title: Association between phthalates and attention deficit disorder and learning disability in U.S. children, 6-15 years.
abstract: OBJECTIVE
  This study investigates the association between urinary phthalate metabolite levels and attention deficit disorder (ADD), learning disability (LD), and co-occurrence of ADD and LD in 6-15-year-old children.
  
  
  METHODS
  We used cross-sectional data from the National Health and Nutrition Examination Survey (NHANES, 2001-2004). Phthalate metabolites with ≥75% detection in urine samples were examined. The study population comprised 1493 children with parent-reported information on ADD or LD diagnosis and phthalate concentrations in urine. Phthalate concentrations were creatinine-adjusted and log10-transformed for analysis. All models controlled for child sex, age, race, household income, blood lead, and maternal smoking during pregnancy.
  
  
  RESULTS
  There were 112 ADD cases, 173 LD cases, and 56 ADD and LD cases in the sample. After adjusting for potential confounders, we found increased odds of ADD with increasing urinary concentration of di-2-ethylhexyl phthalates (OR: 2.1; 95% CI: 1.1, 3.9) and high molecular weight phthalates (OR: 2.7; 95% CI: 1.2, 6.1). In addition, dibutyl phthalates (OR: 3.3; 95% CI: 0.9, 12.7) and high molecular weight phthalates (OR: 3.7; 95% CI: 0.9, 14.8) were marginally associated with increased odds of co-occurring ADD and LD. We did not find associations for any phthalate and LD alone. We observed stronger associations between phthalates and ADD and both ADD and LD in girls than boys in some models.
  
  
  CONCLUSIONS
  We found cross-sectional evidence that certain phthalates are associated with increased odds of ADD and both ADD and LD. Further investigations with longitudinal data are needed to confirm these results.
authors.affiliation: Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA. Electronic address: choprav@obgyn.ucsf.edu.
authors.forename: Vidita
authors.initials: V
authors.lastname: Chopra
authors.affiliation: Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA.
authors.forename: Kim
authors.initials: K
authors.lastname: Harley
authors.affiliation: Division of Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Lahiff
authors.affiliation: Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA. Electronic address: eskenazi@berkeley.edu.
authors.forename: Brenda
authors.initials: B
authors.lastname: Eskenazi
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000139:chemically induced* / Q000453:epidemiology / Q000652:urine; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007859:Learning Disabilities / Q000139:chemically induced* / Q000453:epidemiology / Q000652:urine; D008297:Male; D009749:Nutrition Surveys; D010795:Phthalic Acids / Q000009:adverse effects* / Q000652:urine; D014481:United States / Q000453:epidemiology
chemical_list: D010795:Phthalic Acids
keywords: ADD; ADHD; Attention deficit disorder; CDC; CI; Centers for Disease Control and Prevention; DBP; DEHP; DSM-IV; Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition; High M.W; LD; LOD; Learning disability; Low M.W; MBzP; MCPP; MEP; NHANES; National Health and Nutrition Examination Survey; OR; PIR; Phthalates; Plasticizers; attention deficit disorder; attention-deficit/hyperactivity disorder; confidence interval; di-2-ethylhexyl phthalate; dibutyl phthalate; high molecular weight; learning disability; limit of detection; low molecular weight; mono-(3-carboxypropyl) phthalate; mono-benzyl phthalate; mono-ethyl phthalate; odds ratio; poverty income ratio