Study: Breastfed children less likely to develop ADHD

A study from Tel Aviv University shows that breastfeeding may be protective against a child developing ADHD later in life.

We know that breastfeeding has a positive impact on child development and health -- including protection against illness. Now researchers from Tel Aviv University have shown that breastfeeding may also help protect against Attention Deficit/Hyperactivity Disorder (ADHD), the most commonly diagnosed neurobehavioral disorder in children and adolescents.

Seeking to determine if the development of ADHD was associated with lower rates of breastfeeding, Dr. Aviva Mimouni-Bloch, of Tel Aviv University's Sackler Faculty of Medicine and Head of the Child Neurodevelopmental Center in Loewenstein Hospital, and her fellow researchers completed a retrospective study on the breastfeeding habits of parents of three groups of children: a group that had been diagnosed with ADHD; siblings of those diagnosed with ADHD; and a control group of children without ADHD and lacking any genetic ties to the disorder.

The researchers found a clear link between rates of breastfeeding and the likelihood of developing ADHD, even when typical risk factors were taken into consideration. Children who were bottle-fed at three months of age were found to be three times more likely to have ADHD than those who were breastfed during the same period. These results have been published in Breastfeeding Medicine.

Understanding genetics and environment

In their study, the researchers compared breastfeeding histories of children from six to 12 years of age at Schneider's Children Medical Center in Israel. The ADHD group was composed of children that had been diagnosed at the hospital, the second group included the siblings of the ADHD patients, and the control group included children without neurobehavioral issues who had been treated at the clinics for unrelated complaints.

In addition to describing their breastfeeding habits during the first year of their child's life, parents answered a detailed questionnaire on medical and demographic data that might also have an impact on the development of ADHD, including marital status and education of the parents, problems during pregnancy such as hypertension or diabetes, birth weight of the child, and genetic links to ADHD.

Taking all risk factors into account, researchers found that children with ADHD were far less likely to be breastfed in their first year of life than the children in the other groups. At three months, only 43 percent of children in the ADHD group were breastfed compared to 69 percent of the sibling group and 73 percent of the control group. At six months, 29 percent of the ADHD group was breastfed, compared to 50 percent of the sibling group and 57 percent of the control group.

One of the unique elements of the study was the inclusion of the sibling group, says Dr. Mimouni-Bloch. Although a mother will often make the same breastfeeding choices for all her children, this is not always the case. Some children's temperaments might be more difficult than their siblings', making it hard for the mother to breastfeed, she suggests.

Added protection

While researchers do not yet know why breastfeeding has an impact on the future development of ADHD -- it could be due to the breast milk itself, or the special bond formed between mother and baby during breastfeeding, for example -- they believe this research shows that breastfeeding can have a protective effect against the development of the disorder, and can be counted as an additional biological advantage for breastfeeding.

Dr. Mimouni-Bloch hopes to conduct a further study on breastfeeding and ADHD, examining children who are at high risk for ADHD from birth and following up in six-month intervals until six years of age, to obtain more data on the phenomenon.

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Gestational Diabetes and Poverty Linked to Increased Chance of ADHD

While gestational diabetes and poverty are shown to have an increased chance of a child having ADHD, breastfeeding shows the opposite effect.

Gestational diabetes and a lower socioeconomic status are the latest environmental factors to be associated with an increased risk of attention-deficit/hyperactivity disorder (ADHD), according to new research.

The German study found that children born to mothers who developed high blood sugar during pregnancy (gestational diabetes) were almost twice as likely to have ADHD as children born to mothers without gestational diabetes. The study also found more than double the risk of ADHD for children born into a family with a low socioeconomic status compared to those in the highest socioeconomic class. Children in the middle class had almost a 60 percent higher rate of ADHD compared to the upper-class children.

"This study found interesting associations that have public health implications," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at the Steven and Alexandra Cohen Children's Medical Center of New York, in New Hyde Park, N.Y. Adesman wasn't involved in the current research.

"The U.S. is experiencing an increasing epidemic of obesity, which is a risk factor for gestational diabetes. We need to be mindful of the broader implications of these unfortunate trends. They won't just have an impact on the mother's health, but can also affect the offspring," Adesman said.

The good news from this study is they found that breast-feeding appeared to be protective. Children who were breast-fed were almost 20 percent less likely to develop ADHD, according to the study.

Results of the study were published online as a research letter in the Sept. 10 issue of the Archives of Pediatrics & Adolescent Medicine.

In the United States, more than 5 million children between 3 and 17 years of age have been diagnosed with ADHD, a neurobiological condition that often persists into adulthood. ADHD is characterized by difficulty focusing on tasks and controlling behavior, unusual restlessness and impulsiveness.

The authors of the new study noted they had seen a U.S. study suggesting that gestational diabetes and socioeconomic status might be linked to ADHD. So, they reviewed health information from a national German database and focused on more than 13,000 children and teens from 3 years to 17 years old.

Of that group, nearly 5 percent had an ADHD diagnosis.

In addition to the gestational diabetes and socioeconomic status findings, the researchers found a number of factors associated with the development of ADHD. Boys were more than four times as likely to develop the condition as girls were, according to the study.

Maternal smoking was associated with a nearly 50 percent increased risk of ADHD in the child. Perinatal health problems (such as birth defects, preterm birth and low birthweight) increased the risk of a child developing ADHD by 69 percent, according to the study. Researchers also found that having the allergic skin condition eczema was associated with a 62 percent increased risk of ADHD.

"During pregnancy and for the first few years after birth, the brain is undergoing active development, and is vulnerable to a range of influences," Adesman said.

Dr. Mary Rosser, an assistant professor of obstetrics, gynecology and women's health at Montefiore Medical Center, in New York City, said the study covers new ground.

"We've known for a while that perinatal factors have been cited as potential causes for many childhood problems," Rosser said. "Smoking during pregnancy has always been one of the factors that has been linked to ADHD in kids. This study is one of the first I've seen that's looking at gestational diabetes and ADHD."

Noting that "an unfavorable uterine environment can cause developmental issues," Rosser recommended that women see an obstetrician before getting pregnant, and that they continue prenatal care throughout their pregnancies. This can help prevent or treat some of the issues, such as gestational diabetes, that may contribute to ADHD in the child.

In addition, she recommended that women breast-feed their babies. Breast-feeding may be protective for ADHD, and it's known to be beneficial for the baby's overall health, she said.

The study did not prove that gestational diabetes and a lower socioeconomic status cause ADHD, it merely found an association.

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Effect of duration of breastfeeding on neuropsychological development at 10 to 12 years of age in a cohort of healthy children

Effect of duration of breastfeeding on neuropsychological development at 10 to 12 years of age in a cohort of healthy children
Aim  The aim of this article was to explore the effect of duration of breastfeeding on neurocognitive development.

Method  The long-term effect of breastfeeding on neurodevelopment was examined through a battery of neuropsychological tests in 1403 children (693 females, 710 males; mean age 11y 9mo [SD 6mo], range: 10y 3mo–12y 8mo) who were originally recruited at 6 to 12 weeks of age for a clinical trial on acellular pertussis vaccines. An estimated IQ was obtained from scores of the vocabulary, similarities, block design, and coding tests. Breastfeeding data had been prospectively collected throughout the first year of life. Duration of exclusive breastfeeding was defined as the time during which children received breast milk without receiving any supplemental formula or food. Children were assessed at 10 to 12 years of age. We adjusted the analysis on test scores for multiple potential confounders.

Results  Multivariate analysis showed a significant association between exclusive breastfeeding duration and test scores in the vocabulary (odds ratio [OR] 0.05; confidence interval [CI] 0.00–0.10; p=0.04) and similarities (OR 0.06; CI 0.01–0.11; p=0.03) tests. These associations have a negligible effect size, however. Scores on one writing praxis test subcategory decreased with increasing duration of both exclusive breastfeeding (OR −0.06; CI −0.11 to −0.01; p=0.03) and breastfeeding irrespective of consumption of other foods (OR −0.06; CI −0.11 to −0.01; p=0.03). A negative association was also found between one subcategory of the California verbal learning test and breastfeeding duration longer than 6 months (OR −0.21; CI −0.42 to −0.01; p=0.04).

Interpretation  Breastfed healthy children may perform better on neuropsychological tests in the language domain at 10 to 12 years of age. However, the effect of breast milk on neuropsychological performance in healthy children may have a limited clinical relevance and is confounded by parental education.

Abstract here