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Associations of phthalates exposure with attention deficits hyperactivity disorder: A case-control study among
Dan Hu1, Yi-Xin Wang2, Wen-Jing Chen1
1Department of Maternal and Child Health Care, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China.
Insights
Childhood exposure to phthalates, such as MEHHP, MEOHP, and MEHP, is linked to attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). These phthalates also correlate with increased inattention, hyperactivity, and behavioral issues in children.
Area of Science:
- Environmental Health
- Pediatric Health
- Toxicology
Background:
- Phthalate exposure is a growing concern for child development.
- Previous research on phthalates and attention deficit hyperactivity disorder (ADHD) has yielded inconsistent findings.
- Understanding the specific associations between phthalates and behavioral disorders in children is crucial for public health.
Purpose of the Study:
- To investigate the relationship between urinary phthalate metabolite concentrations and ADHD in Chinese children.
- To examine associations with co-occurring oppositional defiant disorder (ODD), ADHD symptoms, and related behavioral problems.
- To evaluate dose-dependent relationships between specific phthalate metabolites and these conditions.
Main Methods:
- A case-control study involving 225 children with ADHD and 225 healthy controls (aged 6-13 years) in Liuzhou, China.
- Collection of repeated urine samples across four visits for phthalate metabolite analysis using high-performance liquid chromatography and tandem mass spectrometry.
- Assessment of ADHD symptoms, ODD, and behavioral problems using validated scales (Swanson, Nolan, and Pelham Version IV; Child Behavior Checklist).
Main Results:
- Higher urinary concentrations of MEHHP, MEOHP, and MEHP were dose-dependently associated with increased odds of ADHD and ODD.
- Positive trends were observed between these phthalate metabolites and scores for inattention, hyperactivity, and ODD symptoms.
- Monomethyl phthalate (MMP) was linked to higher inattention and ODD symptom scores, while MEHP also associated with depressed and internalizing behaviors.
Conclusions:
- Childhood exposure to specific phthalate metabolites (MEHHP, MEOHP, MEHP, MMP) may contribute to the development of ADHD and ODD.
- Phthalate exposure is associated with a range of behavioral problems, including inattention, hyperactivity, aggression, and internalizing behaviors.
- These findings highlight the potential neurodevelopmental impact of phthalates and underscore the need for exposure reduction strategies.
Abstract:
Researches on associations between phthalates exposure and child attention deficit hyperactivity disorder (ADHD) are inconsistent. This study aimed to evaluate the associations of urinary phthalates with ADHD, co-occurring oppositional defiant disorder (ODD), related symptoms and behavior problems among Chinese children. We enrolled 225 ADHD cases and 225 healthy controls aged 6-13 years old in Liuzhou, China. Each child provided repeated urine samples at 4 visits. Eight phthalate metabolites were measured by high-performance liquid chromatography and tandem mass spectrometry. Child ADHD symptoms and related behaviors were assessed using Swanson, Nolan, and Pelham Version IV scale and child behavior checklist. Higher urinary concentrations of mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono-(2-ethyl)-hexyl phthalate (MEHP) were dose-dependently associated with ADHD [odds ratios (ORs) ranged from 2.35 to 3.04 for the highest vs. the lowest tertile] and co-occurring ODD (ORs ranged from 3.27 to 4.44 for the highest vs. the lowest tertile) in the multivariable logistic regression models (all p for trend ≤ 0.01), which were consistent with positive trends of increased scores of inattention domain, hyperactive domain and ODD symptoms (all p for trend ≤ 0.01). Besides, the monomethyl phthalate (MMP) concentration was associated with higher scores of inattention domain and ODD symptoms (both p < 0.05). Additionally, the MEHHP, MEOHP and MEHP concentrations were related to child attention problems, aggressive behaviors and externalizing behaviors (all p < 0.05). We also observed positive associations of the MEHP concentration with depressed behaviors and internalizing behaviors (all p < 0.05). Our results indicate that child exposure to phthalates may contribute to ADHD, ODD and externalizing and internalizing behavior problems.
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