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factors causing attentiondefidt /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 Rating Scale
(ACTRS) scores in children v.ith ADHD.
Methods T his crosssectional study was performed in children
aged 5 12 years who were newly diagnosed \\lith ADHD. Subjects
were recruited from the Klinik Anakku Kelapa Gading, the
Neurology Outpatient Clinic, the Growth and Development
Social Pediatrics Outpatient Clinic, and the Integrated Child
Clinic of Cipto Mangunkusumo Hospital. ADHD diagnoses were
established using Diagnostic and Statistical Manual of Mental
Disorders, 4th edition (DSMIV). 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, \\lith a median age of onset of 4 (range
2 10) years. The combined type of ADHD (with inattention and
hyperactivityimpulsivity) was more commonly found (20/33)
in our subjects. T he 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. Median serum ferritin levels of
the two ADHD type groups were similar. Median ACTRS scores
of parents and teachers tended to be higher in the irondeficient
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'
Conclusion Serum ferritin level showed no correlation to ACTRS
scores of parents and teachers, respectively. However, the median
ACTRS score was higher in the irondeficiency group than in the
normal iron status group, suggesting that there may be a qualitative
relationship between iron deficiency and ADHD symptoms.
[Paediatr lndanes. 2012;52:329-35].
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