Correlation between serum ferritin levels and attention-deficit/hyperactivity disorder symptom scores in children based on the Abbreviated Conners Teachers Rating Scale
Abstract: Dopamine deficiency is thought to be one of
the factors causing attention-deficit /hyperactivity disorder (ADHD) in
children. Iron contributes to the regulation of dopamine neurotransmitter
activity, thus, iron deficiency has been associated with ADHD. Several studies
have been conducted in other countries to assess for a correlation between
serum ferritin levels and ADHD symptom scores, but with varied results.
Objective To examine the relationship between iron deficiency and ADHD
symptoms, in particular the correlation between serum ferritin levels and
Abbreviated Conners Teachers Rrating Scale (ACTRS) scores in children with
ADHD.
Methods This cross-sectional study was performed in children aged 5-12
years who were newly diagnosed with ADHD. Subjects were recruited from the
Klinik Anakku Kelapa Gading, the Neurology Outpatient Clinic, the Growth and
Development-Social Pediatrics Clinic, and the Integrated Child Clinic of Cipto
Mangunkusumo Hospital. ADHD diagnoses were established using Diagnostic and
Statistical Manual of Mental Disorders, 4th edition (DSMm-IV). Subjects’
parents and teachers were asked to complete the ACTRS instrument sheet. Venous
blood specimens were obtained for peripheral blood and serum ferritin level
tests.
Results Of the 33 subjects recruited, 23 were male. Subjects’ ages ranged
from 5-12 years, with a median age of onset of 4 (range 2-10) years. The
combined type of ADHD (with inattention and hyperactivity-impulsivity) was more
commonly found (20/33) in our subjects. The mean serum ferritin was 51.31 (SD
27.7) ng/mL. Using 20 ng/mL as the serum ferritin cutoff value, 5/33 subjects
were considered to be iron deficient. Median ACTRS score by parents and
teachers were 15 and 15, respectively. Higher scores were found in the combined
type subject group than in the inattention type subject group. Mmedian serum
ferritin levels of the two ADHD type groups were similar. ACTRS scores of
parents and teachers tended to be higher in the iron-deficient group (16 and
16, respectively) than in the normal serum iron group (14.5 and 12.5,
respectively). Serum ferritin level showed no correlation (r=-0.243; P=0.086)
to the parents’ ACTRS score, and no correlation (r=-.057; P=0.377) to the
teachers’ ACTRrS score.
Conclusion Serum ferritin level showed no correlation to ACTRS scores of
parents and teachers, respectively. However, the median ACTRS score was higher
in the iron-deficiency group than in the normal iron status group, suggesting
that there may be a qualitative relationship between iron deficiency and ADHD
symptoms.
Author: Intan Alita Putri
Tumbelaka, Hardiono D Pusponegoro, Rinawati Rohsiswatmo
Journal Code: jpkedokterangg120132
