title: The influence of low level pre- and perinatal exposure to PCDD/Fs, PCBs, and lead on attention performance and attention-related behavior among German school-aged children: results from the Duisburg Birth Cohort Study.
abstract: BACKGROUND
  Prenatal exposure to polychlorinated biphenyls (PCBs) and lead are thought to be risk factors for attention-deficit hyperactivity disorder (ADHD), whereas the prenatal influence of polychlorinated dibenzo-p-dioxins and -furans (PCDD/Fs) on attention performance has been less studied.
  
  
  OBJECTIVE
  Within the Duisburg Birth Cohort Study, we investigated low-level exposure to these compounds in relation to children's attention.
  
  
  METHODS
  We measured blood levels of PCDD/Fs, PCBs and lead from pregnant mothers (32(nd) week of pregnancy) and PCDD/Fs and PCBs in breast milk (2 weeks after delivery). The attention of school-aged children (N=117) was investigated with a computer-based test battery of attention performance (KITAP) and a parent rating questionnaire of behaviors related to ADHD (FBB-ADHS). Influences of the exposure on attention were analyzed by multiple regression analyses.
  
  
  RESULTS
  Increasing prenatal PCDD/F and PCB concentrations were significantly (p<0.05) associated with a higher number of omission errors in the subtest Divided Attention (47% and 42%; 95% confidence intervals (95%-CI): 1.08-2.00 and 1.07-1.89, respectively). Prenatal lead concentrations had few significant associations with attention performance (e.g., a 23% higher number of omission errors in the subtest Distractibility; 95%-CI: 1.00-1.51), whereas ADHD-related behavior (questionnaire based) was increased with increasing lead exposure (Overall-ADHD: 9%; 95%-CI: 1.01-1.17). ADHD-related behavior was negatively associated with prenatal PCDD/F or PCB exposures (e.g., for PCB exposure: -10%; 95%-CI: 0.82-0.99).
  
  
  CONCLUSIONS
  Pre- and perinatal PCDD/F and PCB exposure may have subtle influences on attention performance in healthy children at low environmental levels, while behavior changes are negatively associated. Furthermore, we provide additional evidence for the impact of prenatal lead exposure on attention deficits.
authors.affiliation: Department of Hygiene, Social and Environmental Medicine, Ruhr-University Bochum, Universitätsstraße 150, D-44801 Bochum, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Neugebauer
authors.affiliation: Department of Hygiene, Social and Environmental Medicine, Ruhr-University Bochum, Universitätsstraße 150, D-44801 Bochum, Germany. Electronic address: wittsiepe@hygiene.rub.de.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wittsiepe
authors.affiliation: Department of Hygiene, Social and Environmental Medicine, Ruhr-University Bochum, Universitätsstraße 150, D-44801 Bochum, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Kasper-Sonnenberg
authors.affiliation: Department of Developmental Psychology, Ruhr-University Bochum, Universitätsstraße 150, D-44801 Bochum, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Schöneck
authors.affiliation: Department of Developmental Psychology, Ruhr-University Bochum, Universitätsstraße 150, D-44801 Bochum, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Schölmerich
authors.affiliation: Department of Hygiene, Social and Environmental Medicine, Ruhr-University Bochum, Universitätsstraße 150, D-44801 Bochum, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Wilhelm
mesh_terms: D019958:Attention Deficit and Disruptive Behavior Disorders / Q000209:etiology*; D001572:Benzofurans / Q000633:toxicity*; D002648:Child; D015331:Cohort Studies; D000072338:Dibenzofurans, Polychlorinated; D004785:Environmental Pollutants / Q000633:toxicity*; D005260:Female; D005858:Germany; D006801:Humans; D007361:Intelligence Tests; D007854:Lead / Q000633:toxicity*; D008297:Male; D011078:Polychlorinated Biphenyls / Q000633:toxicity*; D000072317:Polychlorinated Dibenzodioxins / Q000031:analogs & derivatives* / Q000633:toxicity; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D012044:Regression Analysis
chemical_list: D001572:Benzofurans; D000072338:Dibenzofurans, Polychlorinated; D004785:Environmental Pollutants; D000072317:Polychlorinated Dibenzodioxins; D007854:Lead; D011078:Polychlorinated Biphenyls
keywords: Attention performance; Attention-deficit hyperactivity disorder; Children; Dioxin; Lead; PCB