No association between maternal and child PFAS concentrations and repeated measures of ADHD symptoms at age 2½ and 5 years in children from the Odense Child Cohort

Neurotoxicol Teratol. 2021 Nov-Dec;88:107031. doi: 10.1016/ Epub 2021 Sep 24.


Introduction: The potential impact of exposure to perfluoroalkyl substances (PFAS) on childhood Attention-Deficit Hyperactivity-Disorder (ADHD) is unclear and deserves scrutiny. The majority of previously conducted longitudinal studies found no association between maternal serum-PFAS concentrations and ADHD symptoms in the offspring, but some studies observed possible associations with postnatal PFAS exposures, mainly in girls.

Objective: To investigate the association between maternal and child serum concentrations of five PFAS and symptoms of ADHD at ages 2½ and 5 years.

Methods: In the Odense Child Cohort (OCC) women were recruited in early pregnancy in 2010-12 and their children are being prospectively followed. Mothers donated serum samples in the first trimester and children at age 18 months to be analyzed for perfluorohexane sulfonic acid (PFHxS), perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA) and perfluorodecanoic acid (PFDA). Parents completed the Child Behavior Check List for ages 1.5-5 years (CBCL/1½-5), including a 6-item ADHD symptom scale at age 2½ years and again at 5 years. Negative binomial and logistic regression models taking account of repeated measures were used to investigate the association between maternal and child serum-PFAS concentrations and the ADHD symptom score. Effect modification by child sex was investigated as well.

Results: A total of 1138 mother-child pairs were included. At age 2½ years, 17.4% of the children had an ADHD scale score ≥ 5 (equivalent to the 90th percentile), whereas the proportion was 15.8% at age 5. We found no association between either maternal or child PFAS concentrations in serum and symptoms of ADHD at age 2½ or 5 years, and no evidence of effect modification by sex.

Conclusion: We found no evidence of an association between early-life PFAS exposure and the risk of developing symptoms of ADHD.

Keywords: ADHD; Child Cohort; Epidemiology; Neurotoxicology; Perfluoroalkyl substances.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attention Deficit Disorder with Hyperactivity / etiology*
  • Caprylates / toxicity
  • Child
  • Child, Preschool
  • Cohort Studies
  • Decanoic Acids / toxicity
  • Environmental Exposure / adverse effects*
  • Environmental Pollutants / blood*
  • Female
  • Fluorocarbons / toxicity*
  • Humans
  • Infant
  • Mothers
  • Pregnancy
  • Prenatal Exposure Delayed Effects*
  • Young Adult


  • Caprylates
  • Decanoic Acids
  • Environmental Pollutants
  • Fluorocarbons
  • perfluorodecanoic acid
  • perfluorooctanoic acid
  • perflexane