In much of the research on Autism and Autism Spectrum Disorders recently, the pervasive view is that the condition is one a child is born with. A child may develop autistic-like symptoms from other means, but generally, it is assumed that eventually we can identify which children will develop autism ahead of time. Perhaps that’s true for some forms of disorders on the Autism spectrum, but there’s a piece of research that a friend recently shared with me from 2006 that I had not heard of. No idea why because I think it speaks volumes to the complexity around developmental disorders and how we approach research and treatment.
The article, headed by Stephen Schultz, utilized data from the Autism Internet Research Survey, an on-line parent-report survey to determine potential causes of the increased rates of Autism seen in our society. Parents reports duration of breastfeeding, supplementation of formula, and the specific brand of formula to determine if it was one supplemented with docosahexaenoic acid (DHA) and arachidonic acid (ARA).
What is DHA and ARA? They are long-chain polysaturated fatty acids that are naturally found in breastmilk. Although the amount of DHA and ARA will vary depending on the mother’s diet, it has been linked to neurological development, making it key for a quickly maturing brain. Although infants are capable of converting other acids into DHA and ARA, the ability is limited and thus receiving preformed long-chain polysaturated fatty acids via breastmilk aides in the development of the brain.
Children ranged in age from 2 to 18. Adjusting for age, children who were not breastfed at all were two and half times more likely to have developed Autism or an ASD. Because formula with DHA/ARA was only available starting in 2002, examinations for ASDs and formula use were limited to children aged 2 to 4; however, even with this limited time range, the authors found that children who had used formula without DHA/ARA supplementation were nearly four and a half times more likely to have developed an ASD. Compared to the exclusive breastfeeding group, the use of formula with DHA/ARA supplementation was associated with a nearly three-fold increase in ASDs while the use of formula without DHA/ARA supplementation was associated with a nearly 13-fold increase in ASDs. This research came after years of no one following up on other research that found that compared to matched controls, children diagnosed with Autism were three times more likely to have been weaned within a week of birth. And again, we have gone years with nothing that has followed up on this research (published, to date, that I could find; a point that angers me as it seems like the odds ratios here are high enough to warrant some discussion or further research).
What are we to make of this? Personally I think it highlights three important points that we must consider when looking at child development and disorders.
1) Often the rates of developmental disorders have been the topic of discussion given they seem to be ever-increasing. I don’t think many would argue that some of this inflation comes from better (or broader) diagnostic testing and thus a greater number of diagnoses. There is also the fact that people are more willing to seek diagnosis and treatment – something that was less common years ago. But looking at this over a longer historical trajectory, I think we have to acknowledge that our massive deviation from physiological or biological norms for infant development is affecting our children. And thus when we research these disorders or diseases, we should start from the point of what infants are biologically expecting to see what may be different and thus affecting their health.
2) This brings me to point two. Do I think the lack of breastfeeding causes some types of ASDs? Absolutely not. But one thing we do know about many diseases/disorders/illnesses is that they come about in the “perfect storm” of events. Individuals typically have a predisposition for them but are then put in a critical situation in which this predisposition becomes a reality. Thus, it seems that for some types of ASDs, not breastfeeding may be a factor that serves as but one component of a perfect storm for individuals with a predisposition. And for those who would argue that we’ve seen an even greater rise in the past 20 years as breastfeeding rates increase, a reminder I do not think this is the only factor that can serve to protect an infant from developing a disorder for which they have a predisposition. For example, I believe we have much greater toxins in our environment that I would be shocked to discover did not affect myriad health and developmental issues. (And there is still the issue of an increase in diagnoses mentioned above.) Rather, I think not breastfeeding is one area that may now contribute to activating predispositions for a variety of illnesses or disorders and part of the rise is the dramatic decrease of breastfeeding over the past hundred years.
3) Finally, it is important to remember that there were children who were exclusively breastfed who developed an ASD. In line with the “perfect storm” of events, when we make claims that breastfeeding prevents ASDs, we do a disservice because it’s not true. It may reduce the risk, but the risk is still there and real. As mentioned in point 1, we need to simply treat acts that are biologically normal as just that – normal – without increased or decreased risk. Like the “breast is best” motto, when we speak of the “wonders” of breastmilk, we treat it like it is up on a pedestal, to be revered, and thus not “normal”. Starting at the very basics of research, we need to treat breastfeeding as the baseline and compare rates to that baseline.
I think if we consider these points, as researchers and parents who share this research, we may move forward in our understanding of various childhood disorders.
[Photo credit: Prince William County Public Schools Website]
 Schultz ST, Klonoff-Cohen HS, Wingard DL, Akshoomoff NA, Macera CA, Ji M, Bacher C. Breastfeeding, infant formula supplementation, and Autistic Disorder: the results of a parent survey. International Breastfeeding Journal 2006; 1: 16.
 Larque E, Demmelmair H, Koletzko B. Perinatal supply and metabolism of long-chain polyunsaturated fatty acids. Importance for the early development of the nervous system. Annals of the New York Academy of Sciences 2002; 967: 299-310.
 Tanoue Y, Oda S. Weaning time of children with infantile autism. Journal of Autism and Developmental Disorders 1989; 19: 425-434.