Autism and Breastfeeding

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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[1], 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[2], 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[3].  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]

[1] 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.

[2] 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.

[3] Tanoue Y, Oda S.  Weaning time of children with infantile autism.  Journal of Autism and Developmental Disorders 1989; 19: 425-434.

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  1. LCD says

    Very interesting article. The topic of ASD is so interesting because it can be so devastating. When I was doing my Master’s we looked at a study that examined two groups of kids, one wih moderate to severe ASD and one control group. They watched videos of their 1st birthday parties to see if there were any significant differences between the 2 groups. They found that kids who were pointing at objects and bringing objects to show their parents did not go on to develop ASD. None of them, which is interesting and it would add support to the idea that children are ‘born’ with ASD, but 1 year is also a long time for environmental toxins to do their work as well. David Suzuki also looked at causes of ASD Ina Nature of Things episode. Apparently there is a lot of evidence that gut flora abnormalities are found in kids with ASD. They found that kids withe high levels of antibiotic use in the first year were more at risk. They didn’t examine breast feeding, it would have been interesting if they did though! They did look specifically at a group of Somali immigrants who had high levels of diagnosis upon moving to North America but none among relatives living back in Somalia. The thinking was that something in the North American diet was causing the chane in rates. Perhaps higher levels of formula use?

  2. Niki says

    I hope formula manufacturers will research/find out why breastfed babies are at such a lower risk. Yes the DHA and ARA supplementation helps but it obviously isn’t enough. The more formula mimics breastmilk the better in my opinion because tons of children rely on it for a plethora of reasons none of which is the mother being “lazy.”

  3. Meagan says

    I wondered about this after reading Jenny McCarthy’s “Belly Laughs” book about her pregnancy, where she specifically states that she did not even try to breastfeed her son. Of course, there is some debate over whether her son actually had/has an ASD or something else, but it’s always been in the back of my brain, wondering if not breastfeeding put her son at risk.

  4. says

    I breast fed my son till he was almost 3 years old. I stopped 2 months before his birthday. When he was 3 years and 2 months old he has a fever for a couple of days. Not a high fever. Afterwards he has a sudden onset of autism. He still has the diagnosis. Thankfully, very mild. I often wondered if he has a genetic precondition or vulnerability to autism and if it could have been triggered by infection and if breast feeding protected him for as long as it did.

    • Tracy says

      Unfortunately I don’t think we’ll ever truly know, but I’m sure it’s possible! It’s amazing how little we know about what triggers things that seem to be at least partially genetic!

  5. Ashley says

    I need to know if the formula fed group were born to mothers who did not attempt Breastfeeding at all, or if something possibly from the child’s end was related to not achieving a working Breastfeeding relationship. I really want this to be true, but that information seems important when assessing the outcomes.

  6. Em says

    As a mom of an autistic boy who was breastfed to natural weaning age and still developed autism, I appreciate the last statement.

    There seems to be this misconception in parts of the AP/EP community that as long as babies are breastfed and non-vaccinated that they can’t possibly develop autism, to the point that I met a woman at a local AP group who looked at my son and haughtily informed me that if I had “really” practiced natural parenting there was no way he would be autistic and began spouting off about Jenny McCarthy’s “cure” for her son’s autism. Everyone needs to understand that the causes of autism are still unknown and that we can do what we can to lower risks, but it doesn’t mean developmental disabilities won’t happen anyway.

  7. says

    Thank you for an informative and balanced post – much appreciated! Following on from this research on the impact of not breastfeeding and the development of ASD, I was wondering if you know of any research on women with ASD and their rates of breastfeeding? I am a woman with ASD and breastfed all 5 of my kids with varying degrees of “success” (anywhere from 3 weeks to 20 months depending on the child). I had severe difficulties with 4 and only milf difficulties with the one I got to 20 months (one minor bought of mastitis, no latch problems). It got me thinking that with the nature of ASD and its sensory issues, including issues of touch/contact, that women with ASD might be at greater risk of early termination of breastfeeding which can then have an impact on the rates at which their children develop the condition. If you know of any research on women with ASD and breastfeeding, I would be ever so grateful to know about it. Many thanks!

  8. S.C. van Schaik says

    My son is still in the “system”, trying to get diagnosed, so we are not 100% sure he is ASD. That said, he has a lot of stereotypical behavior, does not speak (he’s 27 months) and chews on everything and anything. He has obsessions with certain items and shapes. All in all, we are fairly confident we will get a diagnosis of ASD at some point.

    I am pregnant right now, due within days. This pregnancy I noticed how different the two babies behaved, even in the womb.

    My son did not kick and jerk like my daughter is. He would move, but it was more like changing position and putting a limb in a location and leaving it there for a period of time. I do not recall him responding to outside stimuli, unlike my daughter. I was induced one day after due date, as the OBGYN feared he would be too big. APGAR scores were good.

    We attempted breast feeding but he never got the hang of it. He was treated for jaundice for 4 days, forcing me to give him formula as he stayed in the hospital. I pumped for two weeks, but my supply never really kicked in (too stressed).. he got a little bit, but not much. I am curious if autistic infants have possibly a harder time breastfeeding, rather than lack of breastfeeding causing autism.

    He was an extremely easy going baby, at 6 weeks old he was sleeping through the night (10-12 hours!) and had to be woken to feed. He never learned or even tried to hold his own bottle, unlike most children. He could not figure out that you have to tip a cup or bottle back for the liquid to flow. He was two by the time he figured out how to use a sippy cup. However, he was eating with a fork by the time he was a year old. Very curious to me.

    He had very little interest in toys, until much later than usual. He did not walk until 18 months old. He did attempt to speak some at 10 months (bye bye, dada), but stopped after a week. It took him over a year to get back to saying bye bye. He can say a few words now, but mostly by repeating and he rarely uses words on his own. He knows a few signs, which he has been working on with Early Intervention, but he does not use those unless prompted by example first. He cannot communicate by language or signing.

    We have had a variety of genetic testing done and none of the usual markers show anything wrong. He has been tested for genetic hearing loss as well, since his hearing is reduced (mild loss in higher frequencies). They ran tests for fragile X as well as other developmental markers… no results.

    Something went wrong in the womb, it is all I can conclude.. what went wrong, not a clue. I was healthy as could be, never smoked or drank alcohol while pregnant. Did not get sick, avoided cleaning the cat litter box, avoided most medications.

    I did take Tylenol for back aches, as I was still working. I used one Z pack (antibiotic). I was given a flu shot and TDAP vaccine. I do not believe vaccines cause autism, but if they do, I would choose autism over risking children’s LIVES still.

  9. Stephen says

    The article cited by this author(by Stephen Shutz ) has been totally discredited. The more recent research seems to indicate a link between breast feeding and higher rates of autism. I don’t know if they are right but you should do your own research before you put your faith in one article with claims that have never been reporduced by any other studies.

    • says

      I have not seen any research indicating a higher risk of autism with breastfeeding – would you care to share some links for me?

      Also, I never believe one article is the be all and end all, but as this was written a while ago, it was relevant to share the research that was found. If it hasn’t been replicated, then it hasn’t been replicated (though at the time this was written – 2 1/2 years ago – no study published reported attempting to replicate)! I haven’t heard it’s been “discredited” (I’m not sure that’s the term you mean as it suggests something inherently wrong with the research itself, not just a spurious finding), but also if you read my points, nowhere did I suggest we put our faith in one article or even that this was at all conclusive. In fact, quite the opposite, I said I didn’t believe in a causal link.

  10. says

    Tracey, I ran across this theory, that is very interesting as well and linked to breastfeeding, although not related to formula per se, but the eye contact that is inherent in the process of breast feeding. We need more research. Also, I ran across an article that says that women in Eastern Europe get 52 weeks of maternity leave (the most of any developed country). It would be interesting to see if the rates of ASD are lower in those countries.


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