Jale KARAKAYA, Meral HURİ, Hülya KAYIHAN, Elif N. ÖZMERT, Tuba ÇELEN YOLDAŞ

Sensory profile, ferritin and zinc levels in preschool-aged children with symptoms of attention deficit hyperactivity disorder

disorders and has a big impact on the well-being of children. The disorder can lead to noticeable functional limitations for children and bio-ecological factors also contribute to symptoms of ADHD. We aimed to investigate the associations between ADHD symptoms and some related bio-ecological factors including serum ferritin, zinc levels and sensory processing in preschool-aged children. Methods. Twenty-two children who had been referred to the division of Developmental Pediatrics because of ADHD symptoms and 22 participants from the general pediatric outpatient clinics were included in the study. The symptoms of ADHD were evaluated with Conners’ Parent Rating Scale-Revised Short form. Complete blood count, serum ferritin and zinc levels were also evaluated. A blind occupational therapist implemented sensory processing measurements. The characteristics of each participant such as prematurity, perinatal complications, developmental practices and sociodemographic data were also considered. Results. Sensory processing measurement analysis revealed that all Sensory Profile scores were significantly lower in the children with ADHD symptoms compared to the control group indicating that the child shows the behavior more than desired. The low level of zinc (p=0.026, OR=6.153, 95% CI= 1.247-30.362) and the presence of perinatal complications (p=0.045, OR=10.864, 95% CI=1.059-111.499) increased the risk of ADHD symptoms. We could not find an association for ferritin levels in our study. Conclusions. The evaluation of zinc level and sensory profile parallel to other strategies can be recommended during the management of ADHD symptoms in preschool children.

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1. Wolraich M, Brown L, Brown RT, et al; Subcommittee on Attention-Deficit/Hyperactivity Disorder; Steering Committee on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 2011; 128: 1007-1022.
2. Ercan ES, Polanczyk G, Akyol Ardıc U, et al. The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T). Nord J Psychiatry 2019; 73: 132-140.
3. Thapar A, Cooper M. Attention deficit hyperactivity disorder. Lancet 2016; 387: 1240-1250.
4. Tandon M, Pergjika A. Attention deficit hyperactivity disorder in preschool-age children. Child Adolesc Psychiatr Clin N Am 2017; 26: 523-538.
5. Faraone SV, Perlis RH, Doyle AE, et al. Molecular genetics of attention-deficit/hyperactivity disorder. Biol Psychiatry 2005; 57: 1313-1323.
6. Biederman J. Attention-deficit/hyperactivity disorder: a selective overview. Biol Psychiatry 2005; 57: 1215- 1220.
7. Tseng PT, Cheng YS, Yen CF, et al. Peripheral iron levels in children with attention-deficit hyperactivity disorder: a systematic review and meta-analysis. Sci Rep 2018; 8: 788.
8. Konofal E, Lecendreux M, Deron J, et al. Effects of iron supplementation on attention deficit hyperactivity disorder in children. Pediatr Neurol 2008; 38: 20-26.
9. Verlaet AA, Noriega DB, Hermans N, Savelkoul HF. Nutrition, immunological mechanisms and dietary immunomodulation in ADHD. Eur Child Adolesc Psychiatry 2014; 23: 519-529.
10. Oner O, Oner P, Bozkurt OH, et al. Effects of zinc and ferritin levels on parent and teacher reported symptom scores in attention deficit hyperactivity disorder. Child Psychiatry Hum Dev 2010; 41: 441- 447.
11. Doom JR, Georgieff MK. Striking while the iron is hot: Understanding the biological and neurodevelopmental effects of iron deficiency to optimize intervention in early childhood. Curr Pediatr Rep 2014; 2: 291-298.
12. Wang Y, Huang L, Zhang L, Qu Y, Mu D. Iron status in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. PLoS One 2017; 12: e0169145.
13. Konofal E, Lecendreux M, Arnulf I, Mouren MC. Iron deficiency in children with attention-deficit/ hyperactivity disorder. Arch Pediatr Adolesc Med 2004; 158: 1113-1115.
14. Arnold LE, Bozzolo H, Hollway J, et al. Serum zinc correlates with parent- and teacher- rated inattention in children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2005; 15: 628-636.
15. Krause J. SPECT and PET of the dopamine transporter in attention-deficit/hyperactivity disorder. Expert Rev Neurother 2008; 8: 611-625.
16. Yorbik O, Ozdag MF, Olgun A, Senol MG, Bek S, Akman S. Potential effects of zinc on information processing in boys with attention deficit hyperactivity disorder. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32: 662-667.
17. Uckardes Y, Ozmert EN, Unal F, Yurdakok K. Effects of zinc supplementation on parent and teacher behaviour rating scores in low socioeconomic level Turkish primary school children. Acta Paediatr 2009; 98: 731-736.
18. Koziol LF, Budding D. ADHD and sensory processing disorders: placing the diagnostic issues in context. Appl Neuropsychol Child 2012; 1: 137- 144.
19. Zimmer M, Desch L. Section on Complementary and Integrative Medicine, Council on Children with Disabilities; American Academy of Pediatrics. Sensory integration therapies for children with developmental and behavioral disorders. Pediatrics 2012; 129: 1186-1189.
20. Pfeiffer B, Daly BP, Nicholls EG, Gullo DF. Assessing sensory processing problems in children with and without attention deficit hyperactivity disorder. Phys Occup Ther Pediatr 2015; 35: 1-12.
21. Ben-Sasson A, Carter AS, Briggs-Gowan MJ. Sensory over-responsivity in elementary school: prevalence and social-emotional correlates. J Abnorm Child Psychol 2009; 37: 705-716.
22. Yochman A, Parush S, Ornoy A. Responses of preschool children with and without ADHD to sensory events in daily life. Am J Occup Ther 2004; 58: 294-302.
23. Engel-Yeger B, Ziv-On D. The relationship between sensory processing difficulties and leisure activity preference of children with different types of ADHD. Res Dev Disabil 2011; 32: 1154-1162.
24. Durmazlar N, Ozturk C, Ural B, Karaagaoglu E, Anlar B. Turkish children’s performance on Denver II: effect of sex and mother’s education. Dev Med Child Neurol 1998; 40: 411-416.
25. Kaner S, Büyüköztürk, Ş, İşeri, E. Conners anababa dereceleme ölçeği-yenilenmiş kısa: Türkiye stardardizasyon çalışması. Nöropsikiyatri Arşivi 2013; 50: 100-109.
26. Hollingshead AB, Redlich FC. Social class and mental illness: a community study. 1958. Am J Public Health 2007; 97: 1756-1757.
27. Frankenburg WK, Dodds J, Archer P, Shapiro H, Bresnick B. The Denver II: a major revision and restandardization of the Denver Developmental Screening Test. Pediatrics 1992; 89: 91-97.
28. Ermer J, Dunn W. The sensory profile: a discriminant analysis of children with and without disabilities. Am J Occup Ther 1998; 52: 283-290.
29. Kayihan H, Akel BS, Salar S, et al. Development of a Turkish version of the sensory profile: translation, cross-cultural adaptation, and psychometric validation. Percept Mot Skills 2015; 120: 971-986.
30. Ayres AJ. Sensory Integration and Praxis Test (SIPT). Los Angeles: Western Psychological Services, 1989.
31. Schaaf RC, Burke JP, Cohn E, et al. State of measurement in occupational therapy using sensory integration. Am J Occup Ther 2014; 68: e149-e153.
32. DiGirolamo AM, Ramirez-Zea M. Role of zinc in maternal and child mental health. Am J Clin Nutr 2009; 89: S940-S945.
33. Henriksen L, Wu CS, Secher NJ, Obel C, Juhl M. Medical augmentation of labor and the risk of ADHD in offspring: a population-based study. Pediatrics 2015; 135: e672-e677.
34. Silva D, Colvin L, Hagemann E, Bower C. Environmental risk factors by gender associated with attention-deficit/hyperactivity disorder. Pediatrics 2014; 133: e14-e22.
35. Halmoy A, Klungsoyr K, Skjaerven R, Haavik J. Preand perinatal risk factors in adults with attentiondeficit/ hyperactivity disorder. Biol Psychiatry 2012; 71: 474-481.
36. Sciberras E, Mulraney M, Silva D, Coghill D. Prenatal risk factors and the etiology of ADHD-review of existing evidence. Curr Psychiatry Rep 2017; 19: 1.
37. Ketzer CR, Gallois C, Martinez AL, Rohde LA, Schmitz M. Is there an association between perinatal complications and attention-deficit/ hyperactivity disorder-inattentive type in children and adolescents? Braz J Psychiatry 2012; 34: 321-328.