Environmental and lifestyle factors associated with attention-deficit/hyperactivity disorder in children and development of a Nomogram risk assessment model

Abstract

Objective To investigate factors associated with attention-deficit/hyperactivity disorder (ADHD) in children, and to develop and validate a risk assessment model, so as to provide a scientific basis for early screening of high-risk children and the formulation of prevention and treatment strategies. Methods A retrospective case-control study was conducted, including 348 children diagnosed with ADHD at Dalian Women and Children's Medical Center from January to September 2024 as the case group, and 150 age- and sex-matched healthy controls by propensity score matching.Sociodemographic, household environment, and lifestyle information were collected via questionnaires. Univariate analysis and Lasso regression were used for preliminary variable screening, followed by multivariate logistic regression to identify associated factors. Finally, a Nomogram prediction model was constructed and validated using R software. Results Multivariate logistic regression analysis showed that non-parental rearing (OR=2.267,95%CI:1.089 - 4.719), primary consumption of bottled water (OR=1.960,95%CI: 1.206 - 3.185), reliance on air conditioning for indoor ventilation (OR=3.613,95%CI:1.368 - 9.540), moving into a newly renovated residence during infancy and early childhood (OR=1.781,95%CI:1.059 - 2.996), and use of solvent-based wall coatings in children's main activity areas (OR=2.067, 95%CI:1.268 - 3.368) were positively associated with ADHD, whereas moving into a residence at least 2 years after renovation was negatively associated with ADHD (OR = 0.399, 95%CI: 0.230 - 0.692). The Nomogram model developed using these six variables demonstrated acceptable discrimination (AUC=0.73, 95%CI: 0.69 - 0.78) and good calibration (Hosmer-Lemeshow test, P=0.220). Conclusions Childhood ADHD is associated with family rearing patterns, lifestyle characteristics, and indoor environmental exposure factors. The Nomogram model developed in this study shows moderate predictive performance and may serve as a useful tool for the early identification and targeted intervention among children at increased risk of ADHD.

Keywords

attention-deficit/hyperactivity disorder / lifestyle / environmental factors / Nomogram model / children