title: Attention Deficit/Hyperactivity Disorder and Urinary Nonylphenol Levels: A Case-Control Study in Taiwanese Children.
abstract: OBJECTIVE
  Nonylphenol (NP) belongs to the family of endocrine disruptors, and it is widely used in industrial applications and is ubiquitous in daily foods. Animal studies have suggested that NP exposure might promote motor hyperactivity, likely by causing deficits in dopaminergic neurons. However, research assessing NP exposure and epidemiology studies on human populations are limited. The aim of this study was to explore the association between child NP exposure and ADHD while considering particular covariants, such as lead levels and dopamine-related gene variations.
  
  
  METHODS
  A case-control study was conducted on patients with clinically diagnosed ADHD; the Swanson, Nolan and Pelham, Fourth Revision (SNAP-IV) questionnaire was used to identify normal controls aged 4-15 years. Participants were examined for urinary NP concentrations, blood lead levels, and select single-nucleotide polymorphisms of two dopamine-related genes (D4 dopamine receptor, DRD4, and dopamine transporter, DAT1). Socio-demographic variables, maternal lifestyle factors during pregnancy and family medical history were obtained using a questionnaire.
  
  
  RESULTS
  A total of 97 children with doctor-diagnosed ADHD and 110 normal controls were enrolled. The blood lead levels in both groups were similar (1.57±0.73 vs. 1.73±0.77 μg/dL, p = 0.15). No significant difference in urinary NP concentration was found between the children with ADHD and the control subjects (4.52±3.22 μg/g cr. vs. 4.64±2.95 μg/g cr., p = 0.43). ADHD was significantly more prevalent among males in this study (male to female ratio: 5:1 for the ADHD group and 1.3:1 for the control group, p<0.01). The analysis was repeated after excluding the females, but this had no effect on the association between NP and ADHD. The regression model, including or excluding females, indicated no increased odds of having ADHD in the context of NP exposure after adjusting for covariants.
  
  
  CONCLUSIONS
  This study indicated that NP exposure might not promote ADHD in children, even though children in Taiwan had relatively high levels of NP compared to those reported previously and those in developed nations.
authors.affiliation: Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Ching-Jung
authors.initials: CJ
authors.lastname: Yu
authors.affiliation: Department of Pediatrics, Taipei City Hospital, Zhongxiao branch, Taipei, Taiwan.
authors.forename: Jung-Chieh
authors.initials: JC
authors.lastname: Du
authors.affiliation: Department of Child and Adolescent Psychiatry, Taipei City Hospital, Songde branch, Taipei, Taiwan.
authors.forename: Hsien-Chih
authors.initials: HC
authors.lastname: Chiou
authors.affiliation: Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Shang-Han
authors.initials: SH
authors.lastname: Yang
authors.affiliation: Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Kai-Wei
authors.initials: KW
authors.lastname: Liao
authors.affiliation: Department of Pediatrics, Taipei City Hospital, Yangming branch, Taipei, Taiwan.
authors.forename: Winnie
authors.initials: W
authors.lastname: Yang
authors.affiliation: Department of Life Sciences and Institute of Genome Sciences, National Yang Ming University, Taipei, Taiwan.
authors.forename: Ming-Yi
authors.initials: MY
authors.lastname: Chung
authors.affiliation: School of Public Health, Taipei Medical University, Taipei, Taiwan.
authors.forename: Ling-Chu
authors.initials: LC
authors.lastname: Chien
authors.affiliation: Department of Pediatrics, Taipei City Hospital, Zhongxiao branch, Taipei, Taiwan.
authors.forename: Betau
authors.initials: B
authors.lastname: Hwang
authors.affiliation: Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan.
authors.forename: Mei-Lien
authors.initials: ML
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000235:genetics / Q000652:urine*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000378:metabolism; D003710:Demography; D004298:Dopamine / Q000378:metabolism; D004781:Environmental Exposure / Q000032:analysis; D005260:Female; D014644:Genetic Variation; D006801:Humans; D007854:Lead / Q000009:adverse effects; D008297:Male; D016017:Odds Ratio; D010636:Phenols / Q000652:urine*; D020641:Polymorphism, Single Nucleotide / Q000235:genetics; D013624:Taiwan
chemical_list: D010636:Phenols; D007854:Lead; C025256:nonylphenol; D003404:Creatinine; D004298:Dopamine