Association Between Neonicotinoids and Neurobehavioral Development in Preschool Children from South China: A Biomonitoring-Based Study

Neonicotinoid insecticides (NEOs), one of the most widely used pesticide classes worldwide, have raised concerns due to potential neurotoxic effects. Yet evidence on human exposure and health outcomes, particularly in preschool children, remains limited. In this study, 506 children aged 3-6 years from Shenzhen, China, were assessed. Neurobehavioral development was evaluated with the Strengths and Difficulties Questionnaire (SDQ), and urinary concentrations of 11 NEOs were measured, including imidacloprid (IMI), clothianidin (CLO), thiamethoxam (THM), dinotefuran (DNT), nitenpyram (NIT), sulfoxaflor (SFX), acetamiprid (ACE), thiacloprid (THD), flonicamid (FLO), 6-chloronicotinic acid (6-CINA), N-desmethyl-acetamiprid (NACE), and N-desmethyl-thiamethoxam (NTHM). Seven compounds showed high detection rates, including IMI (97.4%), CLO (100%), THM (100%), DNT (99.8%), NIT (99.8%), NACE (100%), and NTHM (99.8%). The mean urinary concentration was 234.145 μg/g creatinine, exceeding levels in earlier studies and indicating widespread exposure. IMI, NTHM, and NACE showed significant positive dose-response relationships with emotional symptoms, hyperactivity, and total difficulties and were major contributors in mixture models; sex-stratified analyses suggested effect modification for NTHM and NACE. These findings provide new epidemiological evidence to inform public health risk assessment and regulatory action on NEOs.