Objective The purpose of this study was to evaluate the effect of altitude on rates of ADHD. As decreased dopamine (DA) activity has been reported with ADHD and hypoxia has shown to be associated with increased DA, we hypothesized that states at higher altitudes would have lower rates of ADHD. Method State estimates from the 2007 National Survey of Children’s Health (NSCH) report and 2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) report were used to extract the percentages of youth ages 4 to 17 diagnosed with ADHD. Results Both the datasets independently revealed that the prevalence of ADHD decreases with increasing altitude (R2 = .38, p < .001; R2 = .31, p < .001), respectively. This study controlled for potential confounds (e.g., low birth weight, ethnicity, and household size). Conclusion These findings suggest a need for further investigation into the extent by which altitude may serve as a protective factor for ADHD.

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Bipolar disorder (BD) is a severe, chronic illness identified by recurrent episodes of mania and depression. BD is among the leading causes of disability worldwide because it is highly impairing 1 with an increased risk for suicide. 2 Many adults with BD retrospectively report initial onset of mood symptoms in childhood or adolescence [3][4][5] with typical onset between 18 to 22 years. 6,7 However, BD that onsets prior to age 18 was considered extremely rare until recently. 8 Opinions regarding the prevalence of BD among youth began to change when

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