When Does Adolescents’ Stress Become Somatic Symptoms? A Moderated Mediation Model of ADHD Tendency, Stress, and Somatic Symptoms by Household Economic Status

Background: This study examines whether stress mediates the association between Attention-Deficit/Hyperactivity Disorder (ADHD) tendency and somatic symptoms among adolescents, and whether this association varies by household economic status.Methods: Using nationwide data from 6,689 Korean adolescents, ADHD tendency, perceived stress, somatic symptoms, and subjective household economic status were assessed using validated self-reporting scales. Multiple regression and the PROCESS Macro were applied to test the direct, mediation (Model 4), and moderated mediation effects (Model 14), controlling for gender, age, and out-of-school status. Bootstrapping was performed using 10,000 re-samples.Results: ADHD tendency was positively associated with somatic symptoms. Stress partially mediated this relationship. Stress’ effect on somatic symptoms was negatively moderated by household economic status. Consequently, ADHD tendency’s indirect effect on somatic symptoms through stress significantly varied by household economic status.Conclusions: ADHD tendency contributes to somatic symptoms through elevated stress. This process is shaped by the socioeconomic context. Interventions targeting stress reduction, particularly among economically vulnerable adolescents, may help prevent somatic symptom development.