title: Exposure to fluoridated water and attention deficit hyperactivity disorder prevalence among children and adolescents in the United States: an ecological association.
abstract: BACKGROUND
  Epidemiological and animal-based studies have suggested that prenatal and postnatal fluoride exposure has adverse effects on neurodevelopment. The aim of this study was to examine the relationship between exposure to fluoridated water and Attention-Deficit Hyperactivity Disorder (ADHD) prevalence among children and adolescents in the United States.
  
  
  METHODS
  Data on ADHD prevalence among 4-17 year olds collected in 2003, 2007 and 2011 as part of the National Survey of Children's Health, and state water fluoridation prevalence from the Centers for Disease Control and Prevention (CDC) collected between 1992 and 2008 were utilized.
  
  
  RESULTS
  State prevalence of artificial water fluoridation in 1992 significantly positively predicted state prevalence of ADHD in 2003, 2007 and 2011, even after controlling for socioeconomic status. A multivariate regression analysis showed that after socioeconomic status was controlled each 1% increase in artificial fluoridation prevalence in 1992 was associated with approximately 67,000 to 131,000 additional ADHD diagnoses from 2003 to 2011. Overall state water fluoridation prevalence (not distinguishing between fluoridation types) was also significantly positively correlated with state prevalence of ADHD for all but one year examined.
  
  
  CONCLUSIONS
  Parents reported higher rates of medically-diagnosed ADHD in their children in states in which a greater proportion of people receive fluoridated water from public water supplies. The relationship between fluoride exposure and ADHD warrants future study.
authors.affiliation: Department of Psychology, York University, Keele St., 4700, Toronto, Canada. ashleyjs@yorku.ca.
authors.forename: Ashley J
authors.initials: AJ
authors.lastname: Malin
authors.affiliation: Department of Psychology, York University, Keele St., 4700, Toronto, Canada. ctill@yorku.ca.
authors.forename: Christine
authors.initials: C
authors.lastname: Till
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000139:chemically induced / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004781:Environmental Exposure; D005260:Female; D005457:Fluoridation / Q000009:adverse effects*; D005459:Fluorides / Q000009:adverse effects*; D006801:Humans; D008297:Male; D015995:Prevalence; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
chemical_list: D005459:Fluorides