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Background: Evidence linking fine particulate matter (PM2.5) constituents to childhood attention deficit hyperactivity disorder (ADHD) was limited.

Objectives: To investigate the individual and joint effects of exposure to PM2.5 constituents on ADHD.

Methods: We conducted a large population-based survey involving 110,818 school children aged 6–18 years across six cities in the Pearl River Delta region, China. The three-year average concentrations of PM2.5 constituents (black carbon (BC), organic matter (OM), sulfate, nitrate, and ammonium) were estimated using the ChinaHighAirPollutants dataset. Parents completed an ADHD checklist using the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. The individual and joint associations between PM2.5 components and ADHD were estimated using generalized linear mixed models and the quantile g-computation regression model, respectively.

Results: The exposure-response relationships between PM2.5 constituents and ADHD primarily exhibited a nonlinear pattern. Compared with the lowest tertile, the highest tertiles of PM2.5 and its components were linked to greater odds for ADHD (e.g., the adjusted odds ratio (OR) was 1.37 (95 % confidential interval (CI): 1.27, 1.47) for PM2.5, 1.51 (95 %CI: 1.40, 1.63) for OM, 1.29 (95 %CI: 1.20, 1.39) for BC, and 1.20 (95 %CI:1.08, 1.34) for sulfate). Similar positive associations were observed between BC and sulfate exposure and ADHD subtypes. Moreover, joint exposure to PM2.5 components was associated with ADHD (OR = 1.14, 95 % CI:1.10, 1.18), with OM and BC contributing more to the observed associations.

Conclusions: These findings highlight the varying contributions of PM2.5 constituents to ADHD and underscore the importance of reducing specific PM2.5 component emissions to mitigate the burden of PM2.5-associated neurodevelopmental diseases.