Social Determinants of Neurodevelopmental Disorders: A Population-Based Analysis of ADHD and ASD in U.S. Children

Background: Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are among the most common neurodevelopmental disorders in childhood and are increasingly recognized as conditions shaped by social and structural determinants of health. However, nationally representative evidence quantifying how family socioeconomic position, insurance, food security, and neighborhood context relate to ADHD and ASD remains limited. Methods: This cross-sectional, population-based study used pooled data from the 2018–2023 National Survey of Children’s Health (NSCH) for children aged 3–17 years. Parent-reported, clinician-diagnosed current ADHD and ASD were the primary outcomes. Key exposures included federal poverty level–based household income, highest parental education, health insurance type, food insecurity, and caregiver-reported neighborhood safety. Analyses incorporated survey weights, strata, and primary sampling units. Weighted prevalence estimates, Rao–Scott χ² tests, and survey-weighted logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for ADHD and ASD associated with social determinants. Results: The analytic sample comprised 205,480 children, representing approximately 73.1 million U.S. children. The weighted prevalence of current ADHD was 9.7% (95% CI 9.3–10.1), and ASD was 2.9% (95% CI 2.7–3.2); 1.1% had comorbid ADHD and ASD. Boys had a higher prevalence of ADHD (13.3% vs. 6.0%) and ASD (4.1% vs. 1.1%) than girls. Strong social gradients were evident. Compared with children in households at ≥400% of the federal poverty level (FPL), those below 100% FPL had 2.11 times higher odds of ADHD (95% CI 1.82–2.46) and 1.73 times higher odds of ASD (95% CI 1.32–2.28) after adjustment. Low parental education, public insurance, unsafe neighborhoods, and food insecurity independently predicted higher odds of both disorders. Hispanic children had lower adjusted odds of ASD than non-Hispanic White children despite similar contextual risk patterns. Conclusions: ADHD and ASD among U.S. children are patterned along socioeconomic and environmental lines. Income, parental education, food security, and neighborhood safety are powerful independent predictors of both prevalence and severity. Findings support integrating developmental screening with social risk assessment, strengthening neighborhood-level investments, and designing equity-focused early intervention strategies to reduce neurodevelopmental disparities.