Abstract
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Two hundred children and adolescents 7–17 years of age who had been diagnosed as having ADHD were studied by Sabuncuoglu et al. 1 The Connors Parent and Teacher Rating Scales were used to determine the presence of any behavioral disturbances. A questionnaire including the breastfeeding period, early feeding history, and parafunctional oral habits was distributed to parents. The results involved 200 confirmed ADHD children and 175 healthy schoolchildren confirmed not to have ADHD.
The affected children had earlier initiation and longer duration of bottle feeding. In addition, they had earlier and more extensive use of pacifiers, variable nail and toenail biting in addition to pencil biting, bruxism, and snoring proportional to the length of bottle feeding. These habits were also associated with greater risks of malocclusion and disordered dentofacial development. The authors proceed to note the association of sleep-disordered breathing on executive functions such as cognitive flexibility, task initiation, self-monitoring, planning, organization, and self-regulation. After summarizing their results, Sabuncuoglu et al. 1 concluded that the ADHD group had different early feeding practices and an increased rate of parafunctional oral habits.
An important additional parameter that needs study is whether these infants were difficult to breastfeed, and did this struggle result in shorter breastfeeding duration? Furthermore, in families with a history of ADHD, should greater effort to breastfeed be made by the mother and her lactation professionals?
The association of early weaning and formula feeding with ASD is suggested by Shafai et al. 2 in a letter to the Editor in this issue. They reported 145 parents who responded to a questionnaire: 60 of their children had ASD, and 85 did not. Increased duration of breastfeeding was associated with a decline in the diagnosis of ASD. The authors attributed this to the decrease in sensory experiences inherent in bottle feeding and a possible association with oxytocin release.
Long before autism was identified and catalogued, astute clinicians noted that some babies were like inanimate pieces of wood, whereas most infants mold to the caregiver's body when held. These board-like infants were difficult to breastfeed and continued to relate passively to their caregivers.
The research for causes of lactation failure continues, but it is clear that there is association with better outcomes in multiple parameters when breastfeeding is continued exclusively for 6 months and longer while adding complementary feedings.
More studies that investigate the experience the infant has with feeding, especially, with breastfeeding, should help us understand the possible relationship with a lack of breastfeeding and neuropsychiatric disorders.
This apparent association between lack of breastfeeding and neuropsychiatric disorders provides the typical chicken-and-the-egg question. Which came first: the disorder or the inability to breastfeed? Is the neuropsychiatric problem a cause or an effect of inadequate breastfeeding? And can it be prevented with good experienced care during lactation? Do the infants who appear to reject the breast suffer from the early manifestations of one of the neuropsychiatric disorders such as ADHD or ASD?
This is the first step in a long journey.