January 16, 2024
Infants begin to transition from breast or formula milk to solid food at about six months of age, as they gradually develop interest in food and the ability to chew.
The American Academy of Pediatrics recommends breastfeeding for the first six months. The European Society of Pediatric Gastroenterology Hepatology and Nutrition recommends initiation of supplementary food around that time. The World Health Organization (WHO) has set a 2025 goal of getting most mothers worldwide to breastfeed exclusively through the first six months of infancy.
Noting that “inconsistent findings have been reported in previous national survey-based studies,” a South Korean study team conducted a nationwide population study to explore the relationship between breastfeeding and subsequent rates of ADHD.
South Korea has a mandatory single-payer national health insurance system – the National Health Insurance Service (NHIS) – that covers virtually the entire population. Detailed and consistent NHIS records facilitate nationwide population studies.
One NHIS program is the National Health Screening Program for Infants and Children (NHSPIC), which includes periodic examinations by trained pediatricians up to six years of age.
Using these national records, the team identified a cohort of over 1.1 million infants. These same records show that a little over a third (36%) received nothing but formula milk feeding during their first six months. About a fifth (21%) received a mix of formula and breast feeding. Almost a half (43%) were exclusively breastfed.
ADHD diagnoses were made by physicians during hospital visits.
The team adjusted for a series of confounders that were found to influence outcomes: sex, year of examination, residence, socioeconomic status, preterm birth, birth weight, and body measurements (weight, microcephaly) at examination (4–6 months of age).
With these adjustments, partial breastfeeding was associated with a small but significant (9%) reduction in the odds of infants later being diagnosed with ADHD, relative to infants receiving only formula milk feeding.
Exclusive breastfeeding was associated with a much larger 23% reduction in the odds of infants later being diagnosed with ADHD, relative to exclusive formula feeding.
What’s especially noteworthy is the dose-response pattern that suggests that breastfeeding may have a protective effect.
A separate analysis comparing infants who began transitioning to supplementary solid food before versus after six months found absolutely no difference in the odds of subsequently being diagnosed with ADHD.
A similar pattern emerged for autism spectrum disorder on all counts, again reflecting a dose-response pattern, pointing to what may be a broader beneficial effect of breastfeeding for healthy neurologic development.
The team concluded, “The risk of ADHD and ASD [autism spectrum disorder] considerably decreased with breastfeeding, and this tendency was more prominent in children who received EBF [exclusive breastfeeding] than in those who received PBF [partial breastfeeding]. Our study strengthens and supports the idea that breastfeeding is beneficial in preventing NDDs [neurodevelopmental disorders] in children. We suggest that breastfeeding be encouraged and recommended to promote good neurodevelopmental outcomes.”
Jong Ho Cha, Yongil Cho, Jin-Hwa Moon, Juncheol Lee, Jae Yoon Na, and Yong Joo Kim, “Feeding practice during infancy is associated with attention-deficit/ hyperactivity disorder and autism spectrum disorder: a population-based study in South Korea,” European Journal of Pediatrics (2023), https://doi.org/10.1007/s00431-023-05022-z.
Prevalence of cannabis use among pregnant women is on the rise with the spread of legalization. The most frequently reported reasons for use are to relieve stress or anxiety, nausea or vomiting, pain, and for recreation.
Given that the primary psychoactive ingredient of cannabis, ∆9-tetrahydrocannabinol (THC) is a small fat-soluble molecule that can easily cross the placenta, an Israeli-U.S. research team conducted a systematic search of the peer-reviewed medical literature for studies exploring possible neuropsychiatric effects on offspring.
They included not only studies evaluating likelihood of ADHD, but also autism spectrum disorder, anxiety, depression, and psychotic symptoms. For each of these, adjustment was made for known confounding variables.
With that adjustment, meta-analysis of six studies with a total of over half a million (503,661) participants reported a 13% increase in the odds of ADHD in offspring of mothers using cannabis during pregnancy compared with offspring of mothers not using cannabis while pregnant.
That is generally considered a small effect size increase in risk. But there are multiple reasons to question even this minimal finding:
Meta-analysis of two studies with a total of 741 individuals reported a 20% increase in offspring use of cannabis among mothers who used cannabis during pregnancy, but once again this was subject to methodological shortcomings:
Some studies have suggested a link between cannabis and psychotic symptoms. But meta-analysis of four studies combining over nineteen thousand persons found no significant association between maternal cannabis use during pregnancy and offspring psychotic symptoms.
Many studies have pointed to commonalities in the etiology of ADHD and autism spectrum disorder (ASD). Yet meta-analysis of five studies encompassing over half a million participants found absolutely no association between maternal prenatal cannabis use and ASD.
The remaining meta-analyses also reported no association with depression or anxiety.
With the caution that absence of evidence is not the same as evidence of absence, it is by no means clear from what is presently known that prenatal cannabis exposure has any significant neuropsychiatric effects on offspring. And if further research finds any effects, they are likely to be minor.
Dasotraline is a serotonin-norepinephrine-dopamine reuptake inhibitor (SNDRI) that had been under development by Sunovion for treating ADHD and binge eating disorder.
An Indian research team conducted a systematic search of the peer-reviewed medical literature to perform meta-analyses of the quantitative outcomes of clinical trials.
Meta-analysis of five double-blinded randomized clinical trials (RCTs) with a combined total of 1,498 participants reported a small-to-medium effect size reduction in ADHD symptoms in patients given dasotraline as opposed to those given placebo.
There were, however, strong indications of publication bias. Using the trim-and-fill procedure to correct for that bias yielded a small effect size reduction in ADHD symptoms in patients given dasotraline compared with those given placebo.
Insomnia were more than four times more frequent among patients given dasotraline than among those given placebo. There was no evidence of the frequency of insomnia being dose-dependent.
Similarly, patients given dasotraline were more than four times more likely to report decreased appetite than those receiving placebo. In this case, however, the effect was clearly dose-dependent, rising from 3x for 2mg to 4x for 4mg to 5x for 6mg and almost 8x for 8mg.
The authors concluded, “dasotraline can reduce the core symptoms of ADHD, that is, hyperactivity/impulsivity and inattentiveness, leading to an overall improvement of ADHD compared to placebo. Dasotraline can also improve clinician-determined patients’ global functioning compared to the placebo. The most common adverse drug reactions related to dasotraline were insomnia and decreased appetite. However, to fill the knowledge gap, multicentric randomized active-controlled clinical trials are warranted in this domain for a successful translation into clinical practice.”
Weighing these less than impressive initial results against the cost of further RCTs, Sunovion withdrew its application for approval by the Food and Drug Administration, stating, “while Sunovion considers dasotraline to be a promising, novel treatment for binge eating disorder and ADHD, we believe that further clinical studies would be needed to support a regulatory approval for dasotraline in these indications.”
Children and adolescents with ADHD are known to have difficulties in relating to family members, peers, and teachers. Over the long run this can contribute to anxiety or even delinquency.
Several cognitive functions that allow individuals to process social information and interact with others contribute to shaping everyday social interactions. These include:
A European research team performed a systematic search of the peer-reviewed medical literature to conduct meta-analyses of ToM, Empathy, Facial and Non-Facial Emotion Recognition in children and adolescents with ADHD when compared to typical development. As a comparison measure, they also included Everyday Social Skills (using self, parent, teacher, or clinician questionnaires/interviews of social skills) as an outcome.
The search yielded 142 case-control studies (including dissertations) with a total of 16,283 participants.
Meta-analysis of 82 studies with a combined total of 10,770 participants found a very large effect size impairment in everyday social skills among children and adolescents with ADHD when compared with typically developing peers. Adjusting for covariates only strengthened the finding. There was no sign of publication bias.
This was mirrored in three out of five measures of social cognition:
The team concluded, “Our findings show that children and adolescents with ADHD have deficits in ToM, Facial Emotion Recognition, and Everyday Social Skills, three domains that warrant clinical attention.”
_logo%201.svg)
