The Influence of Socio-Economic Status on the Prevalence of School-Age Childhood Behavioral Disorders in a Local District Clinic of North West England

Abstract

There are several types of childhood behavioral disorders. The most common disruptive behavior disorders include ODD, CD and ADHD. Socioeconomic factors are known to influence the prevalence of chronic childhood disabling conditions including emotional and behavioral disorders. Assessment of school-age children for difficult or challenging behavior constitutes a major case load of neurodevelopmental pediatricians (mainly designated as community pediatricians) and child/adolescent psychiatrists in the UK. We aimed to evaluate the influence of the socioeconomic status among school-age children on the distribution and types of behavioral disorders, including ADHD, in a local district Community Pediatric unit of a large healthcare NHS Foundation Trust in the North West of England. The record of all the patients who were seen in any outpatient clinic over a 22-month period between Jan 2014 and Oct 2015 were retrospectively analyzed. Information was collected on the range of clinical presentation and socioeconomic characteristics. The socioeconomic status of each child was determined using the latest published Index of Multiple Deprivation (IMD) 2015. A total of 201 school-age children were referred (9 monthly), corresponding to an average of 31% of total monthly caseload. The proportion of patients living in the most deprived deciles and quintiles was 39% and 70% respectively. The prevalence in the most deprived decile (11.6/1000) was 193 times that of the most affluent area. History of family and social adversities was common among the patients including separated parents (24%), fostered / adopted (11%) and previous exposure to abuse, domestic violence or neglect (9%). Socioeconomic deprivation is significantly associated with the prevalence of behavior problems in children living in the NorthWest of England. Poverty-related chronic stressors are hypothesized to cumulatively compromise parental psychology and ultimately childhood behavioral and mental health outcomes. Tackling the problem requires integrated multidisciplinary and multi-agency approach.