816 Distribution of ADHD among CYP in different socioeconomic areas of a South East England Local Authority

Objectives

Attention Deficit Hyperactivity Disorder (ADHD) is the commonest neurobehavioural disorder affecting children and young people (CYP) worldwide, with an average prevalence of 5% to 12%. It often persists into adulthood with multi-domain impairment affecting education, employment, criminal system and family relationships. Previous research have shown evidence of significant effect of socioeconomic stress and deprivation as aetiologic factors in the distribution and prevalence of chronic childhood disabling conditions including emotional and behavioural disorders such as ADHD. Deprivation leads to unequal access to education, employment, healthcare and good housing, and often leads to significant health inequalities. We investigated the relationship between the distribution of ADHD among CYP in a large South East England district and the index of deprivation scores of their residential areas, used as a surrogate measure of their socioeconomic status.

Method

We retrospectively reviewed the records of CYP with ADHD, within a period of January and December 2019. CYP were diagnosed with ADHD using standard clinical procedures based on DSM-5 criteria by the community paediatric services. We identified the socioeconomic status of each patient using the latest Index of Multiple Deprivation (IMD) scores 2019 based on their respective postcodes and corresponding small areas known as Lower Super Output area (LSOA). We calculated the deciles and quintiles by dividing the England’s 32,844 LSOAs into 10 and 5 equal groups respectively.

Results

A total of 343 CYP aged between 6 and 18 years (average 12 years) were identified, 81% males (277/343). Figure 1 shows the proportion of patients living in the most deprived deciles being 14%, three times greater than those living in the least deprived centile (4%). ADHD prevalence in the most deprived decile (15/1000) was more than 3 times that of the most affluent area (4.5/1000). Using Mid 2019 estimated, average ADHD prevalence per 1000 children’s population between 6 and 18 years was 12.1, highest for 4th Decile (16.2) and lowest for 10th decile (least deprived) (4.5).

Conclusion

This small study confirmed a significant relationship between the socioeconomic deprivation of the local residents and the prevalence of ADHD among CYP. A larger prospective study is required to confirm possible direct causal relationship. This study points to the public health importance of funding a wide range of preventive measures including prenatal, early years and school health, education and social welfare projects, as cost-effective strategies in reducing the overall burden and life-long impacts of ADHD among the general population.

Reference

Michael O. Ogundele. The Influence of Socio-Economic Status on the Prevalence of School-Age Childhood Behavioral Disorders in a Local District Clinic of North West England. Journal of Family Medicine and Health Care December 2016;2(Issue 4):98–107. doi: 10.11648/j.jfmhc.20160204.22