Exposure to environmental and lifestyle factors and attention-deficit / hyperactivity disorder in children - A review of epidemiological studies

Attention-defi cit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children. Although the mechanisms that lead to the development of ADHD remain unclear, genetic and environmental factors have been implicated. These include heavy metals and chemical exposures, nutritional and lifestyle/psychosocial factors. The aim of this review was to investigate the association between ADHD or ADHD-related symptoms and widespread environmental factors such as phthalates, bisphenol A (BPA), tobacco smoke, polycyclic aromatic hydrocarbons (PAHs), polyfl uoroalkyl chemicals (PFCs) and alcohol. Medline, PubMed and Ebsco search was performed to identify the studies which analyze the association of prenatal and postnatal child exposure to environmental toxicants and lifestyle factors and ADHD or ADHD-related symptoms. The review is restricted to human studies published since 2000 in English in peer reviewed journals. Despite much research has been done on the association between environmental risk factors and ADHD or ADHD symptoms, results are not consistent. Most studies in this fi eld, focused on exposure to tobacco smoke, found an association between that exposure and ADHD and ADHD symptoms. On the other hand, the impact of phthalates, BPA, PFCs, PAHs and alcohol is less frequently investigated and does not allow a fi rm conclusion regarding the association with the outcomes of interest.