I seem to have caused a bit of a ruckus with my comment on breastfeeding and
ADHD.  Here is more info:

As far as I am aware, there has been only one study published on ADHD that
included infant feeding as a variable and they found that their ADHD cases
had a lower frequency of "ever breastfed" than the controls and that among
those who were breastfed, the cases had a lower average duration of
breastfeeding than the controls.  Both of these differences were highly
statistically significant.

Stevens, L.J., Zentall, S.S., Deck, J.L., Abate, M.L., Watkins, B.A., Lipp,
S.R. and Burgess, J.R. (1995)  Essential fatty acid metabolism in boys with
attention-deficit hyperactivity disorder.  American Journal of Clinical
Nutrition 62:761-768.

Intriguingly, in the abstract, they do NOT mention the links they found
between ADHD and infant feeding mode, nor in the conclusions section do they
offer breastfeeding as a recommendation for preventing or lessening the
severity of ADHD.  Alas, this is often the fate of such findings about
breastfeeding.  I talked at length on the phone with Burgess several years
ago, and he mentioned that they were going to begin clinical trials of
supplementing some of the boys' diets with essential fatty acids (and others
with placebos), as the ones with the most severe symptoms seemed to have
abnormal fatty acid metabolism.  Of course, breast milk has a number of
fatty acids that are not found in formula, including docosahexanoic acid (DHA).

Dr. Rowland of the National Institutes of Health here in the US is currently
doing research on ADHD and has included breastfed/formula-fed and duration
of breastfeeding as variables in his study as well.  He and his colleagues
say that their preliminary studies implicate environmental toxins, though it
wasn't clear from his email whether he meant exposure in utero or during
early childhood.

It is clear that in the US, ADHD shows up in clusters geographically and is
increasing in incidence, both suggesting that it is not "simply" a genetic
condition, though clearly there are genetic predispositions.  It is also the
case that there are kids with ADHD and then there are kids with ADHD.  By
which I mean, there are children who are a little fidgety in school and seem
to have more energy than normal but are otherwise bright and well-adjusted
(but who are diagnosed with ADHD and put on Ritalin), and then there are
children who literally bounce off the walls and can't concentrate long
enough to read a complete sentence, or learn to do Tae Kwan Do, or anything
that requires listening to someone else give directions.

Probably, like everything else, breastfeeding/formula-feeding is just one of
many factors that contribute to the presence or absence of specific conditions.

One Lactnetter wrote to me privately and said:

>Totally unscientific, but almost none of the severely ADHD kids I know
>were breastfed *at all*. However, I do think ADHD babies might be
>difficult to nurse, as there is a high correlation with fussy, colicy
>babies. Tactile defensiveness is a common issue with ADHD, too, as are
>all sensory integration issues. OTOH, many of these kids were not even
>breastfed once.

I think she may be onto something here.  It would be very interesting if,
instead of just asking "breastfed or not" and "if breastfed, for how long"
if they actually interviewed moms about their intentions with respect to
breastfeeding and how did it work out, and if it *didn't* work out, why not.
It may be that kids start out with genetic or early uterine environmental
predispositions to ADHD, which are then made worse by not getting breast
milk, or not for long enough.

Again, the Lactnetter writes:
>The consensus in the various ADHD support groups is that [supplemental]
EFAs are not the answer.

I think that Burgess and colleagues suspect that it is the addition of EFAs
to the diet *during brain growth* (that is, before age 7) which could make
the difference -- not once the brain is formed.  The brain is actively
growing and forming very rapidly for the first 6-7 years of life, by which
time 95% of brain growth is complete.  It isn't just the first year or two.

Given the low rate of breastfeeding in the US, I suspect a lot of kids who
end up diagnosed as ADHD were bottle-fed from day one, and a lot of moms who
stop after 3 days or 3 weeks or 6 weeks or 3 months, would have done so
anyway -- just like moms of kids who *don't* end up diagnosed as ADHD.


Kathy Dettwyler

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