Abstract
ADHD prevalence has risen in parallel with rising prevalence of pregnancy smoking and childhood obesity. The objective was to determine the epidemiological association of pregnancy smoking and childhood obesity with ADHD. A cross-sectional community study was conducted in 2006 using a parental questionnaire. A total of 1,074 schoolchildren aged 5–11 years were enrolled from 15 primary schools in a lower socio-economic area of Merseyside. ADHD was defined by the question “does your child have Attention Deficit Hyperactivity Disorder, (ADHD), which has been diagnosed by a doctor?” The prevalence estimates for childhood obesity, maternal smoking during pregnancy and childhood ADHD were 14.9% (116/777), 28.0% (269/955), and 3.4% (32/945), respectively. ADHD prevalence increased fivefold in children with obesity (RR, 4.80, 95% CI 2.2–10.4, P < 0.001) and more than twofold in children of mothers who smoked during pregnancy (RR, 2.44, 95% CI 1.2–4.9, P = 0.02). Regression analysis adjusting for obesity, overweight, maternal smoking during pregnancy, heavy maternal smoking, household member smoking during pregnancy, doctor-diagnosed asthma, preterm birth, and low birthweight showed significant independent associations of ADHD prevalence with obesity (AOR, 4.66, 95% CI 1.57–13.89, P = 0.006) and pregnancy smoking (AOR, 3.19, 95% CI 1.08–9.49, P = 0.04). There was a positive dose–response association of ADHD with the number of maternal cigarettes smoked during pregnancy. Measures to reduce both smoking among pregnant women and childhood obesity might reduce prevalence of childhood ADHD.
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Agranat-Meged AN, Deitcher C, Goldzweig G, Leibenson L, Stein M, Galili-Weisstub E (2005) Childhood obesity and attention deficit/hyperactivity disorder: a newly described comorbidity in obese hospitalized children. Int J Eat Disord 37:357–359
Al Hamed JH, Taha AZ, Sabra AA, Bella H (2008) Attention Deficit Hyperactivity Disorder (ADHD) among male primary school children in Dammam, Saudi Arabia: prevalence and associated factors. J Egypt Public Health Assoc 83:165–182
Albuquerque CA, Smith KR, Johnson C, Chao R, Harding R (2004) Influence of maternal tobacco smoking during pregnancy on uterine, umbilical and fetal cerebral artery blood flows. Early Hum Dev 80:31–42
Arnsten AF (2009) Toward a new understanding of attention-deficit hyperactivity disorder pathophysiology: an important role for prefrontal cortex dysfunction. CNS Drugs 23(Suppl 1):33–41
Bazar K, Yun A, Lee P, Daniel S, Doux J (2006) Obesity and ADHD may represent different manifestations of a common environmental oversampling syndrome: a model for revealing mechanistic overlap among cognitive, metabolic and inflammatory disorders. Med Hypotheses 66:263–269
Berkey CS, Ware JM, Speizer FE, Ferris BG (1984) Passive smoking and height growth of preadolescent children. Int J Epidemiol 13:454–458
Biederman J, Wilens T, Mick E et al (1997) Is ADHD a risk factor for psychoactive substance use disorders? Findings from a four-year prospective follow-up study. J Am Acad Child Adolesc Psychiatry 36:21–29
Blackman JA, Gurka MJ (2007) Developmental and Behavioural comorbidities of asthma in children. J Dev Behav Pediatr 28:92–99
Bloom B, Dey AN, Freeman G (2006) Summary health statistics for US children: national health interview survey, 2005. Vital Health Stat 231:1–84
Brook JS, Brook DW, Whiteman M (2000) The influence of maternal smoking during pregnancy on the toddler’s negativity. Arch Pediatr Adolesc Med 154:381–385
Buitelaar J, Medori R (2009) Treating attention-deficit/hyperactivity disorder beyond symptom control alone in children and adolescents: a review of the potential benefits of long-acting stimulants. Eur Child Adolesc Psychiatry 19:325–340
Bundred P, Kitchiner D, Buchan I (2001) Prevalence of overweight and obese children between 1989 and 1998: Population based series of cross sectional studies. BMJ 322:326–328
Button TB, Maughan P, McGuffin P (2007) The relationship of maternal smoking to psychological problems in the offspring. Early Hum Dev 83:727–732
Centers for Disease Control and Prevention (CDC) (2001) MMWR 50:682–686
Chen A, Pennell ML, Klebanoff MA, Rogan WJ, Longnecker MP (2006) Maternal smoking during pregnancy in relation to child overweight: follow-up to age 8 years. Int J Epidemiol 35:121–130
Chinn S, Rone RJ (2001) Prevalence and trends in overweight and obesity in three cross sectional studies of British children, 1974–94. BMJ 322:24–26
Cornelius JR, Lynch K, Martin CS, Cornelius MD, Clark DB (2001a) Clinical correlates of heavy tobacco use among adolescents. Addict Behav 26:273–277
Cornelius MD, Ryan CM, Day NL, Goldschmidt L, Willford JA (2001b) Prenatal tobacco effects on neuropsychological outcomes among preadolescents. Dev Behav Pediatr 22:217–225
Cruz NV, Bahna SL (2006) Do food or additives cause behaviour disorders? Pediatr Ann 35:744–5, 748–54
Davis C, Levitan RD, Smith M, Tweed S, Curtis C (2006) Associations among overeating, overweight and attention deficit/hyperactivity disorder:a structural equation modelling approach. Eat Behav 7:266–274
Dolan SA, Jarman B, Bajekal M, Davies PM, Hart D (1995) Measuring disadvantage: changes in the underprivileged area, Townsend, and Carstairs scores 1981–91. J Epidemiol Community Health 49:S30–S33
Faddagh ME, Laucht M, Maras A, Vohringer L, Schmidt MH (2004) Association of dopamine D4 receptor (DRD4) gene with attention-deficit/hyperactivity disorder (ADHD) in a high-risk community sample: a longitudinal study from birth to 11 years of age. J Neural Transm 111:883–889
Faraone SV, Perlis RH, Doyle AE et al (2005) Molecular genetics of attention-deficit/hyperactivity disorder. Biol Psychiatry 57:1313–1323
Gilthrope MS (1995) The importance of normalisation in the construction of deprivation indices. J Epidemiol Community Health 492:S45–S50
Huijbregts SC, Séguin JR, Zoccolillo M, Boivin M, Tremblay RE (2008) Maternal prenatal smoking, parental antisocial behaviour, and early childhood physical aggression. Dev Psychopathol 20:437–453
Ilana R, Chertok A, Luo J, Robert HA (2010) Association between changes in smoking habits in subsequent pregnancy and infant birth weight in West Virginia. Matern Child Health J. doi: 10.1007/s10995-010-0582-y
Kelly YJ, Brabin BJ, Milligan P, Heaf DP, Reid J, Pearson MG (1995) Maternal asthma, premature birth, and the risk of respiratory morbidity in schoolchildren in Merseyside. Thorax 50:525–530
Kemp A (2008) Food additives and hyperactivity. BMJ 336:1144
Koshy G, Delpisheh A, Brabin BJ (2010) Dose response association of pregnancy cigarette smoke exposure, childhood stature, overweight and obesity. Eur J Public Health (in press)
Kotimaa AJ, Moilanen I, Taanila A, Ebeling H, Smalley SL, McGough JJ, Hartikainen AL, Jarvelin MR (2003) Maternal smoking and hyperactivity in 8-year-old children. J Am Acad Child Adolesc Psychiatry 42:826–833
Lemiere J, Bart B, Marina D (2010) No association between the 2D:4D fetal testosterone marker and multidimensional attentional abilities in children with ADHD. Dev Med Child Neurol 52:790–791
Li MD, Cheng R, Ma JZ, Swan GE (2003) A meta-analysis of estimated genetic and environmental effects on smoking behaviour in male and female adult twins. Addiction 98:23–31
Linnet KM, Wisborg K, Obel C et al (2005) Smoking during pregnancy and the risk for hyperkinetic disorder in offspring. Pediatrics 116:462–467
Lynch F, Mills C, Daly I, Fitzpatrick C (2006) Challenging times: prevalence of psychiatric disorders and suicidal behaviours in Irish adolescents. J Adolesc 29:555–573
Maher BS (2002) Dopamine system genes and attention deficit hyperactivity disorder: a metaanalysis. Psychiatr Genet 12:207–215
Munafo M, Clark T, Johnstone E, Murphy M, Walton R (2004) The genetic basis for smoking behavior: a systematic review and meta analysis. Nicotine Tob Res 6:583–597
Muneoka K, Ogawa T, Kamei K et al (1997) Prenatal nicotine exposure affects the development of the central serotonergic system as well as the dopaminergic system in rat offspring: involvement of route of drug administrations. Brain Res Dev Brain Res 102:117–126
Murphy KR, Barkley RA (1996) Parents of children with attentiondeficit/hyperactivity disorder: psychological and attentional impairment. Am J Orthopsychiatry 66:93–102
National Institute for Clinical Excellence (2000) Technology appraisal guidance–No 13, Guidance on the use of methylphenidate (Ritalin, Equasym) for attention deficit/hyperactivity disorder (ADHD) in Childhood, October, National Institute for Clinical Excellence, London. Available at: http://www.nice.org.uk. Accessed on Oct 15th, 2009
National Statistics on Smoking, UK (2007) Available at http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/smoking/statistics-on-smoking-england-2007-%5Bns%5D, p 8. Accessed on 4th Dec 2009
National UK birth statistics (2007) Available at http://www.statistics.gov.uk/pdfdir/preterm0507.pdf. Accessed on 6th Dec 2009
Plessen KJ, Bansal R, Zhu H et al (2006) Hippocampus and amygdala morphology in attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 63:795–807
Rizwan S, Reid J, Kelly Y, Bundred PE, Pearson M, Brabin BJ (2004) Trends in childhood and parental asthma prevalence in Merseyside, 1991–1998. J Pub Health 26:337–342
Rizwan S, Manning JT, Brabin BJ (2007) Maternal smoking during pregnancy and possible effects of in utero testosterone: evidence from the 2D:4D finger length ratio. Early Hum Dev 83:87–90
Robison LM, Sclar DA, Skaer TL, Galin RS (1999) National trends in the prevalence of attention-deficit/hyperactivity disorder and the prescribing of methylphenidate among school-age children: 1990–1995. Clin Pediatr (Phila) 38:209–217
Robison LM, Skaer TL, Sclar DA, Galin RS (2002) Is attention deficit hyperactivity disorder increasing among girls in the US? Trends in diagnosis and the prescribing of stimulants. CNS Drugs 16:129–137
Roy TS, Sabherwal U (1998) Effects of gestational nicotine exposure on hippocampal morphology. Neurotoxicol Teratol 20:465–473
Soares SR, Simon C, Remohí J, Pellicer A (2007) Cigarette smoking affects uterine receptiveness. Hum Reprod 22:543–547
Thapar A, Fowler T, Rice F, Scomfield J, van den Bree M, Thomas H et al (2003) Maternal smoking during pregnancy and attention deficit hyperactivity disorder symptoms in offspring. Am J Psychiatry 160:1985–1989
Todd RD, Neuman RJ (2007) Gene–environment interactions in the development of combined type ADHD: evidence for a synapse- based model. Am J Med Genet Part B 144B:971–975
Todd RD, Huang H, Smalley SL et al (2005) Collaborative analysis of DRD4 and DAT genotypes in population-defined ADHD subtypes. J Child Psychol Psychiatry 46:1067–1073
Tourmaa TE (1995) The adverse effects of tobacco smoking on reproduction. Nutr Health 10:105–120
Van den ban E, Souverein P, Swaab H, van Engeland H, Heerdink R, Egberts T (2010) Trends in incidence and characteristics of children, adolescents, and adults initiating immediate- or extended-release methylphenidate or atomoxetine in the Netherlands during 2001–2006. J Child Adolesc Psychopharmacol 20:55–61
Von Kries R, Toschke AM, Koletzko B, Slikker W (2002) Maternal smoking during pregnancy and childhood obesity. Am J Epidemiol 156:954–961
Wakschlag LS, Hans SL (2000) Maternal smoking during pregnancy and conduct problems in high-risk youth: a developmental framework. Dev Psychopathol 14:351–369
Walker A, Rosenberg M, Gil KB (1999) Neurodevelopmental and neurobehavioral sequelae of selected substances of abuse and psychiatric medications in utero. Child Adolesc Psychiatr Clin N Am 8:845–867
Yoshimasu K, Kiyohara C, Minami T et al (2009) Maternal smoking during pregnancy and offspring attention-deficit/hyperactivity disorder: a case–control study in Japan. ADHD Atten Def Hyp Disord 1:223–231
Acknowledgments
The co-operation of Mr Greg Harper from the Liverpool School of Tropical Medicine and Dr. Jane Richardson, who helped with optical reading of the questionnaires, are gratefully acknowledged. We thank the head teachers and school children for participating in the study. The 2006 survey was funded by the Liverpool Children’s Research Fund and Leverhulme Research Fund.
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Koshy, G., Delpisheh, A. & Brabin, B.J. Childhood obesity and parental smoking as risk factors for childhood ADHD in Liverpool children. ADHD Atten Def Hyp Disord 3, 21–28 (2011). https://doi.org/10.1007/s12402-010-0041-z
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DOI: https://doi.org/10.1007/s12402-010-0041-z