BREASTFEEDING MEDICINE

Volume 10, Number 0, 2015 Letter to the Editor

ª Mary Ann Liebert, Inc.
DOI: 10.1089/bfm.2015.0033

Breastfeeding History in Children with Autism

and Attention Deficit Hyperactivity Disorder

Gökçe Nur Say, Zehra Babadağı, and Koray Karabekiroğlu

Dear Editor: The mean duration of breastfeeding was significantly

A utism spectrum disorder (ASD) and attention
deficit/hyperactivity disorder (ADHD) are both life-
long neurodevelopmental conditions that begin in early child-
hood, and there are suggestions that insufficient breastfeeding
may be related to development of either ASD or ADHD.1–3
In the present study, we compared breastfeeding dura-
tions of ASD and ADHD groups with each other and with
healthy controls. The study included 98 children 3–18 years
of age with ASD, 96 age- and gender-matched children with
ADHD, and 79 age- and gender-matched healthy controls.
Subjects with ASD or ADHD were recruited from among
outpatients of the Department of Child and Adolescent Psy-
chiatry, Ondokuz Mayıs University Medical Hospital, Samsun,
Turkey. The diagnoses of ASD and ADHD were established by
interviews with patients and parents based on Diagnostic and
Statistical Manual of Mental Disorders, 4th edition, criteria.
Demographic features and duration of breastfeeding were
evaluated by a questionnaire that was prepared by the authors
and completed by the mothers of participants.
The mean age of the ASD group was 8.73 – 3.86 years
(77% boys, 23% girls), that of the ADHD subjects was
8.80 – 1.98 years (71% boys, 21% girls), and that of the
healthy control group was 8.45 – 4.61 years (78% boys, 22%
girls). There were no significant differences among groups
regarding age/gender of children, maternal age at birth, and
education of parents.
shorter in the ADHD group (9.10 – 7.847 months) compared
with the ASD (12.18 – 10.480 months) and healthy control
(12.99 – 8.658 months) groups ( p = 0.005). We also evalu-
ated the rates of children who were never breastfed and those
who continued breastfeeding at 1 month, 3 months, 6 months,
12 months, and 24 months of age. The rate of children who
were never breastfed was significantly higher in the ADHD
group (9.6%) compared with the healthy control group (1.3%)
( p = 0.034). The ADHD group showed significantly lower
rates of exclusive breastfeeding at 1, 3, and 6 months of age
than the other groups. At 1 month of age, 84% of children with
ADHD were still breastfed, whereas 93% of the ASD group
were breastfed, and 98% of the healthy controls were breastfed
( p = 0.001). At 3 months of age, 71% of the ADHD group were
still breastfeeding compared with 78% in the ASD group and
88% in the healthy control group ( p = 0.025). By 6 months of
age, breastfeeding rates were as follows: 50% in the ADHD
group, 58% in the ASD group, and 72% in the healthy control
group ( p = 0.012). The ASD group did not show any signifi-
cant differences regarding mean duration and rates of breast-
feeding compared with either the ADHD or healthy control
group. The rates of breastfeeding were similar in all groups at 1
and 2 years of age. The results are summarized in Table 1.
Breastfeeding has promoting effects on mental and motor
development of the newborn.4 This preliminary study noted
that children with ADHD were more likely to be less breast-
fed, especially during the first 6 months after birth, compared

Table 1. Mean Duration and Rates of Breastfeeding

ASD (n = 98) ADHD (n = 96) Controls (n = 79) v2/z p
Breastfeeding duration (months) 12.18 – 10.48 9.10 – 7.847 12.99 – 8.658 10.704 0.005a
Never breastfed 5 (5.1%) 10 (9.6%) 1 (1.3%) 1.623 0.034a
Breastfed at
1 month of age 92 (93.8%) 81 (84.4%) 78 (98.7%) 11.219 0.001a
3 months of age 77 (78.6%) 69 (71.9%) 70 (88.6%) 7.373 0.025a
6 months of age 57 (58.2%) 48 (50%) 57 (72.2%) 8.902 0.012a
12 months of age 34 (34.7%) 24 (25%) 31 (39.2%) 4.305 0.116
24 months of age 8 (8.2%) 1 (1%) 3 (3.8%) 5.947 0.051
Data are mean – standard deviation values or number (%), as indicated.
a
Statistically significant difference.
ADHD, attention deficit /hyperactivity disorder; ASD, autistic spectrum disorder.

Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey.

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with children with ASD or healthy controls. In the ASD
group, the rates of breastfeeding during the first 6 months
after birth were also lower than those in the healthy controls,
but the difference did not reach statistical significance. We
think that possible explanations for this observation are as
follows: mothers of children with ADHD may also have
ADHD, leading to inadequate nursing skills; children with
ADHD may have an inability to maintain breastfeeding; or
the neurotrophic benefits of breastmilk itself may reduce the
risk. However, as no proof of causation exists, the lower
breastfeeding rate may just be a marker for neurobehavior of
the infant. Either way, a possible association of ADHD with
inadequate breastfeeding should be added to the list of rea-
sons for supporting breastfeeding in the mother–infant dyad.
References
1. Mimouni-Bloch A, Kachevanskaya A, Mimouni FB, et al.
Breastfeeding may protect from developing attention-deficit/
hyperactivity disorder. Breastfeed Med 2013;8:363–367.
2. Sabuncuoglu O, Orengul C, Bikmazer A, et al. Breastfeeding
and parafunctional oral habits in children with and without
attention-deficit/hyperactivity disorder. Breastfeed Med 2014;
9:244–250.
3. Shafai T, Curtis A, Mustafa M, et al. Influence of infant
feeding methods (breastfeeding, breastmilk, or formula feed-
ing) on the prevalence of ASD spectrum disorders. Breastfeed
Med 2014;9:275–276.
4. Quigley MA, Hockley C, Carson C, et al. Breastfeeding is
associated with improved child cognitive development: A
population-based cohort study. J Pediatr 2012;160:25–32.
Address correspondence to:
Gökçe Nur Say, MD
xocuk ve Ergen Psikiyatrisi Anabilim Dalı
C
Ondokuz Mayıs Üniversitesi Tıp Fakültesi Hastanesi
Kurupelit, Samsun 55139, Turkey
E-mail: gokcenurtasdemir@yahoo.com.tr