Elsevier

Pediatric Neurology

Volume 34, Issue 3, March 2006, Pages 200-203
Pediatric Neurology

Original article
Serum Ferritin in Children With Attention-Deficit Hyperactivity Disorder

https://doi.org/10.1016/j.pediatrneurol.2005.09.001Get rights and content

To further define a role for iron deficiency in attention-deficit hyperactivity disorder, serum ferritin was included in a battery of laboratory tests obtained in children attending a clinic for attention deficit disorders. In a total of 68 consecutive patients (ages 5-16 years; 54 male, 14 female), the range of serum ferritin levels was a low of 7.7 ng/mL and a high of 150 ng/mL. The mean (±S.D.) serum ferritin level in patients with attention-deficit hyperactivity disorder (39.9 ± 40.6 ng/mL) was not different from that of control subjects. Seventy-four percent of patients had serum ferritin levels below 50 ng/mL; 44% were below 30 ng/mL; and 18% below 20 ng/mL. None had evidence of iron deficiency anemia. A comparison of the clinical characteristics of the 12 patients with the lowest serum ferritin levels (<20 ng/mL) and 12 with the highest levels (>60 ng/mL) disclosed no significant difference in severity or frequency of attention-deficit hyperactivity disorder and comorbid symptoms or response to medications. In this patient cohort, a causative role for low serum ferritin in attention-deficit hyperactivity disorder has not been confirmed.

Introduction

Serum ferritin is a reliable measure of iron storage in body tissues, including brain, and low levels are a sign of iron deficiency and an early precursor of iron-deficiency anemia [1]. Anemia is a late sign of iron deficiency, and a routine screen for hemoglobin or complete blood count may not detect an early iron deficiency sufficient to cause neurologic or behavioral symptoms. Iron deficiency has been invoked as a risk factor in a number of neurologic disorders [2], but its involvement as a contributing cause of attention-deficit hyperactivity disorder was reported only recently [3]. The observation that disorders such as cognitive and learning disorders [4], often associated with attention-deficit hyperactivity disorder, were linked to iron deficiency prompted the inclusion of a serum ferritin level in the battery of laboratory tests obtained on patients attending our neurology clinic for attention-deficit disorders. We compared the serum ferritin levels in patients with attention-deficit hyperactivity disorder with control subjects, and have attempted to correlate the lowest levels with severity and frequency of attention-deficit hyperactivity disorder symptoms, degree of learning and other comorbid problems, and response to therapy.

Section snippets

Methods

Patients referred to the Neurology Attention Deficit Disorders Clinic at Children’s Memorial Hospital, Chicago, with a diagnosis of suspect attention-deficit hyperactivity disorder received a history and physical, a neurologic examination, and a battery of laboratory tests. Blood analyses included lead, T4, thyroid-stimulating hormone, complete blood count, chem 14, and after 2001, a routine serum ferritin level. An electroencephalogram was recorded in patients with a history of seizure or

Results

In a total of 68 consecutive patients (ages 5-16 years; 54 male, 14 female), the range of serum ferritin levels was a low of 7.7 (a male patient) and a high of 150 ng/mL (in a female). Figure 1 presents the serum ferritin values plotted according to age. The range of assumed normal values in our hospital laboratory was 22-322 ng/mL for males and 10-291 ng/mL in females. The mean (±S.D.) serum ferritin level in the 68 patients with attention-deficit hyperactivity disorder (39.9 ± 40.6 ng/mL) was

Discussion

The association of iron deficiency and various neurologic disorders has been demonstrated in both laboratory and clinical studies [2]. In 1963, iron-deficiency anemia was reported in 23% of children with breath-holding spells [7], and, in a subsequent study, treatment with ferrous sulfate was followed by complete or partial control of attacks in 88% of 33 cases, compared with a 6% control in 34 receiving placebo [8]. That iron plays a specific role in the etiology of breath-holding was

References (9)

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  • T2<sup>∗</sup> magnetic resonance imaging: A non-invasive biomarker of brain iron content in children with attention-deficit/hyperactivity disorder

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    Many researchers have studied the relation between decreased serum iron and ADHD [11–13]. However, serum ferritin is not an accurate biomarker for brain iron content [11,7,14] and correlation of peripheral iron with brain iron content is still unclear. Although low peripheral iron levels may negatively affect brain iron, several authors failed to ascertain an association between peripheral and brain iron [15].

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