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Association between urine cotinine levels, continuous performance test variables, and attention deficit hyperactivity disorder and learning disability symptoms in school-aged children

Published online by Cambridge University Press:  21 May 2012

S.-C. Cho ,
Y.-C. Hong ,
J.-W. Kim ,
S. Park ,
M.-H. Park ,
J. Hur ,
E.-J. Park ,
S.-B. Hong ,
J.-H. Lee  and
M.-S. Shin
...Show all authors
S.-C. Cho
Affiliation:
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
Y.-C. Hong
Affiliation:
Department of Preventive Medicine, Seoul National University College of Medicine and Institute of Environmental Medicine, Seoul, Republic of Korea
J.-W. Kim*
Affiliation:
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
S. Park
Affiliation:
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
M.-H. Park
Affiliation:
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
J. Hur
Affiliation:
SPSS Korea Data Solution Inc., Seoul, Republic of Korea
E.-J. Park
Affiliation:
Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
S.-B. Hong
Affiliation:
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
J.-H. Lee
Affiliation:
Department of Social Welfare, Soongsil University, Seoul, Republic of Korea
M.-S. Shin
Affiliation:
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
B.-N. Kim
Affiliation:
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
H.-J. Yoo
Affiliation:
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
I.-H. Cho
Affiliation:
Department of Psychiatry, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Republic of Korea
S.-Y. Bhang
Affiliation:
Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of medicine, Ulsan, Republic of Korea
S.-K. Han
Affiliation:
Medical Research Collaboration Center, Seoul National University College of Medicine, Seoul, Republic of Korea
*
*Address for correspondence: Dr Jae-Won Kim, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, 101 Daehak-No, Chongno-Gu, Seoul, Korea. (Email: adore412@paran.com)
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Abstract

Background

We examined the cross-sectional relationship between environmental tobacco smoke exposure, continuous performance test (CPT) measures, and attention deficit hyperactivity disorder (ADHD) or learning disability symptoms in school-aged children.

Method

In total, 989 children (526 boys, mean age 9.1 ± 0.7 years), recruited from five South Korean cities participated in this study. We used urine cotinine as a biomarker for environmental tobacco smoke exposure, and obtained the children's scores on a CPT. Parents completed the Korean versions of the ADHD Rating Scale – IV (ADHD-RS) and Learning Disability Evaluation Scale (LDES). Using generalized linear mixed model (GLMM), we assessed the associations between urine cotinine concentrations, neuropsychological variables, and symptoms of ADHD and learning disabilities. Additionally, we conducted structural equation models to explore the effects' pathways.

Results

After adjusting for a range of relevant covariates, GLMM showed urinary cotinine levels were significantly and positively associated with CPT scores on omission errors, commission errors, response time, and response time variability, and with parent- and teacher-rated ADHD-RS scores. In addition, urine cotinine levels were negatively associated with LDES scores on spelling and mathematical calculations. The structural equation model revealed that CPT variables mediated the association between urine cotinine levels and parental reports of symptoms of ADHD and learning disabilities.

Conclusions

Our data indicate that environmental exposure to tobacco smoke is associated with ADHD and learning disabilities in children, and that impairments in attention and inhibitory control probably mediate the effect.

Keywords

Attention deficit hyperactivity disorder (ADHD)childrencognitionenvironmental healthlearning disabilitysmoking
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 1 , January 2013 , pp. 209 - 219
Copyright
Copyright © Cambridge University Press 2012

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