Association between ambient gaseous and particulate air pollutants and attention deficit hyperactivity disorder (ADHD) in children; a systematic review

Attention-deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder in children and adolescents. Symptoms of ADHD and its treatment can impact an individual's quality of life (QoL). The present study aimed to evaluate the effect of atomoxetine treatment, demographic characteristics, and seasonal variation on QoL in children with a recent diagnosis of ADHD and their parents. The present study included a cohort of 200 children diagnosed with ADHD. In addition to the recruited children, one of their parents was included in the study. ADHD symptoms were assessed using Conners' Parent Rating Scale. QoL of the participants was assessed with the PedsQL, while parents' QoL was evaluated using the World Health Organization Quality of Life questionnaire (WHOQOL-Bref). There was significant improvement in pediatric and parental QoL after treatment with atomoxetine. Significant factors related to better QoL in the participants included spring season, above average Conner's score, male sex, and rural residence. However, after using multivariate regression analysis, only patients' sex and Conner's score were significant predictors of pediatric QoL at the end of treatment with atomoxetine. Medical treatment significantly improved QoL in children with ADHD and their parents. Level of improvement was affected by patients' sex and ADHD severity.

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“…26,27 However, the better QoL in children with ADHD living in rural areas may be related to lower pollution rates. 28,29…”

Section: Discussionmentioning

confidence: 99%

Effect of Demographic Factors on Quality of Life in Children with ADHD under Atomoxetine Treatment: 1-Year Follow-up

Ragab

Eid

Badr

2020

Journal of Child Science

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“…However, this review included only one study on the association between PM and ADHD, and it found no significant associations with PM 10 . Another recent systematic review [38]studied whether air pollution caused by ambient gaseous (NO 2 , SO 2 , polychlorinated debenzo-p-dioxins and dibenzofurans, benzene) and particulate matters (PM 10 , PM 2.5 , PM 7 , polycyclic aromatic hydrocarbons, elemental carbon/black carbon) was associated with an increased risk of ADHD in children. This systematic review found seven epidemiological studies on the effects of PM and ADHD, five of which did not detect any significant association.…”

Section: Discussionmentioning

confidence: 99%

Particulate Matter Exposure and Attention-Deficit/Hyperactivity Disorder in Children: A Systematic Review of Epidemiological Studies

Donzelli

Llópis-González

Llopis-Morales

et al. 2019

IJERPH

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Attention-deficit/hyperactivity disorder (ADHD) is the most common cognitive and behavioural disorder affecting children, with a worldwide-pooled prevalence of around 5%. Exposure to particulate matter (PM) air pollution is suspected to be associated with autism spectrum disorders and recent studies have investigated the relationship between PM exposure and ADHD. In the absence of any synthesis of the relevant literature on this topic, this systematic review of epidemiological studies aimed to investigate the relationship between the exposure of children to PM and ADHD and identify gaps in our current knowledge. In December 2018, we searched the PubMed and EMBASE databases. We only included epidemiological studies carried out on children without any age limit, measuring PM exposure and health outcomes related to ADHD. We assessed the quality of the articles and the risk of bias for each included article using the Newcastle–Ottawa Scale and the Office of Health Assessment and Translation (OHAT) approach, respectively. The keyword search yielded 774 results. Twelve studies with a total number of 181,144 children met our inclusion criteria, of which 10 were prospective cohort studies and 2 were cross-sectional studies. We subsequently classified the selected articles as high or good quality studies. A total of 9 out of the 12 studies reported a positive association between PM exposure to outdoor air pollution and behavioral problems related to attention. Despite these results, we found a significant degree of heterogeneity among the study designs. Furthermore, 11 studies were judged to be at a probably high risk of bias in the exposure assessment. In conclusion, we opine that further high quality studies are still needed in order to clarify the association between PM exposure and ADHD diagnosis

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“…Risk factors associated with ADHD are pregnancy and delivery complications, mother's use of tobacco and alcohol, exposure to lead, ambient air pollution, socio‐economic stressors, and psychosocial hardship . These findings have influenced the growing literature involving ADHD and ambient air pollution . There is growing interest in understanding how exposure to pollutants may interact with the socio‐economic factors that are highly prevalent in disadvantaged populations …”

Section: Introductionmentioning

confidence: 99%

“…Thus, material hardship must be taken into consideration in the context of environmental pollution due to the disparities in exposure to air pollution that exist across neighbourhoods . The relationship between prenatal air pollution, material hardship, and ADHD has been explored previously in an urban population . However, there remains a gap in the literature illuminating whether the relationships between ambient air pollutants, material hardship, and neurocognitive outcomes also occur in the broader United States paediatric population.…”

Section: Introductionmentioning

confidence: 99%

Combined association of BTEX and material hardship on ADHD‐suggestive behaviours among a nationally representative sample of US children

Dellefratte

Stingone

Cláudio

2019

Paediatric Perinatal Epid

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Background: Previous research shows that environmental and social factors contribute to the development of attention-deficit/hyperactivity disorder (ADHD). Objective:To determine the relationship between early-life exposure to common ambient air pollutants (benzene, toluene, ethylbenzene, and xylene, also known as BTEX), household material hardship (a measure of socio-economic status), and ADHD-suggestive behaviours in kindergarten-age children. Methods: Pollutant exposure estimated from the 2002 National Air Toxics Assessment at each child's residential ZIP code at enrolment was linked to the Early Childhood Longitudinal Study Birth Cohort (n = 4650). Material hardship was assigned as a composite score of access to food, health care, and housing. Kindergarten teachers rated children's behaviours and activity in the classroom using a five-point Likert scale. Children with summary scores in the bottom decile were classified as displaying ADHD-suggestive behaviours. Logistic regression models were constructed to estimate the association between both BTEX exposure and material hardship on ADHD-suggestive behaviours.Results: The odds of displaying ADHD-suggestive behaviours were greater in children with combined high-level exposure to BTEX and in those experiencing material hardship (odds ratio 1.54, 95% confidence interval [CI] 1.12, 2.11, and OR 2.12, 95% CI 1.25, 3.59, respectively), adjusting for covariates. These associations were stronger when restricting the study population to urban areas. There was no evidence of interaction between early life BTEX exposure and material hardship, although the effects of BTEX exposure were slightly greater in magnitude among those with higher material hardship scores.Conclusions: Children exposed to air toxics, material hardship, or both early in life are more likely to display signs of ADHD-suggestive behaviours as assessed by their kindergarten teachers. The associations between exposures to air pollution and to socio-economic hardship were observed in all children but were particularly strong in those living in urban areas. K E Y W O R D S air pollutants, air toxics, child behaviour, socio-economic status, urban environment | 483 DELLEFRATTE ET AL. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Dellefratte K, Stingone JA, Claudio L. Combined association of BTEX and material hardship on ADHD-suggestive behaviours among a nationally representative sample of US children. Paediatr. Perinat.

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Association between ambient gaseous and particulate air pollutants and attention deficit hyperactivity disorder (ADHD) in children; a systematic review

Cited by 56 publications

References 64 publications

Effect of Demographic Factors on Quality of Life in Children with ADHD under Atomoxetine Treatment: 1-Year Follow-up

Effect of Demographic Factors on Quality of Life in Children with ADHD under Atomoxetine Treatment: 1-Year Follow-up

Particulate Matter Exposure and Attention-Deficit/Hyperactivity Disorder in Children: A Systematic Review of Epidemiological Studies

Combined association of BTEX and material hardship on ADHD‐suggestive behaviours among a nationally representative sample of US children

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