Cognitive and cognitive-motor performance among primary school children attending schools in areas with different ambient PM10 profiles: an ecological cross-sectional study

Although executive functions and other higher-order cognitive processes have been investigated in previous studies of childhood air pollution exposure, relatively limited evidence is available regarding specific cognitive and cognitive-motor domains among young school-aged children in Middle Eastern populations. In particular, little is known about whether environmental differences between school settings are associated with distinct aspects of cognitive, perceptual-motor, and praxis-related performance. This ecological cross-sectional study investigated the cognitive and cognitive-motor performance of 247 children enrolled in Grade 1 (aged 6 to 7 years; mean = 6.25, SD = 0.43) attending schools located in areas with different ambient PM10 profiles in the Irbid and Zarqa Governorates. Cognitive performance was assessed using the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), which involves three main indicators: Motor Praxis, Visuomotor Organization, and Thinking Operations. Daily PM10 records from 2019 to 2024 were taken from five monitoring stations in the two governorates through the public AQICN platform, to describe regional ambient PM10 rather than individual exposure. In a supplementary step, one low-cost PurpleAir sensor recorded school-level PM1.0, PM2.5 and PM10 for about two weeks at each of the two Zarqa schools, one school after the other; these data were not used in the regression models. The scores from cognitive testing were compared via regression models using selected sociodemographic variables as control variables. Motor Praxis scores did not differ significantly between school groups, although this domain had a marked ceiling effect and low internal consistency. After adjustment, children at School A in Zarqa scored lower than the Irbid reference group on Visuomotor Organization (− 4.25 points; 95% CI − 5.67 to − 2.84; p < 0.001) and, less consistently across models, on Thinking Operations (− 1.74 points; 95% CI − 3.15 to − 0.33; p = 0.012). Children at School B in Zarqa scored higher than the Irbid reference group on Thinking Operations (3.38 points; 95% CI 2.00 to 4.75; p < 0.001) and did not differ on Visuomotor Organization. These are school-level differences and should not be read as effects of individual PM10 exposure. Children at School A in Zarqa had lower Visuomotor Organization scores and, less consistently across models, lower Thinking Operations scores than the Irbid reference group, whereas School B had higher Thinking Operations scores and did not differ in the other two domains. Exposure was assessed at area and school level and not for individual children, so the findings are associations with school-area environmental context and do not show that PM10 caused the differences.