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Low-Income Kids More Likely to Have ADHD, Asthma
Autism more often diagnosed among children in higher-income families, study finds
By Dennis Thompson
HealthDay Reporter

TUESDAY, Feb. 14, 2017 (HealthDay News) -- Children in families struggling to make ends meet are developing asthma and attention-deficit/hyperactivity disorder (ADHD) at faster rates than kids from families with greater means, a new study finds.

On the other hand, kids from wealthier families are being diagnosed with autism spectrum disorder more often than children in poorer homes. But that likely indicates that those parents have better access to the health care services that can uncover an autism diagnosis, the study authors said.

The findings suggest that family income and access to health insurance play a large role in a child's physical and mental health, said lead researcher Dr. Christian Pulcini. He's a pediatrics resident with the Children's Hospital of Pittsburgh.

"Children in poverty are more at risk for adverse health outcomes, and we need to keep that in mind when we make policy and programs that will benefit children, particularly if they are poor," Pulcini said.

For their study, Pulcini and his colleagues analyzed data from the U.S. National Survey of Children's Health, a federal survey conducted three times between 2003 and 2012.

The investigators specifically reviewed rates of asthma, ADHD and autism for two reasons, Pulcini explained. Other studies had found all three conditions on the rise in the United States. And the disorders provided a good mix of physical (asthma) and mental (ADHD and autism) health conditions that children face.

The study found that parent-reported rates of all three conditions are increasing. Asthma and ADHD rates rose 18 percent and 44 percent, respectively, between 2003 and 2012, while autism rates increased a whopping 400 percent.

But when the researchers factored poverty into their analysis, the findings showed that family income level had a distinct effect on childhood illness:

  • Asthma rates increased nearly 26 percent among children in families at less than 100 percent of the federal poverty level (FPL), as opposed to about 15 percent in families between 100 percent and 199 percent of the FPL, and about 13.5 percent in families earning 200 percent or more of the poverty level.
  • ADHD rates were much lower for families at or above 400 percent of the federal poverty level (33 percent) than families earning less money (43 percent to 52 percent, depending on income).
  • Autism spectrum disorder was more likely to be diagnosed in kids from families above the federal poverty level (28 percent to just over 43 percent, depending on income) than those who fall below the poverty level (13 percent).

The 2017 federal poverty level is an annual income of $20,420 for a family of three and $24,600 for a family of four, according to the U.S. Department of Health and Human Services.

Dr. Michael Grosso is chairman of the department of pediatrics at Northwell Health's Huntington Hospital, in Huntington, N.Y. He said that asthma and ADHD rates among poorer families could be linked with the physical and mental strains of deprivation -- a phenomenon known as "toxic stress."

Pulcini explained that children in financially struggling families are more likely to be exposed to poorer indoor and outdoor air quality, and are less likely to eat well -- two conditions that have been tied to asthma risk.

Grosso added, "We now understand that infants and children who don't have the benefit of good nutrition, a stable home environment, regular routines and protection from violence are at risk for lasting consequences including behavioral health and other medical conditions."

Conversely, Pulcini said, the fact that better-off children are more likely to be diagnosed with autism could be tied to their families' improved access to health resources.

Families with more financial means "have better access to resources to identify autism. Parents have more resources to get children screened and get them treated," Pulcini said. On the other hand, children in poorer families have to undergo a more circuitous route before their autism is recognized, he said.

"Among children who are eventually diagnosed with autism, if they are poor, they are more likely to be diagnosed with ADHD first and then autism," Pulcini noted.

Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center in New Hyde Park, N.Y., said the study results "emphasize how important it is to consider social risk factors for disease."

"At a time when consideration is being given by some to limit health care coverage and other social services for the poor, the findings from this study emphasize how important it is for all children to have health insurance and other basic essentials," he said.

The study findings were published online Feb. 13 in the journal Pediatrics.

More information

For more about poverty and child health, visit the American Academy of Pediatrics.

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