title: Serum perfluorinated compound concentration and attention deficit/hyperactivity disorder in children 5-18 years of age.
abstract: BACKGROUND
  Perfluorinated compounds (PFCs) are persistent environmental pollutants. Toxicology studies demonstrate the potential for perfluorooctanoic acid (PFOA) and other PFCs to affect human growth and development. Attention deficit/hyperactivity disorder (ADHD) is a developmental disorder with suspected environmental and genetic etiology.
  
  
  OBJECTIVE
  We examined the cross-sectional association between serum PFC concentration and parent or self-report of doctor-diagnosed ADHD with and without current ADHD medication.
  
  
  METHODS
  We used data from the C8 Health Project, a 2005-2006 survey in a Mid-Ohio Valley community highly exposed to PFOA through contaminated drinking water, to study non-Hispanic white children 5-18 years of age. Logistic regression models were adjusted for age and sex.
  
  
  RESULTS
  Of the 10,546 eligible children, 12.4% reported ADHD and 5.1% reported ADHD plus ADHD medication use. We observed an inverted J-shaped association between PFOA and ADHD, with a small increase in prevalence for the second quartile of exposure compared with the lowest, and a decrease for the highest versus lowest quartile. The prevalence of ADHD plus medication increased with perfluorohexane sulfonate (PFHxS) levels, with an adjusted odds ratio of 1.59 (95% confidence interval, 1.21-2.08) comparing the highest quartile of exposure to the lowest. We observed a modest association between perfluorooctane sulfonate and ADHD with medication.
  
  
  CONCLUSIONS
  The most notable finding for PFOA and ADHD, a reduction in prevalence at the highest exposure level, is unlikely to be causal, perhaps reflecting a spurious finding related to the geographic determination of PFOA exposure in this population or to unmeasured behavioral or physiologic correlates of exposure and outcome. Possible positive associations between other PFCs and ADHD, particularly PFHxS, warrant continued investigation.
authors.affiliation: Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York, USA. cheryl.stein@mssm.edu
authors.forename: Cheryl R
authors.initials: CR
authors.lastname: Stein
authors.forename: David A
authors.initials: DA
authors.lastname: Savitz
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000097:blood* / Q000453:epidemiology*; D002210:Caprylates / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005466:Fluorocarbons / Q000097:blood*; D006801:Humans; D008297:Male; D013451:Sulfonic Acids / Q000097:blood
chemical_list: D002210:Caprylates; D005466:Fluorocarbons; D013451:Sulfonic Acids; C471071:perfluorohexanesulfonic acid; C023036:perfluorooctanoic acid