Nutritional Factors

Maternal Folate Levels

In the first epidemiologic study to assess the association between gestational folate
levels and offspring behavior, Schlotz et al. [15] (N=100) investigated ADHD-related
symptoms in children born to mothers who had measures of red blood cell folate at 14
weeks of gestation and total folate intake in early and late pregnancy. Lower maternal
red blood cell folate and total folate intake in early pregnancy were significantly
associated with higher child hyperactivity and peer problem scores at a mean age of
8.75 years.

Maternal Obesity

Rodriguez et al. [16] (N=1,714) examined the link between maternal obesity and
ADHD symptoms in a sample of 5-year-old children After controlling for a range of
child and family factors, maternal pre-pregnancy obesity was found to predict high
child inattentive symptoms ratings on teacher, but not maternal questionnaires, with
no significant associations observed for hyperactivity or ADHD total symptom scores
across raters [17].

Iron

Two 2010 publications supported an association between iron deficiency and ADHD
[18, 19], The longitudinal study by Corapci et al. [19] of 185 healthy Costa Rican
children found that chronic iron deficiency in infancy predicted persistent
externalizing problems at 5 and 11–14 years of age. The case-control study by Juneja
et al. [18] (N=50) in India found that concurrent serum ferritin was significantly lower
in children with ADHD compared with controls, although no significant correlation
was found between ferritin levels and parent or teacher ratings of inattention or
hyperactivity.

Zinc

In a small pilot study (N=43), Kiddie et al. [20] showed that serum zinc levels in
children with ADHD were lower than US population norms but failed to adjust for the
contribution of other ADHD risk factors. Nonetheless, these findings are consistent
with those of several earlier studies documenting a link between lower zinc levels and
ADHD .

Copper

Kiddie et al. [20] (N=43, see above) also found that serum copper levels of children
with ADHD were significantly lower than US population norms but did not determine
if low copper levels remained associated with ADHD if analyses were adjusted for
other potential risk factors (eg, zinc levels, socioeconomic status).
Omega-3 Fatty Acids

Kirby et al. [21] found that higher omega-3 fatty acid levels were associated with
decreased levels of teacher, but not parent inattention/hyperactivity symptom ratings
in a large study (N=411) of Welsh children that adjusted for a range of potential
confounders.

Food Additives

A double-blind, placebo-controlled, crossover trial in England conducted by

Stevenson et al. [22] (N=297) found that food color additives and preservatives
(sodium benzoate) were associated with more ADHD symptoms only in children with
specific genetic polymorphisms, including those involving histamine degradation.

Lifestyle and Psychosocial Factors

Electronic Media Exposure

Two studies evaluated the association between television and video game exposure
and ADHD symptomatology. Cheng et al. [23] analyzed data from a longitudinal
cohort study in Japan (N=316) and found that children with high levels of television
viewing at 18 months of age had greater hyperactive and inattention symptoms at 30
months of age compared with those with low exposure.

Maternal Stress

Two studies investigated the link between prenatal stress and ADHD. Using maternal
bereavement as a proxy for stress in a population-based Danish birth cohort
(N=1,015,912), Li et al. [24] found that boys born to mothers bereaved by the
unexpected death of a child or spouse had a 72% increased risk of ADHD, but no
increased risk was observed for female offspring.

Early Institutional Care

Two studies compared ADHD symptomatology in children initially placed in

institutional care with that of children never placed in an institution. Merz and McCall
[25] (N=1,380) and McLaughlin et al. [26] (N=166) found an association between
early institutional rearing and increased ADHD-related symptoms.
15. Schlotz W, Jones A, Phillips DI, et al. Lower maternal folate status in early
pregnancy is associated with childhood hyperactivity and peer problems in offspring.
J Child Psychol Psychiatr Allied Disc. 2010;51:594–602. [PMC free article]
[PubMed]
16. Rodriguez A. Maternal pre-pregnancy obesity and risk for inattention and
negative emotionality in children. J Child Psychol Psychiatr Allied Disc.
2010;51:134–143. [PubMed]
17. Rodriguez A, Miettunen J, Henriksen TB, et al. Maternal adiposity prior to
pregnancy is associated with ADHD symptoms in offspring: evidence from three
prospective pregnancy cohorts. Int J Obes. 2008;32:550–557. [PubMed]
18. Juneja M, Jain R, Singh V, Mallika V. Iron deficiency in Indian children with
attention deficit hyperactivity disorder. Indian Pediatr. 2010;47:955–958. [PubMed]
19. Corapci F, Calatroni A, Kaciroti N, Jimenez E, Lozoff B. Longitudinal evaluation
of externalizing and internalizing behavior problems following iron deficiency in
infancy. J Pediatr Psychol. 2010;35:296–305. [PMC free article] [PubMed]
20. Kiddie JY, Weiss MD, Kitts DD, Levy-Milne R, Wasdell MB. Nutritional status
of children with attention deficit hyperactivity disorder: a pilot study. Int J Pediatr.
2010;2010 767318. [PMC free article] [PubMed]
21. Kirby A, Woodward A, Jackson S, Wang Y, Crawford MA. Childrens' learning
and behaviour and the association with cheek cell polyunsaturated fatty acid levels.
Res Dev Disabil. 2010;31:731–742. [PubMed]
22. Stevenson J, Sonuga-Barke E, McCann D, et al. The role of histamine degradation
gene polymorphisms in moderating the effects of food additives on children's ADHD
symptoms. Am J Psychiatry. 2010;167:1108–1115. [PubMed]
23. Cheng S, Maeda T, Yoichi S, et al. Early television exposure and children's
behavioral and social outcomes at age 30 months. J Epidemiol. 2010;20 Suppl
2:S482–S489. [PMC free article] [PubMed]
24. Li J, Olsen J, Vestergaard M, Obel C. Attention-deficit/hyperactivity disorder in
the offspring following prenatal maternal bereavement: a nationwide follow-up study
in Denmark. Eur Child Adolesc Psychiatry. 2010;19:747–753. [PubMed]
25. Merz EC, McCall RB. Behavior problems in children adopted from
psychosocially depriving institutions. J Abnorm Child Psychol. 2010;38:459–470.
[PMC free article] [PubMed]
26. McLaughlin KA, Fox NA, Zeanah CH, et al. Delayed maturation in brain
electrical activity partially explains the association between early environmental
deprivation and symptoms of attention-deficit/hyperactivity disorder. Biol Psychiatry.
2010;68:329–336. [PMC free article] [PubMed]