Skip to main content

Advertisement

SpringerLink
Log in

Trace elements, cognitive function and behavioral problems in children with attention-deficit hyperactivity disorder

  • Published:
Current Psychology Aims and scope Submit manuscript

Abstract

Environmental factors, such as trace elements and blood lead, have been implicated in the heterogeneity of children with attention deficit hyperactivity disorder (ADHD). This research aimed to investigate the relationship between blood trace elements and cognitive function as well as behavioral problems in children aged 4–12 years diagnosed with ADHD. In this study, we recruited 146 children with ADHD and 91 neurotypical controls matched for age and gender. We used atomic absorption spectrometry to measure the concentrations of Cu, Zn, Ca, Mg, Fe, and Pb in the whole blood. The Conners Parent Rating Scale (CPRS) and Wechsler intelligence tests were employed to evaluate cognitive function and behavioral problems. Compared with controls, children with ADHD exhibited higher levels of Pb. Pb levels indicated a negative correlation with the verbal comprehension index and the full intelligence scale. Cu levels indicated a negative correlation with the verbal comprehension index but positively correlated with conduct, learning, and impulsive-hyperactivity problems. In addition, Fe levels indicated a positive correlation with psychosomatic symptoms. Wechsler intelligence results indicated substantially higher scores in children with normal Zn levels than those outside the reference range. These results indicate a correlation between the present of Pb, Cu, Fe, and Zn in the blood of Chinese children with ADHD and cognitive function and behavioral problems.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Abou-Khadra, M. K., Amin, O. R., Shaker, O. G., & Rabah, T. M. (2013, Dec 30). Parent-reported sleep problems, symptom ratings, and serum ferritin levels in children with attention-deficit/hyperactivity disorder: a case control study. BMC Pediatr, 13, 217. https://doi.org/10.1186/1471-2431-13-217.

  • Amorós, R., Murcia, M., González, L., Soler-Blasco, R., Rebagliato, M., Iñiguez, C., Carrasco, P., Vioque, J., Broberg, K., Levi, M., Lopez-Espinosa, M. J., Ballester, F., & Llop, S. (2019, Apr). Maternal copper status and neuropsychological development in infants and preschool children. International Journal of Hygiene and Environmental Health, 222(3), 503–512. https://doi.org/10.1016/j.ijheh.2019.01.007.

  • B, T., A, J., M, M., & Id, O. (2021). - Copper, Iron, and Manganese Toxicity in Neuropsychiatric conditions. International Journal of Molecular Sciences, 22(15).

  • Bacchella, C., Nicolis, S., Dell’Acqua, S., Rizzarelli, E., Monzani, E., & Casella, L. (2020). Jan 6). Membrane binding strongly affecting the dopamine Reactivity Induced by Copper Prion and Copper/Amyloid-β (Aβ) peptides. A Ternary Copper/Aβ/Prion Peptide Complex Stabilized and solubilized in Sodium Dodecyl Sulfate Micelles. Inorganic Chemistry, 59(1), 900–912. https://doi.org/10.1021/acs.inorgchem.9b03153.

    Article  PubMed  Google Scholar 

  • Choi, J. W., Jung, A. H., Nam, S., Kim, K. M., Kim, J. W., Kim, S. Y., Kim, B. N., & Kim, J. W. (2020, Aug 6). Interaction between lead and noradrenergic genotypes affects neurocognitive functions in attention-deficit/hyperactivity disorder: a case control study. BMC Psychiatry, 20(1), 407. https://doi.org/10.1186/s12888-020-02799-3.

  • Cortese, S., Solmi, M., Michelini, G., Bellato, A., Blanner, C., Canozzi, A., Eudave, L., Farhat, L. C., Højlund, M., Köhler-Forsberg, O., Leffa, D. T., Rohde, C., de Pablo, G. S., Vita, G., Wesselhoeft, R., Martin, J., Baumeister, S., Bozhilova, N. S., Carlisi, C. O., Leno, V. C., Floris, D. L., Holz, N. E., Kraaijenvanger, E. J., Sacu, S., Vainieri, I., Ostuzzi, G., Barbui, C., & Correll, C. U. (2023). Feb). Candidate diagnostic biomarkers for neurodevelopmental disorders in children and adolescents: A systematic review. World Psychiatry, 22(1), 129–149. https://doi.org/10.1002/wps.21037.

    Article  PubMed  PubMed Central  Google Scholar 

  • de Moura, J. E., de Moura, E. N., Alves, C. X., Vale, S. H., Dantas, M. M., Silva Ade, A., Almeida, M., Leite, L. D., & Brandão-Neto, J. (2013, Oct). Oral zinc supplementation may improve cognitive function in schoolchildren. Biological Trace Element Research, 155(1), 23–28. https://doi.org/10.1007/s12011-013-9766-9.

  • Del-Ponte, B., Quinte, G. C., Cruz, S., Grellert, M., & Santos, I. S. (2019, Jun 1). Dietary patterns and attention deficit/hyperactivity disorder (ADHD): A systematic review and meta-analysis. J Affect Disord, 252, 160–173. https://doi.org/10.1016/j.jad.2019.04.061.

  • Diagnostic and statistical manual of mental disorders: DSM-5™, 5th ed. (2013). https://doi.org/10.1176/appi.books.9780890425596.

  • Díaz-López, A., Canals-Sans, J., Julvez, J., Fernandez-Barrés, S., Llop, S., Rebagliato, M., Lertxundi, N., Santa-Marina, L., Guxens, M., Sunyer, J., & Arija, V. (2022, Dec 1). Maternal iron status during pregnancy and attention deficit/hyperactivity disorder symptoms in 7-year-old children: a prospective cohort study. Sci Rep, 12(1), 20762. https://doi.org/10.1038/s41598-022-23432-1.

  • Huang, S., Hu, H., Sánchez, B. N., Peterson, K. E., Ettinger, A. S., Lamadrid-Figueroa, H., Schnaas, L., Mercado-García, A., Wright, R. O., Basu, N., Cantonwine, D. E., Hernández-Avila, M., & Téllez-Rojo, M. M. (2016). Jun). Childhood blood lead levels and symptoms of attention deficit hyperactivity disorder (ADHD): A cross-sectional study of Mexican Children. Environmental Health Perspectives, 124(6), 868–874. https://doi.org/10.1289/ehp.1510067.

    Article  PubMed  Google Scholar 

  • Izzo, V. A., Donati, M. A., Novello, F., Maschietto, D., & Primi, C. (2019). Oct). The Conners 3-short forms: Evaluating the adequacy of brief versions to assess ADHD symptoms and related problems. Clinical Child Psychology and Psychiatry, 24(4), 791–808. https://doi.org/10.1177/1359104519846602.

    Article  PubMed  Google Scholar 

  • Izzo, V. A., Donati, M. A., & Primi, C. (2019). Apr). Assessing ADHD through the Multi-informant Approach: The contribution of the Conners’ 3 scales. Journal of Attention Disorders, 23(6), 641–650. https://doi.org/10.1177/1087054718815581.

    Article  PubMed  Google Scholar 

  • Park, J. H., Seo, J. H., Hong, Y. S., Kim, Y. M., Kang, J. W., Yoo, J. H., Chueh, H. W., Lee, J. H., Kwak, M. J., Kim, J., Woo, H. D., Kim, D. W., Bang, Y. R., & Choe, B. M. (2016). Blood lead concentrations and attention deficit hyperactivity disorder in Korean children: a hospital-based case control study. BMC pediatrics, 16(1), 156. https://doi.org/10.1186/s12887-016-0696-5.

    Google Scholar 

  • Junaedi, F., Hanurawan, F., Setiowati, A. J., & Ramli, M. (2022). Reducing the new inmates’ anxiety through rational emotive behavior therapy with patronage counseling technique. Emerging Science Journal, 6(2), 306–321. https://doi.org/10.28991/esj-2022-06-02-08.

    Article  Google Scholar 

  • Karalunas, S. L., & Nigg, J. T. (2020, Jul 1). Heterogeneity and Subtyping in Attention-Deficit/Hyperactivity Disorder-Considerations for Emerging Research Using Person-Centered Computational Approaches. Biol Psychiatry, 88(1), 103–110. https://doi.org/10.1016/j.biopsych.2019.11.002.

  • Karta, I. W., Rasmini, N. W., Widiana, I. W., & Ujianti, P. R. (2022). The Effect of Remote Learning, Family Condition, and Mental Resilience on Depression symptoms of early childhood. Emerging Science Journal, 6(6), 1430–1443. https://doi.org/10.28991/esj-2022-06-06-013.

    Article  Google Scholar 

  • Kim, J. H., Kim, J. Y., Lee, J., Jeong, G. H., Lee, E., Lee, S., Lee, K. H., Kronbichler, A., Stubbs, B., Solmi, M., Koyanagi, A., Hong, S. H., Dragioti, E., Jacob, L., Brunoni, A. R., Carvalho, A. F., Radua, J., Thompson, T., Smith, L., Oh, H., Yang, L., Grabovac, I., Schuch, F., Fornaro, M., Stickley, A., Rais, T. B., de Pablo, S., Shin, G., J. I., & Fusar-Poli, P. (2020). Environmental risk factors, protective factors, and peripheral biomarkers for ADHD: An umbrella review. The Lancet Psychiatry, 7(11), 955–970. https://doi.org/10.1016/S2215-0366(20)30312-6.

    Article  PubMed  Google Scholar 

  • Li, G., Jiang, W., Du, Y., & Rossbach, K. (2017). Intelligence profiles of Chinese school-aged boys with high-functioning ASD and ADHD. Neuropsychiatric Disease and Treatment, 13, 1541–1549. https://doi.org/10.2147/ndt.S136477.

    Article  PubMed  PubMed Central  Google Scholar 

  • Li, F., Cui, Y., Li, Y., Guo, L., Ke, X., Liu, J., Luo, X., Zheng, Y., & Leckman, J. F. (2022, Jan). Prevalence of mental disorders in school children and adolescents in China: Diagnostic data from detailed clinical assessments of 17,524 individuals. Journal of Child Psychology and Psychiatry and Allied Disciplines, 63(1), 34–46. https://doi.org/10.1111/jcpp.13445.

  • Lin, Y., Huang, L., Xu, J., Specht, A. J., Yan, C., Geng, H., Shen, X., Nie, L. H., & Hu, H. (2019, Apr 1). Blood lead, bone lead and child attention-deficit-hyperactivity-disorder-like behavior. Sci Total Environ, 659, 161–167. https://doi.org/10.1016/j.scitotenv.2018.12.219.

  • Luo, J., Mo, Y., & Liu, M. (2020, Jan). Blood and hair zinc levels in children with attention deficit hyperactivity disorder: A meta-analysis. Asian J Psychiatr, 47, 101805. https://doi.org/10.1016/j.ajp.2019.09.023.

  • Maitre, L., Julvez, J., López-Vicente, M., Warembourg, C., Tamayo-Uria, I., Philippat, C., Gützkow, K. B., Guxens, M., Andrusaityte, S., Basagaña, X., Casas, M., de Castro, M., Chatzi, L., Evandt, J., Gonzalez, J. R., Gražulevičienė, R., Haug, S., Heude, L., Hernandez-Ferrer, B., Kampouri, C., Manson, M., Marquez, D., McEachan, S., Nieuwenhuijsen, R., Robinson, M., Slama, O., Thomsen, R., Urquiza, C., Vafeidi, J., Wright, M., J., & Vrijheid, M. (2021, Aug). Early-life environmental exposure determinants of child behavior in Europe: A longitudinal, population-based study. Environment International, 153, 106523. https://doi.org/10.1016/j.envint.2021.106523.

  • McWilliams, S., Singh, I., Leung, W., Stockler, S., & Ipsiroglu, O. S. (2022). Iron Deficiency and common neurodevelopmental disorders-A scoping review. PLoS One, 17(9), e0273819. https://doi.org/10.1371/journal.pone.0273819.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mezzaroba, L., Alfieri, D. F., Colado Simão, A. N., & Vissoci Reiche, E. M. (2019, Sep). The role of zinc, copper, manganese and iron in neurodegenerative Diseases. Neurotoxicology, 74, 230–241. https://doi.org/10.1016/j.neuro.2019.07.007.

  • Nurhayati, S., Noor, A. H., Musa, S., Jabar, R., & Abdu, W. J. (2022). A Digital Literacy Workshop Training Model for child parenting in a fourth Industrial Era. HighTech and Innovation Journal.

  • Pal, A., & Prasad, R. (2015, Feb). An overview of various mammalian models to study chronic copper intoxication associated Alzheimer’s disease like pathology. Biometals, 28(1), 1–9. https://doi.org/10.1007/s10534-014-9799-3.

  • Perham, J. C., Shaikh, N. I., Lee, A., Darling, K. A., & Rucklidge, J. J. (2022, Jan). Toward ‘element balance’ in ADHD: an exploratory case control study employing hair analysis. Nutritional Neuroscience, 25(1), 11–21. https://doi.org/10.1080/1028415X.2019.1707395.

  • Robberecht, H., Verlaet, A. A. J., Breynaert, A., De Bruyne, T., & Hermans, N. (2020). Sep 27). Magnesium, Iron, Zinc, copper and selenium status in Attention-Deficit/Hyperactivity disorder (ADHD). Molecules, 25(19). https://doi.org/10.3390/molecules25194440.

  • Ruckart, P. Z., Jones, R. L., Courtney, J. G., LeBlanc, T. T., Jackson, W., Karwowski, M. P., Cheng, P. Y., Allwood, P., Svendsen, E. R., & Breysse, P. N. (2021). Oct 29). Update of the blood lead reference value - United States, 2021. Mmwr. Morbidity and Mortality Weekly Report, 70(43), 1509–1512. https://doi.org/10.15585/mmwr.mm7043a4.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rucklidge, J. J. (2010, Jun). Gender differences in attention-deficit/hyperactivity disorder. The Psychiatric Clinics of North America, 33(2), 357–373. https://doi.org/10.1016/j.psc.2010.01.006.

  • Santa Maria, M. P., Hill, B. D., & Kline, J. (2019). Jul-Sep). Lead (pb) neurotoxicology and cognition. Appl Neuropsychol Child, 8(3), 272–293. https://doi.org/10.1080/21622965.2018.1428803.

    Article  PubMed  Google Scholar 

  • Scassellati, C., Bonvicini, C., Faraone, S. V., & Gennarelli, M. (2012, Oct). Biomarkers and attention-deficit/hyperactivity disorder: A systematic review and meta-analyses. Journal of the American Academy of Child and Adolescent Psychiatry, 51(10), 1003–1019e1020. https://doi.org/10.1016/j.jaac.2012.08.015.

  • Shaari, M., Nasir, N., Harun, N., Muhsin, S., Ridzuan, A. R., & Rasydan, Y. (2023). 07/10). Exploring the Relationship between Tertiary Education and Child Maltreatment: An ARDL Analysis. 3. https://doi.org/10.28991/HEF-2022-03-04-05.

  • Skalny, A. V., Mazaletskaya, A. L., Ajsuvakova, O. P., Bjørklund, G., Skalnaya, M. G., Chao, J. C. J., Chernova, L. N., Shakieva, R. A., Kopylov, P. Y., Skalny, A. A., & Tinkov, A. A. (2020). 2020/03/01/). Serum zinc, copper, zinc-to-copper ratio, and other essential elements and minerals in children with attention deficit/hyperactivity disorder (ADHD). Journal of Trace Elements in Medicine and Biology, 58, 126445. https://doi.org/10.1016/j.jtemb.2019.126445.

    Article  PubMed  Google Scholar 

  • Thaler, N. S., Barchard, K. A., Parke, E., Jones, W. P., Etcoff, L. M., & Allen, D. N. (2015). Dec). Factor structure of the Wechsler Intelligence Scale for children: Fourth Edition in children with ADHD. Journal of Attention Disorders, 19(12), 1013–1021. https://doi.org/10.1177/1087054712459952.

    Article  PubMed  Google Scholar 

  • Wang, Y., Huang, L., Zhang, L., Qu, Y., & Mu, D. (2017). Iron Status in Attention-Deficit/Hyperactivity disorder: A systematic review and Meta-analysis. PLoS One, 12(1), e0169145. https://doi.org/10.1371/journal.pone.0169145.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wei, J., Gianattasio, K. Z., Bennett, E. E., Stewart, J. D., Xu, X., Park, E. S., Smith, R. L., Ying, Q., Whitsel, E. A., & Power, M. C. (2022). Jun 27). The associations of Dietary Copper with cognitive outcomes. American Journal of Epidemiology, 191(7), 1202–1211. https://doi.org/10.1093/aje/kwac040.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wolraich, M. L., Hagan, J. F. Jr., Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., Holbrook, J. R., Lehmann, C. U., Lessin, H. R., Okechukwu, K., Pierce, K. L., Winner, J. D., & Zurhellen, W. (2019). Oct). Clinical practice Guideline for the diagnosis, evaluation, and treatment of Attention-Deficit/Hyperactivity disorder in children and adolescents. Pediatrics, 144(4). https://doi.org/10.1542/peds.2019-2528.

  • Wu, Y., Sun, J., Wang, M., Yu, G., Yu, L., & Wang, C. (2018, Apr). The Relationship of Children’s Intelligence Quotient and Blood Lead and Zinc Levels: a Meta-analysis and System Review. Biological Trace Element Research, 182(2), 185–195. https://doi.org/10.1007/s12011-017-1093-0.

  • Y, L., & LH, L. H. J. X. A. J. S. C. Y. H. G. X. S., N.,H, H (2019). - Blood lead, bone lead and child attention-deficit-hyperactivity-disorder-like. Science of the Total Environment, 659, 161–167.

    Article  Google Scholar 

  • Yeruva, S., Varalakshmi, M. S., Gowtham, B. P., Chandana, Y. H., & Prasad, P. K. (2021). Identification of Sickle Cell Anemia using deep neural networks. Emerging Science Journal, 5(2), 200–210. https://doi.org/10.28991/esj-2021-01270.

    Article  Google Scholar 

  • Zhang, C., Jing, D., Huang, X., Xiao, Y., Shu, Z., Luo, D., Duan, Y., He, M., Xiao, S., Chen, X., Huang, Z., & Shen, M. (2022). 2022/06/20/). Effects of co-exposure to multiple metals on children’s behavior problems in China. Science of the Total Environment, 826, 154062. https://doi.org/10.1016/j.scitotenv.2022.154062.

    Article  PubMed  Google Scholar 

  • Zhou, G., Ji, X., Cui, N., Cao, S., Liu, C., & Liu, J. (2015). Aug 27). Association between serum copper status and working memory in Schoolchildren. Nutrients, 7(9), 7185–7196. https://doi.org/10.3390/nu7095331.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zieminska, E., Ruszczynska, A., Augustyniak, J., Toczylowska, B., & Lazarewicz, J. W. (2021). Zinc and copper brain levels and expression of Neurotransmitter Receptors in two rat ASD models. Frontiers in Molecular Neuroscience, 14, 656740. https://doi.org/10.3389/fnmol.2021.656740.

    Article  PubMed  PubMed Central  Google Scholar 

  • Karatela, S., Ward, N. I., Paterson, J., & Zeng, I. S. (2022). Environmental influences on the behavioural and emotional outcomes of children: a network analysis. International journal of environmental research and public health, 19(14), 8479.

Download references

Acknowledgements

We are deeply grateful to all participants who made contributions to our study for their generous participation, and psychiatrists for their help in the recruitment of children with ADHD.

Author information

Authors and Affiliations

  1. Department of Children’s Health Care, Guangdong Women and Children Hospital, 521, 523, Xingnan Avenue, Nancun Town, Guangzhou, Guangdong, People’s Republic of China

    Xiaoyan Chen, Yu Xiao, Weiyong Huang, Yong Guo, Ranke Zhu & Jieling Wu

Authors
  1. Xiaoyan Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yu Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Weiyong Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yong Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ranke Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jieling Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Yu Xiao, Weiyong Huang,Yong Guo and Ranke Zhu. The first draft of the manuscript was written by Xiaoyan Chen and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jieling Wu.

Ethics declarations

Conflicts of interest

The author reports no conflicts of interest in this work.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, X., Xiao, Y., Huang, W. et al. Trace elements, cognitive function and behavioral problems in children with attention-deficit hyperactivity disorder. Curr Psychol 43, 14127–14135 (2024). https://doi.org/10.1007/s12144-023-05458-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12144-023-05458-4

Keywords

Search

Navigation