Implications for the Prevention of Poverty-Related Environmental Risks for Childhood ADHD: A Narrative Review.

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition with complex, multifactorial origins. While its heritability is well established, growing evidence highlights the role of early environmental risks, particularly those related to poverty, in shaping neurodevelopmental trajectories associated with ADHD. This narrative review synthesizes research on poverty-related risks for childhood ADHD, with a focus on prenatal, infancy, and early childhood periods as windows of heightened neuroplasticity and vulnerability. Key domains of risk include maternal stress and depression, nutritional deficits, limited cognitive stimulation, and exposure to environmental toxins. These adversities often cluster in structurally disadvantaged communities, compounding developmental risk through cumulative and interacting pathways. Notably, poverty-related adversity is neither deterministic nor irreversible. Protective factors, such as responsive caregiving, early psychosocial support, and enriched learning environments, can buffer risk and foster resilience, even in high-adversity contexts. The review also highlights how structural determinants such as parental education, access to healthcare, and neighborhood quality shape both risk and opportunity. Recent research suggests that integrated, developmentally tailored interventions may offer sustainable benefits, particularly those targeting co-regulation and executive functioning during the preschool years. Based on the findings, this review calls for multisectoral prevention strategies that begin before birth and prioritize equity across healthcare, education, and public policy. Future research should address causal mechanisms through longitudinal, culturally inclusive studies and explore the conditions under which resilience emerges. Understanding how poverty "gets under the skin" to shape attention and behaviour, and how supportive environments can mitigate these effects, is critical for reducing disparities in ADHD and promoting healthy development for all children.