Abstract
Background: Lead exposure is associated with behavioral problems in children, but the ages when children are most susceptible to lead toxicity are unclear. Our objective was to evaluate the association of repeated blood lead concentrations with parent-reported behaviors and identify periods of heightened susceptibility.Methods: Between 2003-2006, we recruited pregnant women (n=389) living in homes built pre-1978 from Cincinnati, Ohio (HOME Study) and followed their children until age 8 years. We quantified lead in whole blood samples collected from children at ages 1, 2, 3, 4, 5, and 8 years. We assessed parent-reported child behavior using the Behavioral Assessment System for Children-2 (BASC-2) when children were ages 2, 3, 4, 5, and 8 years. Using linear regression with generalized estimating equations adjusted for covariates, we estimated associations of time-varying blood lead concentrations (ln-transformed, g/L) with behavioral profiles using the BASC-2 composite scales. We used multiple informant models to assess heterogeneity in these associations across exposure periods (n=241).Results: The median blood lead concentration peaked at 15 g/L around age 2 years (25th, 75th=10, 22 g/L) and gradually decreased to 6 g/L around age 8 years (25th, 75th=4, 9) g/L). Higher time-varying blood lead concentrations were associated with more externalizing problems (β:1.8-point; 95% CI= 0.3, 3.2). The association between blood lead levels and externalizing problems varied by exposure timing (lead x period interaction p-value=0.11), with heightened susceptibility around ages 3 (β:2.1-point; 95% CI= 0.6, 3.6) and 8 (β:3.5-point; 95% CI= 1.2, 5.7) years compared with other ages. Conclusion: Children with higher blood lead levels had more parent-reported hyperactive and aggressive behaviors. Future research could investigate if the periods of heightened susceptibility around ages 3 and 8 years are due to unique neurodevelopmental processes.
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