Vol.:(0123456789) 1 3 European Child & Adolescent Psychiatry https://doi.org/10.1007/s00787-018-1248-3 ORIGINAL CONTRIBUTION Ecological model of school engagement and attention‑deficit/ hyperactivity disorder in school‑aged children Minh N. Nguyen 1  · Shinobu Watanabe‑Galloway 1  · Jennie L. Hill 1  · Mohammad Siahpush 2  · Melissa K. Tibbits 2  · Christopher Wichman 3 Received: 18 May 2018 / Accepted: 26 October 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract School engagement protects against negative mental health outcomes; however, few studies examined the relationship between school engagement and attention-deficit hyperactivity disorder (ADHD) using an ecological framework. The aims were to examine: (1) whether school engagement has an independent protective association against the risk of ADHD in chil- dren, and (2) whether environmental factors have an association with ADHD either directly or indirectly via their association with school engagement. This cross-sectional study used data from the 2011–2012 National Survey of Children’s Health, which collected information about children’s mental health, family life, school, and community. The sample contained 65,680 children aged 6–17 years. Structural equation modeling was used to estimate the direct association of school engagement and ADHD and indirect associations of latent environmental variables (e.g., family socioeconomic status (SES), adverse childhood experiences (ACEs), environmental safety, and neighborhood amenities) and ADHD. School engagement had a direct and inverse relationship with ADHD (β = − 0.35, p < 0.001) such that an increase in school engagement corresponds with a decrease in ADHD diagnosis. In addition, family SES (β = − 0.03, p = 0.002), ACEs (β = 0.10, p < 0.001), environment safety (β = − 0.10, p < 0.001), and neighborhood amenities (β = − 0.01, p = 0.025) all had an indirect association with ADHD via school engagement. In conclusion, school engagement had a direct association with ADHD. Furthermore, environmental correlates showed indirect associations with ADHD via school engagement. School programs targeted at reducing ADHD should consider family and community factors in their interventions. Keywords ADHD · School engagement · Ecological model Introduction Attention-deficit/hyperactivity disorder (ADHD) is a com- mon childhood mental disorder characterized by the chronic presence of inattention and/or hyperactivity–impulsivity causing impairment in daily functioning and development [1]. In the United States (US), the prevalence of ADHD in children aged 3–17 years is approximately 6.7% and appeared to show an increasing trend [2]. The number of parent-reported diagnoses of ADHD increased to 33% between 1997 and 2008 [2]. Several factors may be contrib- uting to the increased prevalence such as increased aware- ness among parents and schools, promotion of screening and diagnosis, and advances in treatment of ADHD [2]. ADHD has an early age of onset and often tends to persist over time [3], [4]. It can also result in impairments across cogni- tive, developmental, academic, and health-related domains [3], [5–7]. Due to these factors, reducing the incidence and improving the course of disease for ADHD should be public health priorities. The full etiology of ADHD is unknown. Genetic studies have estimated the mean heritability of ADHD at 76% [8]. Although these studies suggested that genetic variations play a major role, they also implied that environmental factors * Minh N. Nguyen minh.nguyen1022@gmail.com 1 Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198, USA 2 Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198, USA 3 Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198, USA