Objective: The purpose of this study was to evaluate the effect of altitude on rates of ADHD. As decreased dopamine (DA) activity has been reported with ADHD and hypoxia has shown to be associated with increased DA, we hypothesized that states at higher altitudes would have lower rates of ADHD. Method: State estimates from the 2007 National Survey of Children’s Health (NSCH) report and 2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) report were used to extract the percentages of youth ages 4 to 17 diagnosed with ADHD. Results: Both the datasets independently revealed that the prevalence of ADHD decreases with increasing altitude ( R 2 = .38, p < .001; R 2 = .31, p < .001), respectively. This study controlled for potential confounds (e.g., low birth weight, ethnicity, and household size). Conclusion: These findings suggest a need for further investigation into the extent by which altitude may serve as a protective factor for ADHD.

References

Akinbami, L. J., Liu, X., Pastor, P. N., Reuben, C. A. ( 2011 ). Attention deficit hyperactivity disorder among children aged 5-17 years in the United States, 1998-2009 (NCHS Data Brief, No. 70). Hyattsville, MD : Center for Disease Control and Prevention .

Google Scholar

American Psychiatric Association . ( 2000 ). Diagnostic and statistical manual of mental disorders ( 4th ed. , text rev.). Washington, DC : Author .

Google Scholar

Arns, M., van der Heijden, K. B., Arnold, L. E., Kenemans, J. L. ( 2013 ). Geographic variation in the prevalence of attention-deficit/hyperactivity disorder: The sunny perspective . Biological Psychiatry, 74, 585 - 590 . doi:10.1016/j.biopsych.2013.02.010

Google Scholar Crossref | Medline | ISI

Bailey, D. M., Davies, B. ( 1997 ). Physiological implications of altitude training for endurance performance at sea level: A review . British Journal of Sports Medicine, 31, 183 - 190 . Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1332514/

Google Scholar

Brenner, B., Cheng, D., Clark, S., Camargo, C. A. ( 2011 ). Positive association between altitude and suicide in 2584 U.S. counties . High Altitude Medicine & Biology, 12, 31 - 35 . doi:10.1089/ham.2010.1058

Google Scholar Crossref | Medline | ISI

Centers for Disease Control and Prevention . ( 2005 ). Population projections: United States, 2004-2030, by state, age and sex (Wide-Ranging Online Data for Epidemiologic Research [WONDER]). Retrieved from http://wonder.cdc.gov/population-projections.html

Google Scholar

Centers for Disease Control and Prevention . ( 2009 ). National Survey of Children’s Health, 2007. National Center for Health Statistics. Retrieved from http://www.cdc.gov/nchs/slaits/nsch.htm

Google Scholar

Centers for Disease Control and Prevention . ( 2012 ). National Survey of Children With Special Health Care Needs, 2009-2010. National Center for Health Statistics. Retrieved from http://www.cdc.gov/nchs/slaits/cshcn.htm

Google Scholar

Child and Adolescent Health Measurement Initiative . ( 2007 ). National Survey of Children’s Health, NSCH 2007 [Data query]. Available from http://www.childhealthdata.org

Google Scholar

Child and Adolescent Health Measurement Initiative . ( 2010 ). National Survey of Children With Special Health Care Needs, NS-CSHCN 2009-2010 [Data query]. Available from http://www.childhealthdata.org

Google Scholar

Del Campo, N., Chamberlain, S. R., Sahakian, B. J., Robbins, T. W. ( 2011 ). The roles of dopamine and noradrenaline in the pathophysiology and treatment of attention-deficit/hyperactivity disorder . Biological Psychiatry, 69, 145 - 157 . doi:10.1016/j.biopsych.2011.02.036

Google Scholar Crossref | Medline | ISI

DelMastro, K., Hellem, T., Kim, N., Kondo, D., Sung, Y. H., Renshaw, P. F. ( 2011 ). Incidence of major depressive episode correlates with elevation of substate region of residence . Journal of Affective Disorders, 129, 376 - 379 . doi:10.1016/j.jad.2010.10.001

Google Scholar Crossref | Medline

Doshi, J. A., Hodgkins, P., Kahle, J., Sikirica, V., Cangelosi, M. J., Setyawan, J., . . . Neumann, P. J. ( 2012 ). Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States . Journal of the American Academy of Child & Adolescent Psychiatry, 51, 990 - 1002 . doi:10.1016/j.jaac.2012.07.008

Google Scholar Crossref | Medline | ISI

Fiedler, K. K., Kim, N., Kondo, D. G., Renshaw, P. F. ( 2012 ). Cocaine use in the past year is associated with altitude of residence . Journal of Addiction Medicine, 6, 166 - 171 . doi:10.1097/ADM.0b013e31824b6c62

Google Scholar Crossref | Medline

Flatmark, T. ( 2000 ). Catecholamine biosynthesis and physiological regulation in neuroendocrine cells . Acta Physiologica Scandinavica, 168, 1 - 17 . doi:10.1046/j.1365-201x.2000.00596.x

Google Scholar Crossref | Medline

Hinojosa, M. S., Hinojosa, R., Fernandez-Baca, D., Knapp, C., Thompson, L. A., Christou, A. ( 2012 ). Racial and ethnic variation in ADHD, comorbid illnesses, and parental strain . Journal of Health Care for the Poor and Underserved, 23, 273 - 289 . doi:10.1353/hpu.2012.0001

Google Scholar Crossref | Medline | ISI

Iversen, S. D., Iversen, L. L. ( 2007 ). Dopamine: 50 years in perspective . Trends in Neurosciences, 30, 188 - 193 . doi:10.1016/j.tins.2007.03.002

Google Scholar Crossref | Medline | ISI

Ketzer, C. R., Gallois, C., Martinez, A. L., Rohde, L. A., Schmitz, M. ( 2012 ). Is there an association between perinatal complications and attention-deficit/hyperactivity disorder-inattentive type in children and adolescents? Revista Brasileira de Psiquiatria, 34, 321 - 328 . doi:10.1016/j.rbp.2012.01.001

Google Scholar Crossref | Medline | ISI

Kim, N., Mickelson, J. B., Brenner, B. E., Haws, C. A., Yurgelun-Todd, D. A., Renshaw, P. F. ( 2011 ). Altitude, gun ownership, rural areas, and suicide . The American Journal of Psychiatry, 168, 49 - 54 . doi:10.1176/appi.ajp.2010.10020289

Google Scholar Crossref | Medline | ISI

Leibson, C. L., Katusic, S. K., Barbaresi, W. J., Ransom, J., O’brien, P. C. ( 2001 ). Use and costs of medical care for children and adolescents with and without attention deficit/hyperactivity disorder . Journal of the American Academy of Child & Adolescent Psychiatry, 285, 60 - 66 . doi:10.1001/jama.285.1.60

Google Scholar Crossref

Levy, F. ( 2004 ). Synaptic gating and ADHD: A biological theory of comorbidity of ADHD and anxiety . Neuropsychopharmacology, 29, 1589 - 1596 . doi:10.1038/sj.npp.1300469

Google Scholar Crossref | Medline | ISI

Martel, M. M. ( 2013 ). Individual differences in attention deficit hyperactivity disorder symptoms and associated executive dysfunction and traits: Sex, ethnicity, and family income . American Journal of Orthopsychiatry, 83, 165 - 175 . doi:10.1111/ajop.12034

Google Scholar Crossref | Medline

Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Mathews, T. J., Kirmeyer, S., Osterman, M. J. K. ( 2010 ). Births: Final data for 2007 (National Vital Statistics Reports Vol. 58, No. 24). Hyattsville, MD : National Center for Health Statistics

Google Scholar

Mellor, A. ( 2011 ). Research at high altitudes . Journal of the Royal Army Medical Corps, 157, 5 - 7 . doi:10.1136/jramc-157-01-01

Google Scholar Crossref | Medline

National Atlas of the United States . ( 2001 ). County boundaries of the United States. Available from http://nationalatlas.gov

Google Scholar

National Geospatial-Intelligence Agency and National Aeronautics and Space Administration . ( 2000 ). Shuttle Radar Topography Mission (SRTM) dataset. United States Geological Survey. Available from Shuttle Radar Topography Mission

Google Scholar

Orset, C., Parrot, S., Sauvinet, V., Cottet-Emard, J. M., Berod, A., Pequignot, J. M., Denoroy, L. ( 2005 ). Dopamine transporters are involved in the onset of hypoxia-induced dopamine efflux in striatum as revealed by in vivo microdialysis . Neurochemistry International, 46, 623 - 633 . doi:10.1016/j.neuint.2005.02.005

Google Scholar Crossref | Medline | ISI

Pastor, P. N., Reuben, C. A. ( 2008 ). Diagnosed attention deficit hyperactivity disorder and learning disability: United States, 2004-2006 . Vital and Health Statistics, 10(237), 1 - 14 .

Google Scholar

Pliszka, S. ( 2007 ). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder . Journal of the American Academy of Child & Adolescent Psychiatry, 46, 894 - 921 . doi:10.1097/chi.0b013e318054e724

Google Scholar Crossref | Medline | ISI

Ray, K., Dutta, A., Panjwani, U., Thakur, L., Anand, J. P., Kumar, S. ( 2011 ). Hypobaric hypoxia modulates brain biogenic amines and disturbs sleep architecture . Neurochemistry International, 58, 112 - 118 . doi:10.1016/j.neuint.2010.11.003

Google Scholar Crossref | Medline | ISI

Rosa-Neto, P., Lou, H. C., Cumming, P., Pryds, O., Karrebaek, H., Lunding, J., Gjedde, A. ( 2005 ). Methylphenidate-evoked changes in striatal dopamine correlate with inattention and impulsivity in adolescents with attention deficit hyperactivity disorder . NeuroImage, 25, 868 - 876 . doi:10.1016/j.neuroimage.2004.11.031

Google Scholar Crossref | Medline | ISI

Schneider, H., Eisenberg, D. ( 2006 ). Who receives a diagnosis of attention-deficit/hyperactivity disorder in the United States elementary school population? Pediatrics, 117, e601 - e609 . doi:10.1542/peds.2005-1308

Google Scholar Crossref | Medline | ISI

Strine, T. W., Lesesne, C. A., Okoro, C. A., McGuire, L. C., Chapman, D. P., Balluz, L. S., Mokdad, A. H. ( 2006 ). Emotional and behavioral difficulties and impairments in everyday functioning among children with a history of attention-deficit/hyperactivity disorder . Preventing Chronic Disease, 3(2), Article A52.

Google Scholar

Trouvin, J. H., Prioux-Guyonneau, M., Cohen, Y., Jacquot, C. ( 1986 ). Rat brain monoamine metabolism and hypobaric hypoxia: A new approach . General Pharmacology, 17, 69 - 73 .

Google Scholar Crossref | Medline

U.S. Census Bureau . ( 2007 ). Current population survey: Annual social and economic supplement. Washington, DC : U.S. Government Printing Office .

Google Scholar

Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., . . . Blumberg, S. J. ( 2013 ). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011 . Journal of the American Academy of Child & Adolescent Psychiatry, 53, 34 - 46 . doi:10.1016/j.jaac.2013.09.001

Google Scholar Crossref | Medline | ISI