Breastfeeding and Attention Deficit Hyperactivity Disorder in Children Aged 2-5 Years, National Survey of Child Health, 2016-2017 translation missing: es.hyrax.visibility.files_restricted.text

Brasfield, Joy (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/df65v871j?locale=es
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Abstract

Background: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by difficulties sustaining attention and controlling hyperactivity and impulsive behavior often identified in preschool-aged children. While infant breastfeeding has been associated with lower risk of ADHD in a range of ages and world regions, results among preschool-aged children in the U.S. have been mixed. Given a wide range of negative outcomes for young children diagnosed with ADHD and the lack of consistent findings on the relationship between breastfeeding and subsequent diagnosis of ADHD, this study aims to clarify current understanding of the breastfeeding-ADHD relationship among a national sample of 2-5-year-olds from the U.S.

Methods: This thesis uses cross-sectional analysis of the 2016-2017 National Survey of Children’s Health (NSCH). Descriptive analyses were conducted using Rao-Scott Chi-square and Wilson method 95% confidence intervals (CI). Logistic regression, prevalence odds ratios (PORs) and Wald 95% CIs were used to examine associations between exposure and outcome. Analyses were conducted using SAS 9.4, proc surveyfreq and proc surveylogistic to account for the complex survey design.

Results: Exposure and outcome data were available for 14,259 children aged 2-5 years. In the unadjusted analysis, children with any infant breastfeeding had prevalence odds of ADHD 65% lower than children with no breastfeeding (95% CI: 0.17, 0.70). Controlling for age, sex, race/ethnicity, household poverty, secondhand smoke, and parent mental health, prevalence odds of ADHD were 64% lower in children with 6-12 months breastfeeding (95% CI: 0.17, 0.84) compared to those with no breastfeeding. Although not statistically significant, prevalence odds of ADHD relative to children with no breastfeeding, children with less than 6 months and 12 or more months of breastfeeding were 26% (95% CI: 0.33-1.66) and 52% lower (95% CI: 0.17-1.34), respectively.

Conclusion: While initial findings seem to suggest that prevalence of ADHD is reduced among children with any breastfeeding compared to no breastfeeding, after adjusting for age, sex, race/ethnicity, household poverty, secondhand smoke, and parent mental health, prevalence odds of ADHD were statistically significant only for those who were breastfed for 6-12 months as infants. These results highlight the importance of further examining the duration and timing of breastfeeding in studies attempting to further understand the breastfeeding-ADHD association.

Table of Contents

CHAPTER 1: INTRODUCTION ................................... 1

CHAPTER 2: REVIEW OF LITERATURE ...................... 5

INTRODUCTION: ADHD ........................................... 5

HISTORY ................................................................. 5

PREVALENCE .......................................................... 6

CLINICAL FEATURES ................................................ 7

ETIOLOGY ............................................................. 10

BREASTFEEDING AND ADHD ................................. 12

CHAPTER 3: METHODOLOGY ................................. 16

DATA SOURCE ........................................................ 16

STUDY SAMPLE ..................................................... 17

OUTCOME VARIABLE ........................................... 18

EXPOSURE VARIABLE ........................................... 18

CO-VARIABLES ..................................................... 18

DATA ANALYSIS .................................................... 19

CHAPTER 4: RESULTS ........................................... 20

SAMPLE .............................................................. 20

DESCRIPTIVE ANALYSIS ........................................ 20

UNADJUSTED ANALYSIS ........................................ 21

INTERACTION ANALYSIS ....................................... 22

BACKWARD ELIMINATION ..................................... 23

FINAL MODEL ........................................................ 23

CHAPTER 5: CONCLUSIONS .................................. 25

STRENGTHS ........................................................... 26

LIMITATIONS ........................................................ 27

IMPLICATIONS AND CONCLUSION .......................... 28

APPENDIX ............................................................ 31

FIGURE 1 ............................................................... 31

TABLE 1 .................................................................. 32

TABLE 2 .................................................................. 34

TABLE 3 .................................................................. 36

TABLE 4 .................................................................. 37

TABLE 5 .................................................................. 38

TABLE 6 .................................................................. 40

REFERENCES ......................................................... 42

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