Association between ambient gaseous and particulate air pollutants and attention deficit hyperactivity disorder (ADHD) in children; a systematic review

Mina Aghaei; Hosna Janjani; Fatemeh Yousefian; Akram Jamal; Masud Yunesian

doi:10.1016/j.envres.2019.03.030

Association between ambient gaseous and particulate air pollutants and attention deficit hyperactivity disorder (ADHD) in children; a systematic review

Environ Res. 2019 Jun:173:135-156. doi: 10.1016/j.envres.2019.03.030. Epub 2019 Mar 15.

Authors

Mina Aghaei¹, Hosna Janjani¹, Fatemeh Yousefian¹, Akram Jamal¹, Masud Yunesian²

Affiliations

¹ Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
² Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Department of Research Methodology and Data Analysis, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: yunesian@tums.ac.ir.

PMID: 30909100
DOI: 10.1016/j.envres.2019.03.030

Abstract

ADHD is a common neurodevelopmental disorder highly attributed to genetics, but the combination of other social and environmental determinants, as well as potential gene-environment interactions, can also be responsible. This paper aims to review relevant literature published up to April 2018 for determining whether air pollution caused by ambient gaseous (NO₂, SO₂, PCDD/Fs, Benzene) and particulate matters (PM₁₀, PM_2.5, PM₇, PAH, BC/EC) as an environmental risk factor is associated with increased risk of ADHD in children. Relevant literature was identified through electronic searches of PubMed, Embase, Web of Science, Scopus database and gray literature. A total of 872 articles were initially identified 28 of which meeting the defined inclusion criteria were included. The methodological quality of the included articles was evaluated using the modified Critical Appraisal Skills Programs (CASP) and confounding variables, exposure and outcome measurement were assessed. The results of this systematic review revealed that there is more evidence on the detrimental effects of EC, BC, and PM on ADHD compared to PAH. Among gaseous air pollutants, association was found between SO₂ and urinary level of t,t-MA (trans, trans-muconic acid) as a proxy-biomarker of NO₂ exposure, not merely benzene. However few studies related to NO₂ (0.46%) found detrimental effects. Overall, the number of studies reporting an association between air pollution and increased risk of ADHD is relatively higher compared to the number of studies reporting no association. However, the findings of the studies provided limited evidence to support the idea that exposure to air pollution may be linked to increased risk of ADHD. Well-designed and harmonized studies considering standard methods for individual exposure assessment, critical windows of susceptibility, and appropriate tools for outcome measurement, can improve the quality of epidemiological studies and strengthen the evidence. Since ADHD with its long-term consequences can impose large costs to communities and impact the children performance, determination of the risk factors in children and particularly the role of the environment as priorities for research should be considered.

Keywords: Ambient air pollution; Attention deficit hyperactivity disorder; Systematic review.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Air Pollutants
Air Pollution / statistics & numerical data*
Attention Deficit Disorder with Hyperactivity / epidemiology*
Child
Dibenzofurans
Environmental Exposure / statistics & numerical data*
Gases
Humans
Particulate Matter*
Polychlorinated Dibenzodioxins*

Substances

Air Pollutants
Dibenzofurans
Gases
Particulate Matter
Polychlorinated Dibenzodioxins