Study on the Correlation of Urinary Leaden Levels and Attention

Deficit Hyperactivity Disorder

ELENA TRUTA1, ANA MARIA DAVITOIU2, GEORGE JINESCU1, ANA MIHAELA MITU3, GENICA CARAGEA1, MIHAI IONICA4,
ELENA LUMINITA STANCIULESCU1*
1
Clinical Emergency Hospital Bucharest
2
Clinical Emergency Hospital for Children Victor Gomoiu Bucharest
3
Individual Cabinet from psychology Ana Mihaela Mitu Bucharest
4
Military Medical Research Centre

The study on the correlation of urinary leaden levels and attention deficit hyperactivity disorder was conducted
during 2013 - 2014 and included 50 children from orphanage SOS Childrens Villages Bucharest divided in
two groups: group A included 25 children (12 boys and 13 girls) without an attention deficit and hyperactivity
disorder syndrome (ADHD) diagnose and group B included 25 children (14 boys and 11 girls) diagnosed with
ADHD. Toxicology Laboratory of Clinical Emergency Hospital Bucharest made leaden determinations using
Graphite Tube Atomic Absorbtion technique. The average of leaden level determined in both groups was <
2g/L, values under the maximum permissible limit (< 10 g/L). The leaden averages in the two groups do
not differ significantly. Children in the study, regardless of the group they were assigned to, were cared for
and educated in the same social and ambient environment, coming into contact with the same pollutants
from water, air and food, but some have developed ADHD symptoms and others have not been diagnosed
with ADHD. The study was unable to establish connection between values and leaden presence of ADHD
symptoms.
Keywords: lead, attention deficit and hyperactivity disorder syndrome, graphite Tube Atomic Absorbtion
Spectrometry

Attention deficit and hyperactivity are the most common

psychiatric disorders seen in childhood that can persist in
a high percentage in adulthood.
Studies in children diagnosed with ADHD have shown
that symptoms persist in adolescence and adulthood in
two thirds of cases [1, 2].
The American Academy of Pediatrics defines attention
deficit and hyperactivity disorder syndrome (ADHD) as the
most common neurobehavioral disorder that occurs in
childhood and can profoundly affect the academic
environment, wellbeing and social interaction of the child
[3].
Diagnosis is clinical and based on comprehensive
medical, developmental, educational and psychological
evaluations. DSM V diagnostic criteria include 9 symptoms
of inattention, 6 of hyperactivity and 3 of impulsivity. The
diagnosis that is based on these criteria requires that
symptoms be present in at least 2 life situations (home
and school) and be present before the age of 7. The
diagnosis of predominant inattention type requires the
existence of at least 6 of the 9 possible criteria.
Predominant hyperactive-impulsive type diagnosis requires
the existence of at least 6 of 9 possible symptoms of
hyperactivity-impulsivity [4]. The clinical criteria in ADHD,
according to International Classification of Diseases, Tenth
Revision (ICD-10) are hyperactivity/impulsivity and
attention disorders that must be manifest in an enhanced
form [5].
In childhood ADHD is more common in boys than girls,
on a ratio of one to five. This statement is explained through
the fact that boys face more with childhood hyperactivity
and aggression unlike girls who face chronic fatigue and

attention disorders and are therefore less diagnosed and

treated for ADHD.
The disease tends to have a family character. ADHD
does not have a single, identifiable cause. Potential causes
are the genetic, biochemical, sensorimotor, physiological
and behavioral factors. Other risk factors are birth weight
less than 1000 g, brain trauma, exposure to hazards of
lead and prenatal exposure to alcohol, tobacco and cocaine.
About 5% of children with ADHD show other neurological
signs and symptoms. There is increasingly more evidence
to support the involvement of dopaminergic and
noradrenergic systems anomalies in the decreased activity
or stimulation in the upper portion of the brainstem.
In support of our research are studies that have shown a
link between long-term exposure to low concentrations of
lead and low intelligence quotient.
In the nerve cell synapses lead prevents the formation
and volume growth of the brain and may lead to specific
manifestations of ADHD symptoms.
Sources of lead include: exposure to hazards from the
environment (drinking water passed through tubes with
lead paint, toys, and cosmetics), exposure to various
pollutants during pregnancy, lifestyle [6-8].
One example is that of a child diagnosed with autism
associated with ADHD and with a blood lead concentration
of 4.2 g/dL (below the maximum permissible value). After
succimer chelation, a reduction in repetitive behavior and
hyperactive behavior was observed. The author concluded
that there might be a causal relationship between
increased plasma concentrations of lead, ADHD, autism
and treatment of behavioral symptoms [9, 10].

* email: [email protected]
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609

Table 1
THE GENERAL PARAMETERS OF THE
ATOMIC ABSORBTION
SPECTROMETRY SYSTEM FOR
DETERMINING LEAD

In order to reduce poor school results, rejection and

indifference reactions specific to ADHD behavior,
treatment for ADHD is also applied. Psychostimulants
medications are effective and apply as long as it produces
benefits without causing side effects [11]. Pharmacotherapy is associated with behavioral therapy enjoyed by
the whole family.
In blood lead 20 g/dL, toxic effects are produced.
[12] Researches have revealed neurotoxic side effects in
plasma lead concentrations 5 g/dL and it is assumed
that there is no lower limit of blood lead for which neurotoxic
side effects occur. [13-16]. Disease Control and Prevention
(CDC) Advisory Committee on Childhood Lead Poisoning
Prevention recommends as a benchmark of lead plasma
a concentration of 5 g/dL [17].
Another study shows a link between ADHD diagnosis
and plasma concentrations of Pb 2 g/dL [18-20].
Literature mentions the existence of a link between lead
poisoning, food additives and ADHD symptoms.
Establishing a link between urine concentrations of lead
and ADHD symptoms is the focus of this paper.
This paper presents the study on the correlation between
the urinary leaden levels and attention deficit disorder
conducted on children aged 7-15.
Experimental part
Material and methods
The study was conducted during 2013 - 2014. There
were included children from the orphanage SOS Childrens
Villages Bucharest. Urine sampling was done with the
consent of the legal representatives of children. The study
included 50 children divided in two groups: group A
included 25 children (12 boys and 13 girls) without an
ADHD diagnosis and group B included 25 children (14 boys
and 11 girls) diagnosed with ADHD.
Inclusion criteria: children aged 7-15; children diagnosed
and undiagnosed with ADHD.
610

Exclusion criteria for associated psychiatric diagnosis

(autism, psychosis, mental deficiency), associated
neurological disorders (paralysis, cerebral palsy).
The technique used was Graphite Tube Atomic
Absorbtion Spectrometry (GF-AAS) [21, 22].
The devices used have the following characteristics:
Atomic absorption spectrometer AAS-880 with the
following technical characteristics: number of rays double spot; wavelength - 180-900 nm; optical system fully protected for dust and vapor, in three-dimensional
system of aluminum; monochromator - fully automatic,
computer-controlled Czerny-Turner micromotor, focal
length, 0.33 m; fully automatic slit width of 0.1, 0.2, 0.5 and
1 nm and height reducing to 0.2, 0.5 and 1; diffraction
System holographic with 1800 lines/nm; background
correction - deuterium lamp in the field of 185 -425 nm for
abs. (2.5, 2) ms response, electronic modulation with
automatic attenuation; cathode tubes - eight mounted on
a fully automatic carousel with automatic selection of the
type of tube and default parameters; lamp following to be
analyzed is preheated; gas control - fully automatic with
selection and flow for each program; Measurement mode
- manual or automatic, with calculation of the area or peak
height; software methods - maximum 10 points calibration
and the ability to run up to 30 automatic methods,
automatic control of calibration observance, of quality
control, of measurements deviation, of publishing reports,
of data storage and processing.
Graphite tube furnace atomization installation GTA-100
has the following technical characteristics: temperature
range - 40 30000C; temperature measurement - through
water temperature difference on entry/exit of graphite
furnace; maximum number of steps/temperature 20,
with a precision of 10C; maximum temperature gradient 20000C/s; number of controlled gas - two; adjustable gas
flow rate from 0 to 3.1 L/min programmable in steps of 0.1
L/min; cooling with water.

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REV.CHIM.(Bucharest) 67No. 4 2016

Fig. 1. Leaden distribution whiting group A

Fig. 3. Leaden distribution on groups and genders

The leaden average difference between the two groups

is of 0.8g/L. By gender, the leaden average for boys in
group B was higher by 0.77 g/L compared to the leaden
average in group A. Leaden average for girls in group A is
greater than the leaden average for girls in group B, 0.54
g/L. Leaden averages on groups and genders are shown
in figure 3.
The leaden values average in the study groups does not
differ significantly. Leaden values were, in both groups < 2
g/L, under reference value of plasma lead 5g/L and
away from the maximum permissible limit (< 10 g/L).
Fig. 2. Leaden distribution withing group B

Automatic samples distributor, standards, modifiers and

thinners - PSD with following technical characteristics:
maximum number of samples - 50/2 mL; number of
accessories solutions - 5/25 mL; washing solution volume
1L; multiple injection - up to 99; automatic mixing;
automatic dilution; automatic re-injection of samples;
injected amount (min. - max.) l mL - 100 mL.
Water Cooler CFT 33 Neslab model with the following
technical characteristics: working temperature - 5 - 350C;
working accuracy - +/- 10C; working pressure - max. 2
atm.
Domnick Hunter Nitrogen Generator with the following
technical characteristics: max. output pressure - 7 bar;
max. flow 3L/min; nitrogen purity < 10 ppm oxygen.
Argon - gas cylinder under 99.9999 % purity.
Reagents and equipment specific to analytical
toxicology laboratory.
The collection of urine was made from spot (10 mL).
Urine samples were processed with 65% HNO3. The
mixture was left in the tube for 20 min and then centrifuged
at 2500 rev/min for 10 min. The supernatant was intended
for the laboratory matrix.
For statistic analysis the Student impar test has been
performed.
Results and discussions
In group A leaden average was M = 1.32 g/L with AS
= 1.66 and ASM = 0.35. By gender, the leaden average
was for boys: M = 1.35 g/L with AS = 1.57 and ASM =
0.47 and for girls: M = 1.29 g/L with AS = 1.82 and ASM
= 0.55, shown in figure 1.
In group B leaden average was M = 2.02 g/L with AS
= 1.76 and ASM = 0.49. By gender, the leaden average
was for boys: M = 2.12 g/L with AS = 1.76 and ASM =
0.49 and for girls: M = 0.75 g/L with AS = 1.29 and ASM
= 0.39, shown in figure 2.

REV.CHIM.(Bucharest)67 No. 4 2016

Conclusions
Children in the study, regardless of the group they were
assigned to, were cared for and educated in the same
social environment, namely at the orphanage SOS
Childrens Villages. All children have come into contact
with the same pollutants from water, air and food, but some
have developed ADHD symptoms while others were not
diagnosed with ADHD.
ADHD diagnosis was established after the
institutionalization of children. Nothing is known about the
period before institutionalization, on exposure to pollutants
during pregnancy, presence of ADHD symptoms in parents
or premature birth of these children.
Leaden average of the two groups does not differ
significantly and therefore could not be established a
correlation between the leaden values and the ADHD
symptoms presence.
Urinar y leaden level analysis can be the first
investigation for determining the etiology of the attention
deficit and hyperactivity disorder syndrome especially in
industrial areas with emissions of lead.
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Manuscript received: 5.10.2015

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