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Published online May 17, 2010
PEDIATRICS (doi:10.1542/peds.2009-3058)
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Attention-Deficit/Hyperactivity Disorder and Urinary Metabolites of Organophosphate Pesticides

Maryse F. Bouchard, PhDa,b, David C. Bellinger, PhDa,c, Robert O. Wright, MD, MPHa,d,e, Marc G. Weisskopf, PhDa,e,f

Departments of aEnvironmental Health and
fEpidemiology, School of Public Health, Harvard University, Boston, Massachusetts;
bDepartment of Environmental and Occupational Health, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada;
Departments of cNeurology and
dPediatrics, School of Medicine, Harvard University, and Boston Children's Hospital, Boston, Massachusetts; and
eChanning Laboratory, Department of Medicine, School of Medicine, Harvard University, and Brigham and Women's Hospital, Boston, Massachusetts

Objective The goal was to examine the association between urinary concentrations of dialkyl phosphate metabolites of organophosphates and attention-deficit/hyperactivity disorder (ADHD) in children 8 to 15 years of age.

Methods Cross-sectional data from the National Health and Nutrition Examination Survey (2000–2004) were available for 1139 children, who were representative of the general US population. A structured interview with a parent was used to ascertain ADHD diagnostic status, on the basis of slightly modified criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

Results One hundred nineteen children met the diagnostic criteria for ADHD. Children with higher urinary dialkyl phosphate concentrations, especially dimethyl alkylphosphate (DMAP) concentrations, were more likely to be diagnosed as having ADHD. A 10-fold increase in DMAP concentration was associated with an odds ratio of 1.55 (95% confidence interval: 1.14–2.10), with adjustment for gender, age, race/ethnicity, poverty/income ratio, fasting duration, and urinary creatinine concentration. For the most-commonly detected DMAP metabolite, dimethyl thiophosphate, children with levels higher than the median of detectable concentrations had twice the odds of ADHD (adjusted odds ratio: 1.93 [95% confidence interval: 1.23–3.02]), compared with children with undetectable levels.

Conclusions These findings support the hypothesis that organophosphate exposure, at levels common among US children, may contribute to ADHD prevalence. Prospective studies are needed to establish whether this association is causal.

Key Words: attention-deficit/hyperactivity disorder • pesticides • organophosphates • National Health and Nutrition Examination Survey

Abbreviations: DAP = dialkyl phosphate • DMAP = dimethyl alkylphosphate • DEAP = diethyl alkylphosphate • OR = odds ratio • CI = confidence interval • ADHD = attention-deficit/hyperactivity disorder • NHANES = National Health and Nutrition Examination Survey • DISC-IV = Diagnostic Interview Schedule for Children IV • PIR = poverty/income ratio • DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition

Accepted Feb 23, 2010.


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