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Olfactory Impairments in Child Attention-Deficit/Hyperactivity Disorder

Felicity R. Karsz, B.Sci. (Hons.); Alasdair Vance, M.D., Ph.D.; Vicki A. Anderson, Ph.D.; Peter G. Brann, Ph.D.; Stephen J. Wood, Ph.D.; Christos Pantelis, M.D.; and Warrick J. Brewer, Ph.D.

Objective: This study compared unilateral olfactory identification abilities in children with and without attention-deficit/hyperactivity disorder (ADHD) and evaluated the utility of the University of Pennsylvania Smell Identification Test (UPSIT) as a potential screening tool for the diagnosis of ADHD.

Method: Subjects comprised 44 children with DSM-IV ADHD (aged 7-16 years) from 2 Melbourne, Australia, hospital outpatient clinics and 44 healthy children matched for age and sex. The children were assessed from March 2004 to October 2004 for olfactory identification ability using the UPSIT, and behavioral data were gathered using the Rowe Behavioral Rating Inventory. Background and demographic data were also obtained through hospital records and parental interview.

Results: Children with ADHD demonstrated significantly poorer olfactory identification ability compared to healthy controls (p < .01). A significant right nostril advantage for smell identification was evident in the control group (p < .01), whereas significant right nostril impairment was evident among the children with ADHD (p < .01).

Conclusion: The results provide the first evidence of olfactory identification deficits in children with ADHD. As such deficits implicate orbitofrontal regions, this finding is consistent with previous reports of prefrontal compromise in children with ADHD.

(J Clin Psychiatry 2008;69:1462-1468. Online Ahead of Print August 26, 2008.)

Received June 3, 2007; accepted Feb. 27, 2008. From the School of Behavioural Science, University of Melbourne (Dr. Anderson and Ms. Karsz); the Academic Child Psychiatry Unit, Department of Paediatrics, University of Melbourne (Dr. Vance and Ms. Karsz); Royal Children's Hospital (Drs. Vance and Anderson); Murdoch Children's Research Institute (Dr. Anderson); Eastern Health Child and Adolescent Mental Health Service, Maroondah Hospital (Dr. Brann); the Department of Psychological Medicine, Monash University (Drs. Brann and Brewer); Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health (Drs. Wood and Pantelis); and the ORYGEN Research Centre, Department of Psychiatry, University of Melbourne (Dr. Brewer), Melbourne, Australia.

This research was supported by the Colonial Foundation and a National Health and Medical Research Council (NHMRC) Program Grant (ID: 350241). Dr. Wood is supported by an NHMRC Career Development Award (ID: 359223) and a NARSAD Young Investigator Award. Dr. Brewer is the recipient of an NHMRC Career Development Award (ID: 454792).

The authors gratefully acknowledge the assistance of Rebecca Barnett, Ph.D.; Stephanie Kempton, Ph.D.; and Joanne Panayiotis, Ph.D., of Latrobe University, Melbourne, Australia, who assisted in the collection of data. Drs. Barnett, Kempton, and Panayiotis have no pertinent financial or commercial relationships relative to the subject of this article. The authors thank the families and children who generously gave of their time to participate in this research.

The authors report no additional financial or other relationships relevant to the subject of this article.

Corresponding author and reprints: Warrick J. Brewer, Ph.D., ORYGEN Research Centre (Locked bag 10), Parkville, Victoria, 3052, Australia (e-mail: