title: Pediatric neurobehavioral diseases in Nevada counties with respect to perchlorate in drinking water: an ecological inquiry.
abstract: BACKGROUND
  Contamination of drinking water with perchlorate, a known thyrotropic agent, has been demonstrated in areas in the western United States. The health consequences of that exposure have been studied, particularly in the State of Nevada. Previous studies in Nevada, comparing the area with perchlorate in the drinking water and the areas without perchlorate in the drinking water, have found no difference in neonatal thyroxine (T(4)) or thyrotropin (TSH) levels, or in the prevalences of thyroid diseases and thyroid cancer. This same study design has now been applied to the major neurobehavioral diseases of childhood (i.e., attention deficit-hyperactivity disorder (ADHD) and autism) and to school performance in order to determine whether those conditions are more frequent in the area with perchlorate-contaminated water.
  
  
  METHODS
  Medical services data on ADHD and autism were obtained from the Nevada Medicaid system for the period of January 1, 1996, to December 31, 2000, with county of residence used as the basis for residential information. Analyses of fourth-grade school performance results for two recent time periods came from the state government. Perchlorate concentrations in drinking water had been determined by local water authorities. ADHD and autism rates for the area with perchlorate in the drinking water (Clark County) were calculated and compared with the rates for the other areas in the state, as were fourth-grade school performances.
  
  
  RESULTS
  Analysis of the data from the Nevada Medicaid program shows that the rates for ADHD and for autism in the area where perchlorate was in the drinking water did not exceed the rates in those areas where there was no perchlorate contamination in the drinking water. Fourth-grade standardized test results for students in Clark County were not different from those of the remainder of the state.
  
  
  CONCLUSIONS
  This ecological study of children in the exposure area did not find evidence of an increased risk of either ADHD or of autism caused by perchlorate contamination in the drinking water. Furthermore, no difference in overall fourth-grade school performance was observed. No evidence was found that children from the area with perchlorate in the drinking water (up to 24 microg/liter) had either an increase in pediatric neurobehavioral disease (ADHD and autism) or a decrease in fourth-grade academic performance. The limitations of this ecological study relate to diagnostic criteria and ascertainment of geographic and demographic differences and to data on individual residence and water consumption during pregnancy.
authors.affiliation: Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Soju
authors.initials: S
authors.lastname: Chang
authors.forename: Carol
authors.initials: C
authors.lastname: Crothers
authors.forename: Shenghan
authors.initials: S
authors.lastname: Lai
authors.forename: Steven
authors.initials: S
authors.lastname: Lamm
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology* / Q000209:etiology; D001321:Autistic Disorder / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004522:Educational Status; D004782:Environmental Health; D006801:Humans; D007223:Infant; D009505:Nevada / Q000453:epidemiology; D010472:Perchlorates / Q000009:adverse effects* / Q000032:analysis; D017670:Sodium Compounds / Q000009:adverse effects* / Q000032:analysis; D014876:Water Pollution / Q000009:adverse effects*; D014881:Water Supply / Q000032:analysis*
chemical_list: D010472:Perchlorates; D017670:Sodium Compounds; C031068:sodium perchlorate