Correlation between serum ferritin levels and attention-deficit/hyperactivity disorder symptom scores in children based on the Abbreviated Conners Teachers Rating Scale

factors causing attentionZdefidt /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 cross sectional study was performed in children aged 5Z 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 (DSMZIV). 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 5Z 12 years, \\lith a median age of onset of 4 (range 2Z 10) years. The combined type of ADHD (with inattention and hyperactivity impulsivity) 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 ironZdeficient 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=Z0.243; P=0.086) to the parents' ACTRS score, and no correlation (r=Z.057; P=0.377) to the teachers' ACTRS 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 ironZdeficiency group than in the
normal iron status group, suggesting that there may be a qualitative relationship between iron deficiency and ADHD symptoms.