Skip to main content

Is high prevalence of vitamin D deficiency a correlate for attention deficit hyperactivity disorder?

Abstract

The aim of the study was to determine the association between vitamin D and attention deficit hyperactivity disorder (ADHD), and difference in the level of vitamin D in ADHD children and control. This a case–control study carried out in school health and primary health care clinics. A total of 1,331 children and adolescents who were diagnosed with ADHD based on clinical criteria and standardized questionnaires were enrolled in this study and were matched with 1,331 controls, aged 5–18 years old. Data on body mass index (BMI), clinical biochemistry variables including serum 25-hydroxyvitamin D were collected. The study found significant association between ADHD and vitamin D deficiency after adjusting for BMI and sex (adj. OR 1.54; 95 % CI 1.32–1.81; P < 0.001). Majority of the ADHD children were in the age group 5–10 years (40.7 %), followed by 11–13 years (38.4 %). The proportion of BMI <85th percentile was significantly over represented in ADHD group as compared to healthy control (87.8 vs. 83 %; P < 0.001, respectively), while on the other hand, BMI >95th percentile was over represented in the control than ADHD group (7.6 vs. 4.6 %; P < 0.001, respectively). Mean values of vitamin D (ng/mL) were significantly lower in ADHD children (16.6 ± 7.8) than in healthy children (23.5 ± 9.0) (P < 0.001). There was significant correlation between vitamin D deficiency and age (r = −0.191, P = 0.001); calcium (r = 0.272, P = 0.001); phosphorous (r = 0.284, P = 0.001); magnesium (r = 0.292, P = 0.001); and BMI (r = 0.498, P = 0.001) in ADHD children. The vitamin D deficiency was higher in ADHD children compared to healthy children.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

Abbreviations

ADHD:

Attention deficit hyperactivity disorder

BMI:

Body mass index

References

  • Al-Mustafa ZH, Al-Madan M, Al-Majid HJ et al (2007) Vitamin D deficiency and rickets in the Eastern Province of Saudi Arabia. Ann Trop Paediatr 27:63–67

    PubMed  Article  Google Scholar 

  • American Academy of Pediatrics (2000) Committee on quality improvement, subcommittee on attention-deficit/hyperactivity disorder. Clinical practice guideline: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics 105:1158–1170

    Article  Google Scholar 

  • Annweiler C, Allali G, Allain P, Bridenbaugh S, Schott AM, Kressig RW et al (2009) Vitamin D and cognitive performance in adults: a systematic review. Eur J Neurol 16(10):1083–1089

    CAS  PubMed  Article  Google Scholar 

  • Annweiler C, Llewellyn DJ, Beauchet O (2013) Low serum vitamin D concentrations in Alzheimer’s disease: a systematic review and meta-analysis. J Alzheimers Dis 33:659–674

    CAS  PubMed  Google Scholar 

  • Bapai A, Bardia A, Mantan M et al (2005) Non-azotemic refractory rickets in Indian children. Indian Pediatr 42:23–30

    Google Scholar 

  • Barbaresi WJ, Katusic SK, Colligan RC, Pankratz VS, Weaver AL, Weber KJ, Mrazek DA, Jacobsen SJ (2002) How common is attention deficit/hyperactivity disorder? Incidence in a population-based birth cohort in Rochester Minnesota. Arch Pediatr Adolesc Med 156:217–224

    PubMed  Article  Google Scholar 

  • Bener A, Hoffmann GF. Nutritional rickets among children in a sun-rich country (2010) Int J Pediatr Endocrinol. doi:10.1155/2010/410502

  • Bener A, Al-Qahtani R, Abdelaal I (2006) The prevalence of ADHD among primary school children in an Arabian society. J Atten Dis. 10:77–82

    Article  Google Scholar 

  • Bener A, Al Qahtani R, Teebi A et al (2008) The prevalence of attention deficit hyperactivity symptoms in school children in a highly consanguineous community. Med Prin Pract. 17:440–446

    Article  Google Scholar 

  • Bener A, Al-Ali M, Hoffmann GF (2009a) High prevalence of vitamin D deficiency in young children in a highly sunny humid country: a global health problem. Minerva Pediatr 61:15–22

    CAS  PubMed  Google Scholar 

  • Bener A, Al-Ali M, Hoffmann GF (2009b) Vitamin D deficiency in healthy children in a sunny country: associated factors. Int J Food Sci Nutr 60(Suppl 5):60–70

    CAS  PubMed  Article  Google Scholar 

  • Bener A, Alsaied A, Al-Ali M et al (2009c) High prevalence of vitamin D deficiency in type 1 diabetes mellitus and healthy children. Acta Diabetol 46:183–189

    CAS  PubMed  Article  Google Scholar 

  • Biederman J (2005) Attention-deficit/hyperactivity disorder: a selective overview. Biol Psychiatry 57:1215–1220

    PubMed  Article  Google Scholar 

  • Childress AC, Berry SA (2012) Pharmacotherapy of attention-deficit hyperactivity disorder in adolescents. Drugs 72(3):309–325

    CAS  PubMed  Article  Google Scholar 

  • Dawodu A, Khadir A, Hardy DJ et al (2002) Nutritional rickets in UAE: an unresolved cause of childhood morbidity. Middle E Pediatr. 7:12–14

    Google Scholar 

  • de Fernandes Abreu DA, Eyles D, Feron F (2009) Vitamin D, a neuro-immunomodulator: implications for neurodegenerative and autoimmune diseases. Psychoneuroendocrinology 34S(1):S265–S277

    Article  Google Scholar 

  • D’Eufemia P, Parisi P, Celli M, Finocchiaro R, Roggini M, Raccio I, Zambrano A, Villa MP (2012) Vitamin D deficiency rickets in five “at-risk” children. Pediatr Int 54(1):152–155

    PubMed  Article  Google Scholar 

  • El-Rassi R, Baliki G, Fulheihan GE (2009) Vitamin D status in Middle East and Africa. http://www.iofbonehealth.org/download/osteofound/filemanager/health_professionals/pdf/Vitamin-D-reports/Vitamin_D-MEast_Africa.pdf

  • Eyles DW, Feron F, Cui X, Kesby JP, Harms LH, Ko P et al (2009) Developmental vitamin D deficiency causes abnormal brain development. Psychoneuroendocrinology 34(1):S247

    CAS  PubMed  Article  Google Scholar 

  • Eyles DW, Burne TH, McGrath JJ (2013) Vitamin effects on brain development, adult brain function and the links between low levels of vitamin D and neuropsychiatric disease. Front Neuroendocrinol 34(1):47–64

    CAS  PubMed  Article  Google Scholar 

  • Genizi J, Gordon S, Kerem NC, Srugo I, Shahar E, Ravid S (2013) Primary headaches, attention deficit disorder and learning disabilities in children and adolescents. J Headache Pain. 14(1):54. doi:10.1186/1129-2377-14-5

    PubMed Central  PubMed  Article  Google Scholar 

  • Groves NJ, Kesby JP, Eyles DW, McGrath JJ, Mackay-Sim A, Burne TH (2013) Adult vitamin D deficiency leads to behavioural and brain neurochemical alterations in C57BL/6 J and BALB/c mice. Behav Brain Res 241:120–131

    CAS  PubMed  Article  Google Scholar 

  • Hewison M (2011) Vitamin D and innate and adaptive immunity. Vitam Horm 86:23–62

    CAS  PubMed  Article  Google Scholar 

  • Holick MF (2007) Vitamin D deficiency. N Engl J Med 357(3):266–281

    CAS  PubMed  Article  Google Scholar 

  • Holick MF, Binkley NC, Bischoff-Ferrari HA et al (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:1911–1930

    CAS  PubMed  Article  Google Scholar 

  • Majid Molla A, Badawi MH, Al-Yaish S et al (2000) Risk factors for nutritional rickets among children in Kuwait. Pediatr Int 42:280–284

    CAS  PubMed  Article  Google Scholar 

  • McGrath JJ, Burne TH, Feron F, Mackay-Sim A, Eyles DW (2010) Developmental vitamin D deficiency and risk of schizophrenia: a 10-year update. Schizophr Bull 36(6):1073–1078

    PubMed Central  PubMed  Article  Google Scholar 

  • Parisi P, Moavero R, Verrotti A, Curatolo P (2010) Attention deficit hyperactivity disorder in children with epilepsy. Brain Dev 32(1):10–16

    PubMed  Article  Google Scholar 

  • Parisi P, Villa MP, Donfrancesco R, Miano S, Paolino MC, Cortese S (2012) Could treatment of iron deficiency both improve ADHD and reduce cardiovascular risk during treatment with ADHD drugs? Med Hypotheses 79(2):246–249

    PubMed  Article  Google Scholar 

  • Purper OD, Wohl M, Michel G et al (2004) Symptoms variations in ADHD: importance of context, development and comorbidity. Encephale. 30:533–539

    Article  Google Scholar 

  • Sayal K, Hornsey H, Warren S et al (2006) Identification of children at risk of attention deficit/hyperactivity disorder, a school based intervention. Soc Psychiatry Epidemiol 41:806–813

    Article  Google Scholar 

  • Smolders J, Schuurman KG, van Strien ME, Melief J, Hendrickx D, Hol EM et al (2013) Expression of vitamin D receptor and metabolizing enzymes in multiple sclerosis-affected brain tissue. J Neuropathol Exp Neurol 72(2):91–105

    CAS  PubMed  Article  Google Scholar 

  • Swanson JM, Kinsbroune M, Nigg J et al (2007) Etiologic subtypes of attention deficit/hyperactivity disorder: brain imaging, molecular genetic and environmental factors and the dopamine hypothesis. Neuropsychol Rev 17:39–59

    PubMed  Article  Google Scholar 

  • Umhau JC, George DT, Heaney RP, Lewis MD, Ursano RJ, Heilig M et al (2013) Low vitamin D status and suicide: a case-control study of active duty military service members. PLoS ONE 8(1):4

    Article  Google Scholar 

  • Urry Z, Chambers ES, Xystrakis E, Dimeloe S, Richards DF, Gabrysova L et al (2012) The role of 1alpha,25-dihydroxyvitamin D3 and cytokines in the promotion of distinct Foxp3 + and IL-10 + CD4 + T cells. Eur J Immunol 42(10):2697–2708

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  • Vinh Quoc Luong K, Thi Hoang Nguyen L (2012) Vitamin D and Parkinson’s disease. J Neurosci Res 90(12):2227–2236

    PubMed  Article  Google Scholar 

  • Whiting SJ, Green TJ, Calvo MS (2007) Vitamin D intakes in North America and Asia-Pacific countries are not sufficient to prevent vitamin D insufficiency. J Steroid Biochem Mol Biol 103:626–630

    CAS  PubMed  Article  Google Scholar 

Download references

Acknowledgments

This work was generously supported and funded by the Qatar Foundation Grant No. NPRP 04-169-3-055. The authors would like to thank the Hamad Medical Corporation for their support and ethical approval (RC10226/10). This research was supported by the by the Qatar National Research Fund—QNRF NPRP 04-169-3-055. The sponsor of the study had no role in study design; in the collection, analysis, and interpretation of data; in the writing of this report; and in the decision to submit the paper for publication. The authors have indicated they have no financial relationships relevant to this article to disclose.

Conflict of interest

All authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Abdulbari Bener.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kamal, M., Bener, A. & Ehlayel, M.S. Is high prevalence of vitamin D deficiency a correlate for attention deficit hyperactivity disorder?. ADHD Atten Def Hyp Disord 6, 73–78 (2014). https://doi.org/10.1007/s12402-014-0130-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12402-014-0130-5

Keywords

  • Epidemiology
  • Association
  • ADHD
  • Vitamin D
  • Risk factors