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Children (Basel). 2019 Jan 14;6(1). pii: E10. doi: 10.3390/children6010010.

Family Income at Birth and Risk of Attention Deficit Hyperactivity Disorder at Age 15: Racial Differences.

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Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA.
Department of Psychiatry, University of Michigan, Ann Arbor, MI 48104, USA.
Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA.
Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48104, USA.



Socioeconomic status (SES) resources protect children and adults against the risk of medical and psychiatric conditions. According to the Minorities' Diminished Returns theory, however, such protective effects are systemically weaker for the members of racial and ethnic minority groups compared to Whites.


Using a national data set with 15 years of follow up, we compared Black and White youth for the effects of family SES at birth on the risk of Attention Deficit Hyperactivity Disorder (ADHD) at age 15. Methods: The Fragile Families and Child Wellbeing Study (FFCWS, 1998⁻2016) is a longitudinal prospective study of urban youth from birth to age 15. This analysis included 2006 youth who were either White (n = 360) or Black (n = 1646). The independent variable was family income, the dependent variable was ADHD at age 15. Child gender, maternal age, and family type at birth were covariates, and race was the focal moderator. We ran logistic regressions in the overall sample and specific to race.


In the overall sample, high family income at birth was not associated with the risk of ADHD at age 15, independent of all covariates. Despite this relationship, we found a significant interaction between race and family income at birth on subsequent risk of ADHD, indicating a stronger effect for Whites compared to Blacks. In stratified models, we found a marginally significant protective effect of family SES against the risk of ADHD for White youths. For African American youth, on the other hand, family SES was shown to have a marginally significant risk for ADHD.


The health gain that follows family income is smaller for Black than White families, which is in line with the Minorities' Diminished Returns. The solution to health disparities is not simply policies that aim to reduce the racial gap in SES, because various racial health disparities in the United States are not due to differential access to resources but rather the impact of these resources on health outcomes. Public policies, therefore, should go beyond equalizing access to resources and also address the structural racism and discrimination that impact Blacks' lives. Policies should fight racism and should help Black families to overcome barriers in their lives so they can gain health from their SES and social mobility. As racism is multi-level, multi-level interventions are needed to tackle diminished returns of SES.


Attention Deficit Hyperactivity Disorder (ADHD); Blacks; class; ethnicity; income; poverty status; race; socioeconomic position; socioeconomic status

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