A systematic review and meta-analysis examining the interrelationships between chemical and non-chemical stressors and inherent characteristics in children with ADHD
Open accessAbstract
Children may be more vulnerable to the combined interactions of chemical and non-chemical stressors from their built, natural, and social environments when compared to adults. Attention deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed childhood neurodevelopmental disorder and is considered a major public health issue, as 75% of childhood cases persist into adulthood. ADHD is characterized by developmentally inappropriate levels of hyperactivity, impulsivity, and inattention, with the neurotransmitter serotonin regulating these symptoms. Monoamine oxidase A (MAOA) aids in serotonin uptake and is often implicated in behavioral and emotional disorders, including ADHD. When children are exposed to cigarette smoke, bisphenol A (BPA), or organophosphate pesticides, MAOA activity is inhibited. Non-chemical stressors, such as traumatic childhood experiences, and lifestyle factors, complicate the relationship between genotype and exposures to chemical stressors. But the co-occurrence among outcomes between exposures to chemical stressors, non-chemical stressors, and the low activity MAOA genotype suggest that mental illness in children may be influenced by multiple interacting factors. In this systematic review, we examine the existing literature that combines exposures to chemical and non-chemical stressors (specifically childhood trauma), MAOA characteristics, and ADHD diagnosis to investigate the interrelationships present. We observe that chemical (lead [Pb], p…
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Maternal smoking during pregnancy is linked to more than a 50% higher ADHD incidence.
“Three meta-analyses with over twenty studies covering more than three million persons have found prenatal exposure to maternal smoking associated with a greater than 50% increase in incidence of ADHD”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Nilsen and Tulve, 2020
Elevated blood lead is linked to about four times the odds of ADHD.
“A more recent meta-analysis of 14 studies with over 17,000 children reported that higher blood lead levels were associated with quadrupled odds of ADHD”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Nilsen and Tulve, 2020
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“A more recent meta-analysis of 14 studies with over 17,000 children reported that higher blood lead levels were associated with quadrupled odds of ADHD (Nilsen and Tulve, 2020).”
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- Authors
- Nilsen, F. M., & Tulve, N. S.
- Affiliations
- Environmental Protection Agency (US)
- Corresponding author
- Nilsen, Frances M.
- Venue
- Environmental Research
- Publisher
- Elsevier BV
- Published
- 2020-01
- Volume
- 180
- Pages
- 108884
- ISSN
- 0013-9351 (ISSN-L)
- PMC
- PMC6937727
- OpenAlex
- W2988007905
- Cited by
- 78
- References
- 22
- Citations by year
- 2026: 4 · 2025: 14 · 2024: 14 · 2023: 14 · 2022: 11 · 2021: 12 · 2020: 9
- FWCI
- 1.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Environmental Research (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- OSTI OAI (U.S. Department of Energy Office of Scientific and Technical Information) (submittedVersion)
- Funders
- U.S. Department of Energy
- Office of Research and Development
- Oak Ridge Institute for Science and Education
- U.S. Environmental Protection Agency (EPA)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Keywords
- attention deficit hyperactivity disorder, chemical stressors, childhood trauma, monoamine oxidase A, lead exposure, phthalates, plasticizers, persistent organic pollutants, cigarette smoke exposure, bisphenol A, organophosphorus pesticides, serotonin, gene-environment interaction, child mental health
- MeSH terms
- Adult, Attention Deficit Disorder with Hyperactivity, Child, Environmental Pollutants, Genotype, Humans, Impulsive Behavior, Life Style, Monoamine Oxidase, Stress, Physiological
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