Associations between exposure to bisphenol A and behavioral and cognitive function in children with Attention-Deficit/Hyperactivity Disorder : A case-control study
Seung-Jin Yoo 1, Hyunjoo Joo 2, Dohyun Kim 3, Myung Ho Lim 1, 4, Eunjung Kim 1, Mina Ha 2, Hojang Kwon 1, 2, Ki-Chung Paik 1, 5, Kyoung Min Kim 1, 5*
1Environmental Health Center, Dankook University Medical Center, 2Department of Preventive Medicine, Dankook University College of Medicine, 3Department of Psychiatry, Dankook University Hospital, 4Department of Psychology, College of Public Human Resources, Dankook University, 5Department of Psychiatry, Dankook University College of Medicine
Received: September 6, 2019; Revised: November 10, 2019; Accepted: November 10, 2019; Published online: November 10, 2019.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Objective
Bisphenol A (BPA) is a widely produced synthetic chemical used to manufacture polycarbonate plastics and epoxy resins. We aimed to investigate the association between exposure to BPA and behavioral and cognitive function in children with attention-deficit/hyperactivity disorder (ADHD) and healthy controls.
Methods
The study included 444 children aged from 6 to 10 years. The ADHD and control groups included 195 and 249 children, respectively. BPA levels were assessed via urinalysis, while behavior was assessed using the Korean version of the ADHD Rating Scale (K-ARS) and the Behavior Assessment System for Children (BASC-2). Cognitive function was assessed using the Continuous Performance Test (i.e., ADHD Diagnostic System [ADS]). Participants were categorized into tertile groups based on urinary BPA concentration.
Results
Scores on the K-ARS and the hyperactivity, aggression, anxiety, and depression subscales of the BASC-2 were significantly different among tertile groups for urinary BPA levels. Scores on visual omission error, commission error, response time variability, and auditory commission error of the ADS were significantly different among three BPA groups. Subgroup analysis revealed that these differences of behavior and cognition among three BPA groups were observed in only boys and normal controls.
Conclusions
Exposure to BPA was associated with unfavorable behavioral and cognitive outcomes. Our study extends the findings of previous studies regarding the association between BPA exposure and behavior/cognitive function by including children with ADHD. Further studies are required to determine the mechanisms underlying sex- and group-based differences in these associations.
Keywords: ADHD, Bisphenol A, sex differences, internalizing symptoms, externalizing symptoms, Environmental toxin


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