,827 · see citing works
Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis
Simon, V., Czobor, P., Bálint, S., Mészáros, Á., & Bitter, I. (2009) · British Journal of Psychiatry · doi:10.1192/bjp.bp.107.048827 · Cited by 1,601 · see citing works
Attention-deficit hyperactivity disorder
Biederman, J., & Faraone, S. V. (2005) · The Lancet · doi:10.1016/s0140-6736(05)66915-2 · Cited by 1,463 · see citing works
Socioeconomic status and the brain: mechanistic insights from human and animal research
Hackman, D. A., Farah, M. J., & Meaney, M. J. (2010) · Nature Reviews Neuroscience · doi:10.1038/nrn2897 · Cited by 1,409 · see citing works
Characterizing cognition in ADHD: beyond executive dysfunction
Castellanos, F. X., Sonuga-Barke, E. J. S., Milham, M. P., & Tannock, R. (2006) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2006.01.011 · Cited by 1,170 · see citing works
Relationships Between Poverty and Psychopathology: A Natural Experiment
Costello, E. J., Compton, S. N., Keeler, G., & Angold, A. (2003) · JAMA · doi:10.1001/jama.290.15.2023 · Cited by 1,079 · see citing works
Medication for Attention Deficit–Hyperactivity Disorder and Criminality
Lichtenstein, P., Halldner, L., Zetterqvist, J., Sjölander, A., Serlachius, E., Fazel, S., Långström, N., & Larsson, H. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1203241 · Cited by 611 · see citing works
Self-citationSibling Comparison Designs: Bias From Non-Shared Confounders and Measurement Error
Frisell, T., Öberg, S., Kuja-Halkola, R., & Sjölander, A. (2012) · Epidemiology · doi:10.1097/ede.0b013e31825fa230 · Cited by 551 · see citing works
Larson, T., Anckarsäter, H. S., Gillberg, C. I., Ståhlberg, O., Carlström, E. L., Kadesjö, B., Råstam, M., Lichtenstein, P., & Gillberg, C. (2010) · BMC Psychiatry · doi:10.1186/1471-244x-10-1 · Cited by 480 · see citing works
Self-citationFamily-Environment Risk Factors for Attention-Deficit Hyperactivity Disorder
Biederman, J. (1995) · Archives of General Psychiatry · doi:10.1001/archpsyc.1995.03950180050007 · Cited by 476 · see citing works
Hultman, C. M., Sandin, S., Levine, S. Z., Lichtenstein, P., & Reichenberg, A. (2011) · Molecular Psychiatry · doi:10.1038/mp.2010.121 · Cited by 444 · see citing works
Self-citationD’Onofrio, B. M., Lahey, B. B., Turkheimer, E., & Lichtenstein, P. (2013) · American Journal of Public Health · doi:10.2105/ajph.2013.301252 · Cited by 343 · see citing works
Self-citationPreterm birth and attention-deficit/hyperactivity disorder in schoolchildren
Lindström, K., Lindblad, F., & Hjern, A. (2011) · Pediatrics · doi:10.1542/peds.2010-1279 · Cited by 334 · see citing works
What causes attention deficit hyperactivity disorder?
Thapar, A., Cooper, M., Jefferies, R., & Stergiakouli, E. (2011) · Archives of Disease in Childhood · doi:10.1136/archdischild-2011-300482 · Cited by 294 · see citing works
Biederman, J., Faraone, S. V., & Monuteaux, M. C. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.9.1556 · Cited by 291 · see citing works
Within-child associations between family income and externalizing and internalizing problems.
Dearing, E., McCartney, K., & Taylor, B. A. (2006) · Developmental Psychology · doi:10.1037/0012-1649.42.2.237 · Cited by 231 · see citing works
Psychosocial and Clinical Correlates of ADHD in a Community Sample of School-Age Children
Scahill, L. D., Schwab‐Stone, M., Merikangas, K. R., Leckman, J. F., Heping Zhang, D., & Kasl, S. V. (1999) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199908000-00013 · Cited by 224 · see citing works
Hansson, S. L., Svanströmröjvall, A., Rastam, M., Gillberg, C., Gillberg, C., & Anckarsäter, H. (2005) · British Journal of Psychiatry · doi:10.1192/bjp.187.3.262 · Cited by 208 · see citing works
Lahey, B. B., & D’Onofrio, B. M. (2010) · Current Directions in Psychological Science · doi:10.1177/0963721410383977 · Cited by 207 · see citing works
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Sharma, A. (2010) · Springer eBooks · doi:10.1007/978-0-387-79948-3_40 · Cited by 192 · see citing works
Counts, C. A., Nigg, J. T., Stawicki, J. A., Rappley, M. D., & Von Eye, A. (2005) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000162582.87710.66 · Cited by 188 · see citing works
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Donovan, S. J., & Susser, E. (2011) · International Journal of Epidemiology · doi:10.1093/ije/dyr057 · Cited by 161 · see citing works
Zetterqvist, J., Asherson, P., Halldner, L., Långström, N., & Larsson, H. (2013) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12004 · Cited by 155 · see citing works
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Chen, Q., Sjölander, A., Långström, N., Rodriguez, A., Serlachius, E., D'Onofrio, B., Lichtenstein, P., & Larsson, H. (2014) · International Journal of Epidemiology · doi:10.1093/ije/dyt152 · Cited by 127 · see citing works
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D'Onofrio, B. M., Goodnight, J. A., Hulle, C. A. V., Rodgers, J. L., Rathouz, P. J., Waldman, I. D., & Lahey, B. B. (2008) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-008-9280-2 · Cited by 52 · see citing works
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Hao, L., & Matsueda, R. L. (2004) · Social Science Research · doi:10.1016/j.ssresearch.2004.10.003 · Cited by 51 · see citing works
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“A Swedish study of over 800,000 people reported similar results even after adjusting for shared familial/genetic risk factors in families (Larsson et al., 2014b).”
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- Authors
- Larsson, H., Sariaslan, A., Långström, N., D'Onofrio, B., & Lichtenstein, P.
- Affiliations
- Karolinska Institutet (SE)
- Indiana University Bloomington (US)
- Corresponding author
- Larsson, Henrik
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2013-09-23
- Volume
- 55
- Issue
- 5
- Pages
- 428-435
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- PMC
- PMC3962802
- OpenAlex
- W2131757485
- Cited by
- 126
- References
- 40
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 7 · 2023: 14 · 2022: 12 · 2021: 6 · 2020: 13 · 2019: 10 · 2018: 13 · 2017: 13 · 2016: 14 · 2015: 8 · 2014: 7
- FWCI
- 6.84
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Swedish Council for Working Life and Social Research
- Swedish Research Council (2010-3184; 2011-2492)
- National Institute of Child Health and Human Development (HD061817)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- attention deficit hyperactivity disorder, household income, selection bias, familial confounding, causal inference, dose-response relationship, Sweden, child mental health, parental employment
- MeSH terms
- Adult, Attention Deficit Disorder with Hyperactivity, Family, Female, Humans, Income, Parents, Parity, Prospective Studies, Risk Factors, Socioeconomic Factors, Sweden, Proportional Hazards Models, Young Adult
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