Cross-sectional study of perceived neighborhood collective efficacy and risk of adhd among a nationally-representative sample of children

Abstract

Objectives: The development and severity of attention deficit hyperactivity disorder (ADHD) has been linked to a number of psychosocial risk factors. Research has shown that the amount of social capital in a community influences the physical and mental health of community members. We assessed the independent role of perceived neighborhood context, including physical and socioeconomic characteristics, and collective efficacy, a form of social capital, on ADHD prevalence. Methods: Cross-sectional study utilizing the 2007 National Survey of Children’s Health, a nationally representative dataset. The population of interest was children between the ages of four and seventeen living in randomly selected households. Multiple logistic regression models were used to assess the association between indices of perceived neighborhood socioeconomic conditions, built environment, and collective efficacy (study exposures) on risk of ADHD (outcome), controlling for pertinent individual and family risk factors.Results: 9.8 percent of children in the US (ages 4‐17) had ADHD as reported by their caregiver. In multivariate analysis, white race, male gender, increased geographic mobility, exposure to household smoke, exposure to > 2 hours/day TV, and maternal mental illness increased the odds of ADHD, while a two‐parent household reduced the odds. The highest level of perceived neighborhood collective efficacy was associated with reduced risk of ADHD compared to lower levels of perceived collective efficacy (adjusted OR: 0.785; 95% CI: 0.650-0.946; p=.011). Perceived neighborhood socioeconomic conditions and built environment were not associated with ADHD risk.Results: Nine percent of children in the US (ages 4-17 ) had ADHD as reported by their caregiver. Univariately, all 3 neighborhood characteristics were associated with risk of ADHD (p-value =.01, .04, and .0002 for socioeconomic conditions, built environment, and collective efficacy, respectively). After accounting for well-established risk factors for ADHD, perceived neighborhood socioeconomic conditions and built environment were no longer associated with ADHD, while collective efficacy remained significant (p=.0002). Lower level of perceived neighborhood collective efficacy was associated with increased risk of ADHD (OR: 1.7; 95\% CI: 1.3-2.2, comparing the lowest with the highest level).Conclusions: Our study suggests that perceived neighborhood collective efficacy may buffer the impact of individual-and family-level risk factors for ADHD in children.