Scare Mongering and ADHD
Hey, what’s the best way to link Halloween and an increasingly common childhood concern, such as attention deficit disorder? How about some scare-mongering in the form of an ostensibly educational article?
I received an email newsletter from the website, MedHelp.org, that encouraged me to learn about “8 ADHD Culprits Lurking in Your Home: Could your home be a haven for toxins that can cause ADHD?” Hmmm, I thought, I didn’t know that attention deficit hyperactivity disorder (ADHD) was caused by toxins in my home! I like to think I keep up with the research literature, so this was a potentially eye-opening article.
Then I clicked through and found one of those infuriating “photo galleries” that show a stock photo next to each explanation of the toxin. These photo galleries are meant to do only one thing — generate clicks on the website. The article could just as easily be all on one page (and most photo galleries offer that option — but not this one).
Frustrated, I clicked through only to find the kind of shallow article that passes for health journalism nowadays. There are really only 4, possibly 5, toxins in the article — 3 are repeated in order to get to the magical number 8. The three big ones are: lead (in water pipes and paint; both of which have been banned for some time), phthalates, and organophosphate pesticides.
So just for fun, I decided to examine each claim and the research backing for it.
1. Baby Care Products
The claim: Exposure to phthalates has been linked to birth defects, asthma, reproductive problems — and now ADD/ADHD in children.
The claimed fix: Stop using items that contain dibutylphthalate (DBP), dimethylphthalate (DMP) and diethylphthalate (DEP) and use fragrance-free products.
The data: This claim is apparently based upon a single study conducted on 261 Korean children in 2009. The actual findings from the study? “After adjustment for covariates, teacher-rated ADHD scores were significantly associated with DEHP metabolites but not with DBP metabolites.“
The study has not been replicated, so its findings are not considered robust. And the study and has some obvious limitations — a different culture that may have different exposures to these chemicals; teacher-rated ADHD (ADHD in the U.S. is diagnosed by a psychologist or psychiatrist, not teachers); not all covariates (possible confounds) were controlled for; the researchers studied symptoms associated with ADHD, not ADHD itself; and a limited subject pool, among other issues.
The result: This claim is bunk. Until research has replicated and expanded upon these findings, they should be taken with a healthy grain of salt (which has not been linked to ADHD — yet).
2. Paint On Your Walls
The claim: Peeling, chipping or cracking interior and exterior lead-based paint.
The claimed fix: Get your paint tested if house was built before 1978, when lead in paint was banned.
The data: Multiple studies have indicated a connection between lead levels in children’s blood and certain ADHD-like symptoms including hyperactivity and impulsivity. However, these correlations are occurring even at background exposure levels typical in western countries. In other words, children aren’t eating lead-based paint and then getting ADHD.
Increased lead-levels are found in groups of children diagnosed with ADHD, so there appears to be some sort of connection nonetheless. But probably not one you can do much about if it’s occurring even at background exposure levels, as studies have found.
The result: This claim has substance — don’t let your kids eat paint, especially if your house was painted before 1978. Good advice at any age.
3. Non-organic Produce
The claim: Organophosphate pesticides found on fruit that isn’t organically grown has been linked to higher rates of ADHD.
The claimed fix: Only buy organic fruits and vegetables when possible.
The data: The finding is based upon a single study that has not been replicated that analyzed data on a nationally representative sample of 1,139 US children. Increased organophosphate exposure was related to a doubling of risk of an ADHD diagnosis. However, the researchers did not assess the source of the exposure — so the connection to fruits and vegetables is an assumed one.
Previous research has shown a connection between very high organophosphate exposure (such as what one might get in a farming community) and a greater risk of developing ADHD.
The result: This claim has some substance, but it’s still only based on a single study. While we’re waiting for the followup studies in the meantime, wash your fruit and vegetables, whether it’s organic or not. Which you should have been doing anyway, since fruits and vegetables may come in contact with dirt, dirty shipping containers, dirty hands, etc.
4. Soft Plastic Toys
The claim: Exposure to phthalates — which can be found in sippy cups and teething toys — has been linked to birth defects, asthma, reproductive problems – and now ADD/ADHD in children.
The claimed fix: Stop using toys made before February 2009 when phthalates were banned from such toys in the U.S. by Congress.
The data: This is just a regurgitation of the first culprit, since they are the same thing — phthalates — just in a different form. As we noted in #1, this fear is based upon a single study that has yet to be replicated.
The result: The claim remains bunk. Since when has Congress been a scientific research body?
5. Candy and processed foods
The claim: Food coloring and preservatives (which ones?) have been linked to children exhibiting more hyperactivity and shorter attention spans in a 2007 British study.
The claimed fix: “Feed your family mostly whole, unprocessed foods like fruits, vegetables, nonfat milk, nuts and lean proteins.”
The data: This is a long-running debate within the research community — over 30 years — and one that has data on both sides. Eigenmann et al. (2004) in the journal The Lancet called into question such studies showing a link, because of their poor controls and methodology.
In the June 2009 edition of the Harvard Mental Health Letter that reviewed the entire body of research on this issue, the authors conclude that the jury is still out on whether food additives, artificial coloring and preservatives contribute to ADHD.
In any case, the authors of even the 2007 British study cited by MedHelp caution that only a small minority of children are particularly vulnerable to artificial additives.
The result: The claim is mostly bunk, as the jury is still out on the question. Even if true, it would explain and account for less than 10 percent of those diagnosed with ADHD.
6. Tap Water
The claim: Lead pipes and lead solder contribute to increased and unhealthy lead levels in drinking water.
The claimed fix: Test your home for lead piping and replace.
The data: This is just a regurgitation of the second culprit, since they are the same thing — lead — just in a different form. Multiple studies have indicated a connection between lead levels in children’s blood and certain ADHD-like symptoms including hyperactivity and impulsivity.
However, installation of lead water pipes in people’s U.S. homes largely stopped in the 1930s and was banned in 1986. (Lead supply lines from your town’s water supply may be more commonplace, however, and are something to ask your town about.) The MedHelp article notes that up up 8 percent of “lead free” solder may be lead, but there’s been zero research linking lead-free solder to increased lead levels in drinking water, much less ADHD. In other words, most people living in newer, modern homes — anything built in the past 25 years — don’t have to worry about lead in their drinking water.
The simplest and least inexpensive solution to this problem if you’re uncertain — use a water filter. Every water filter on the market today — like Brita — filter out lead.
The result: The claim has substance but is easily fixed with an inexpensive water filter.
7. Bug Spray and Weed Killer
The claim: Bug spray, weed killer, termite exterminators contain organophosphate pesticides.
The claimed fix: Don’t use sprays that contain these pesticides, even though they are already banned from U.S. residential products.
The data: This is just a regurgitation of the third culprit, since they are the same thing — organophosphate pesticides — just in a different form.
The result: This claim has substance. Check with your lawn care provider if they use pesticides on your lawn, and if so, have your child avoid contact with your lawn after it has been treated.
The claim: Nicotine exposure via smoking while pregnant increases the risk of ADHD.
The claimed fix: Don’t smoke while pregnant.
The data: MedHelp cites a 2007 Swedish study, but ignores the 2009 UK followup (Thepar, et al., 2009) in Biological Psyciatry that noted an important confounding factor — genetic inheritance. The UK researchers suggest that the observed association between maternal smoking in pregnancy and increased risk of ADHD might represent an inherited effect — not an effect of the smoking.
The result: This claim may have some substance, but it’s largely a moot point because there are dozens of health reasons not to smoke while pregnant (Besides, who still smokes while they’re pregnant nowadays?). And how is smoking an “ADHD culprit lurking in your home?”
Was it worth my time? Probably not, as most of these “culprits” most of us don’t have to worry about. And the ones you do have to worry about are readily fixed and account for a very small percentage of children who have attention deficit disorder.
Attention deficit disorder is not something you can “catch,” like the common cold or the flu. It is a serious mental disorder that is usually caused by a combination of biological (including genetic), psychological and social factors. These kinds of articles do a disservice to people’s general understanding and perception of ADHD by suggesting that ridding your life of these things will somehow inoculate your child against “catching” ADHD.
See the photo gallery for yourself: 8 ADHD Culprits Lurking in Your Home
Grohol, J. (2010). Scare Mongering and ADHD. Psych Central. Retrieved on April 25, 2015, from http://psychcentral.com/blog/archives/2010/10/27/medhelp-scare-mongering-and-adhd/