A possible nocebo effect in children following the Flint Water Crisis: Evidence from schoolteacher perceptions and neuropsychological evaluations

Objective: Special education enrollment increased in Flint following the 2014-15 Flint Water Crisis but lead exposure is not plausibly responsible. Labeling Flint children as lead poisoned or /brain damaged may have contributed to rising special education needs (i.e., nocebo effect). To better document this possibility, we surveyed schoolteachers and reviewed neuropsychological assessments of children for indications of negative labeling. Methods: A survey of Flint and Detroit (control) public schoolteachers using a modified Illness Perception Questionnaire was conducted five years post-crisis. We also examined neuropsychological assessments from a recently settled class lawsuit. Results: Relative to Detroit (n=24), Flint’s teachers (n=11) believed that a higher proportion of their students had harmful lead exposure (91.8% Flint vs. 46% Detroit; p=0.00034), were lead poisoned (51.3% vs. 24.3%; p=0.018) or brain damaged (28.8% vs. 12.9%; p=0.1), even though blood lead of Flint’s children was always less than half of Detroit’s. Neuropsychological assessments diagnosed lead poisoning and/or brain damage from water lead exposure in all tested children (n=8), even though none had evidence of elevated blood lead and a majority had prior learning disability diagnoses. Conclusion: Teachers’ responses and neuropsychological assessments confirm strong perceptions that Flint children were permanently harmed by lead exposure.