title: Confirmation and extension of association of blood lead with attention-deficit/hyperactivity disorder (ADHD) and ADHD symptom domains at population-typical exposure levels.
abstract: BACKGROUND
  Recent studies have suggested that child attention-deficit/hyperactivity disorder (ADHD) and its symptom domains are related to blood lead level, even at background exposure levels typical in western countries. However, recent studies disagreed as to whether lead was related to inattention or hyperactivity-impulsivity within the ADHD domain. More definitive evaluation of these questions was sought.
  
  
  METHODS
  Two hundred and thirty-six (236) children aged 6-17 years participated (61 ADHD-Combined type, 47 ADHD Predominantly Inattentive type, 99 non-ADHD control, 29 unclassified borderline, situational, or not otherwise specified (NOS) cases). Formal diagnosis was reliably established by a best estimate procedure based on a semi-structured clinical interview and parent and teacher ratings. Lead was assayed from whole blood using inductively coupled plasma mass spectrometry with a method detection limit of .3 microg/dL.
  
  
  RESULTS
  Blood lead levels were slightly below United States and Western Europe population exposure averages, with a mean of .73 and a maximum of 2.2 microg/dL. This is the lowest level of blood lead ever studied in relation to ADHD. After statistical control for covariates including IQ and prenatal smoking exposure, blood lead was associated with ADHD-combined type but not inattentive type. Parent and teacher report indicated association of blood lead with Conners cognitive problems, but only teacher report showed effects on DSM-IV inattention symptoms. Blood lead was associated with hyperactivity-impulsivity in parent report regardless of measurement method, whereas teacher report effects depended on child treatment history.
  
  
  CONCLUSIONS
  These findings confirm that in children with typical US population lead exposure, careful identification of children with ADHD also identifies children with slightly elevated blood lead.
authors: Oregon Health & Science University, Department of Psychiatry, Portland, 97239-3098, USA. niggj@ohsu.edu
authors: Joel T
authors: JT
authors: Nigg
authors: Molly
authors: M
authors: Nikolas
authors: G
authors: G
authors: Mark Knottnerus
authors: Kevin
authors: K
authors: Cavanagh
authors: Karen
authors: K
authors: Friderici
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006801:Humans; D007854:Lead / Q000097:blood*; D008297:Male; D008425:Maternal Behavior; D009483:Neuropsychological Tests; D010500:Perinatology; D012720:Severity of Illness Index; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data
chemical_list: D014028:Tobacco Smoke Pollution; D007854:Lead