ArticleThe Journal of pediatrics2018
A Prospective Birth Cohort Study on Early Childhood Lead Levels and Attention Deficit Hyperactivity Disorder: New Insight on Sex Differences.
Article in The Journal of pediatrics, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 6 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
30 citing papers in PubMed, 6 syntheses or guidelines pooled it, 63 citations in OpenAlex.
- Association between heavy metals exposure and risk of attention deficit hyperactivity disorder (ADHD) in children: a systematic review and meta-analysis.European child & adolescent psychiatry · 2025Pooled it
- Exploring the link between toxic metal exposure and ADHD: a systematic review of pb and hg.Journal of neurodevelopmental disorders · 2024Pooled it
- A Systematic Review and Meta-analysis of Prenatal, Birth, and Postnatal Factors Associated with Attention-Deficit/Hyperactivity Disorder in Children.Prevention science : the official journal of the Society for Prevention Research · 2024Pooled it
- A Systematic Review and Meta-analysis of Parental Depression, Antidepressant Usage, Antisocial Personality Disorder, and Stress and Anxiety as Risk Factors for Attention-Deficit/Hyperactivity Disorder (ADHD) in Children.Prevention science : the official journal of the Society for Prevention Research · 2024Pooled it
- A Systematic Review and Meta-analysis of Chemical Exposures and Attention-Deficit/Hyperactivity Disorder in Children.Prevention science : the official journal of the Society for Prevention Research · 2024Pooled it
- The Association between Lead and Attention-Deficit/Hyperactivity Disorder: A Systematic Review.International journal of environmental research and public health · 2019Pooled it
- Dentine markers of pre/early postnatal lead exposure links with brain, cognitive, and behavioral outcomes in adolescents.medRxiv : the preprint server for health sciences · 2026Article
- Childhood Pb-induced cognitive dysfunction: structural equation modeling of hot and cold executive functions.Journal of exposure science & environmental epidemiology · 2025Article
- Association between infant feeding and ADHD development in childhood: a birth cohort study in Taiwan.Journal of child psychology and psychiatry, and allied disciplines · 2025Article
- Current Understanding of Sex Differences in Metal-Induced Diseases.Current environmental health reports · 2025Review
- Integrating Exposures and Multi-Omics in the Boston Birth Cohort to Elucidate Immune Development across the Life Course: Rationale and Study Design.Precision nutrition · 2025Article
- Childhood lead exposure and sleep problems in adolescents: a longitudinal cohort study.International archives of occupational and environmental health · 2024Article
- Cerebral Vascular Toxicity after Developmental Exposure to Arsenic (As) and Lead (Pb) Mixtures.Toxics · 2024Article
- Early Life Origins of Neurodevelopmental Disabilities in the Boston Birth Cohort: Research findings and future directions.Precision nutrition · 2024Article
- Airborne Lead Exposure and Childhood Cognition: The Environmental Influences on Child Health Outcomes (ECHO) Cohort (2003-2022).American journal of public health · 2024Article
- Disparities in Toxic Chemical Exposures and Associated Neurodevelopmental Outcomes: A Scoping Review and Systematic Evidence Map of the Epidemiological Literature.Environmental health perspectives · 2023Article
- Higher rates of autism and attention deficit/hyperactivity disorder in American children: Are food quality issues impacting epigenetic inheritance?World journal of clinical pediatrics · 2023Review
- Maternal prenatal selenium levels and child risk of neurodevelopmental disorders: A prospective birth cohort study.Autism research : official journal of the International Society for Autism Research · 2021Article
- Human risk associated with the ingestion of artichokes grown in soils irrigated with water contaminated by potentially toxic elements, Junin, Peru.Saudi journal of biological sciences · 2021Article
- Pregnancy exposure to organophosphate esters and the risk of attention-deficit hyperactivity disorder in the Norwegian mother, father and child cohort study.Environment international · 2021Article
Corrections and comments
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Authors and funding
10 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveTo investigate the prospective associations between early childhood lead exposure and subsequent risk of attention deficit hyperactivity disorder (ADHD) in childhood and its potential effect modifiers. STUDY
designWe analyzed data from 1479 mother-infant pairs (299 ADHD, 1180 neurotypical) in the Boston Birth Cohort. The child's first blood lead measurement and physician-diagnosed ADHD was obtained from electronic medical records. Graphic plots and multiple logistic regression were used to examine dose-response associations between lead exposure and ADHD and potential effect modifiers, adjusting for pertinent covariables.
resultsWe found that 8.9% of the children in the Boston Birth Cohort had elevated lead levels (5-10 µg/dL) in early childhood, which was associated with a 66% increased risk of ADHD (OR, 1.66; 95% CI, 1.08-2.56). Among boys, the association was significantly stronger (OR, 2.49; 95% CI, 1.46-4.26); in girls, the association was largely attenuated (P value for sex-lead interaction = .017). The OR of ADHD associated with elevated lead levels among boys was reduced by one-half if mothers had adequate high-density lipoprotein levels compared with low high-density lipoprotein, or if mothers had low stress compared with high stress during pregnancy.
conclusionsElevated early childhood blood lead levels increased the risk of ADHD. Boys were more vulnerable than girls at a given lead level. This risk of ADHD in boys was reduced by one-half if the mother had adequate high-density lipoprotein levels or low stress. These findings shed new light on the sex difference in ADHD and point to opportunities for early risk assessment and primary prevention of ADHD.
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Registered trials
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