Baghurst Peter A.; McMichael, Anthony J.; Tong, Shilu; Wigg, Neil R.; Vimpani, Graham V.; Robertson, Evelyn F.Epidemiology: March 1995 ORIGINAL ARTICLE: PDF Only Free Abstract Early childhood exposure to environmental lead may result in subtle deficits in neuropsychological development. Most studies, however, have reported global measures of development, and the findings have not been consistent. In this report, we examine the association between blood lead concentration and a specific aspect of neuropsychological development, visual-motor integration. Each child in a cohort of 494 children living in and around the lead smelting town of Port Pirie, South Australia, was followed for its first 7 years of life. Serial blood samples were collected at various ages to estimate the lifetime burden of each individual. At the time of each blood sampling, systematic information was obtained on a wide range of other variables relevant to child development. We evaluated visual-motor integration at age 7 with the Beery Developmental Test of Visual-Motor Integration (mean score: 13.4). There was an inverse relation between blood lead concentration and visual-motor performance. After adjustment for potential confounding factors, both prenatal and postnatal blood lead concentrations exhibited a dose-related inverse association with children's visual-motor performance. For an increase in lifetime average blood lead concentration from 10 μag per dl (0.48 μmol per liter) to 30 μg per dl (1.45 μmol per liter), the estimated deficit in children's visual-motor performance was 1.6 points (95% confidence interval = 0.3–2.9). The results indicate that visual-motor integration may be a more sensitive index than global measures of development, such as intelligence quotient, for the assessment of lead effects on child development. © Lippincott-Raven Publishers.