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Particulate Matter Exposure and Attention-Deficit/Hyperactivity Disorder in Children: A Systematic Review of Epidemiological Studies

1
Department of Preventive Medicine and Public Health, Food Sciences, Toxicology, and Legal Medicine, School of Pharmacy, University of Valencia, Avenida Vicente Andres Estellés s/n, Burjassot, 46100 Valencia, Spain
2
Biomedical Research Consortium in Epidemiology and Public Health Network (CIBERESP), Avenida Monforte de Lemos, 3-5, Pabellón 11, Planta 0 28029 Madrid, Spain
3
Scuola Normale Superiore, Piazza dei Cavalieri, 7-56126 Pisa, Italy
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(1), 67; https://doi.org/10.3390/ijerph17010067
Received: 23 November 2019 / Revised: 13 December 2019 / Accepted: 17 December 2019 / Published: 20 December 2019
(This article belongs to the Special Issue The Environment and Children’s Health)
Attention-deficit/hyperactivity disorder (ADHD) is the most common cognitive and behavioural disorder affecting children, with a worldwide-pooled prevalence of around 5%. Exposure to particulate matter (PM) air pollution is suspected to be associated with autism spectrum disorders and recent studies have investigated the relationship between PM exposure and ADHD. In the absence of any synthesis of the relevant literature on this topic, this systematic review of epidemiological studies aimed to investigate the relationship between the exposure of children to PM and ADHD and identify gaps in our current knowledge. In December 2018, we searched the PubMed and EMBASE databases. We only included epidemiological studies carried out on children without any age limit, measuring PM exposure and health outcomes related to ADHD. We assessed the quality of the articles and the risk of bias for each included article using the Newcastle–Ottawa Scale and the Office of Health Assessment and Translation (OHAT) approach, respectively. The keyword search yielded 774 results. Twelve studies with a total number of 181,144 children met our inclusion criteria, of which 10 were prospective cohort studies and 2 were cross-sectional studies. We subsequently classified the selected articles as high or good quality studies. A total of 9 out of the 12 studies reported a positive association between PM exposure to outdoor air pollution and behavioral problems related to attention. Despite these results, we found a significant degree of heterogeneity among the study designs. Furthermore, 11 studies were judged to be at a probably high risk of bias in the exposure assessment. In conclusion, we opine that further high quality studies are still needed in order to clarify the association between PM exposure and ADHD diagnosis View Full-Text
Keywords: air pollution exposure; particulate matter (PM); environmental epidemiology; environmental pollution; attention-deficit/hyperactivity disorder (ADHD); public health policy air pollution exposure; particulate matter (PM); environmental epidemiology; environmental pollution; attention-deficit/hyperactivity disorder (ADHD); public health policy
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Donzelli, G.; Llopis-Gonzalez, A.; Llopis-Morales, A.; Cioni, L.; Morales-Suárez-Varela, M. Particulate Matter Exposure and Attention-Deficit/Hyperactivity Disorder in Children: A Systematic Review of Epidemiological Studies. Int. J. Environ. Res. Public Health 2020, 17, 67.

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