Zinc and Ferritin Deficiency in Children with Attention Deficit HyperactivityDisorder

Background: Insufficient nutritional supply and deficiency of trace elements and other components including various minerals have been suggested to play a role in the development of attention deficit hyperactivity disorder (ADHD) symptoms.Zinc and ferritin in particular were found to be deficient in patients with ADHD compared with healthy controls, so it was concluded that zinc and ferritin deficiency might play a role in the etiopathogenesis of ADHD.Aim of work: Compare serum zinc and ferritin levels between children with ADHD and controls, trying to investigate the association of serum zinc and ferritin levels with ADHD diagnosis, its symptom domains, and severity.Patients and Methods: A cross-sectional case control descriptive study conducted on 90 participants of both sexes with age limit from7to 14 years.The study was divided into two groups (45 participants in each group): Group A included 45 children with ADHD, recruited from the Child outpatient clinic located in Kasr Al Ainy Psychiatric and Addiction Hospital, were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, using the Arabic version of Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime version (K-SADS-PL).Conner's Parent Rating Scale -Revised -Long version (CPRS-R-L) used to assess ADHD symptoms severity.Group B included 45 healthy children as controls, recruited from healthy children attending with their parents in other clinics of Kasr Al Ainy hospital as well as children of employees, workers and nurses working in the same hospital.Serum zinc level using atomic absorption spectroscopy and serum ferritin level using enzyme-linked immunosorbent assay (ELISA) were measured in all children in both groups.All children and their parents interviewed by the researcher individually for socioeconomic status scale (SES).Results: There were no significant differences regarding age, sex, birth order, residence, and socioeconomic level between children with ADHD and controls.Our results point to serum zinc levels, there were no significant differences between both groups regarding serum zinc levels.However; 24.4% of children with ADHD (n=45) had frank zinc deficiency with serum zinc levels less than 60 g/dl in compared with 11.1% of controls(n=45).Among children with ADHD, it is found that hyperactivity-impulsivity, inattention DSM-IV index, and ADHD DSM-IV index subscales were higher in zinc deficient cases than nonzinc deficient cases.Also, serum zinc levels were negatively correlated with cognitive problems and inattention DSM-IV index.Regarding serum ferritin levels, there were no significant differences between children with ADHD and controls.However, (66.7%) of children with ADHD had low serum ferritin levels <30 ng/ml in contrast to (55.6%) of controls.It is worth nothing that there was no correlation between serum ferritin levels and CPRS-R-L subscales scores among children with ADHD.Conclusion: Serum zinc levels were associated with ADHD symptom domains and its severity in contrast to serum ferritin levels.