5 ms·

Acetaminophen exposure in pregnancy linked to higher risk of ADHD, autism: study

100 points by Wald76 7y ago

avs733 7y ago
This study draws data from a broader project called the Boston birth trial. It is a really interesting project that has the potential to teach us a lot about development and health for a long time to come.
mamato 7y ago
How does one exposed to acetaminophen?
- ars 7y ago
  It's a pain pill, you probably know it as paracetamol.
- arkades 7y ago
  It’s Tylenol. One is exposed by ingesting it.
  - Taniwha 7y ago
    "tylenol" is a US brand name, not used much elsewhere. ("acetaminophen" is a name only used in a few countries, including the US)
- catalogia 7y ago
  It's a over the counter drug also known as paracetamol or tylenol (a brand name.) All three names are derived from the chemical name para-acetylaminophenol.
- base3 7y ago
  Tylenol and generic equivalents
- emmelaich 7y ago
  Also sold as Panadol in Aus and the UK. Also generically sold under a range of names.
- markdown 7y ago
  It's called Paracetamol in other parts of the world.
- bb88 7y ago
  Tylenol, as well as many over the counter cold and flu medicines.
ars 7y ago
ibuprofen (and all NSAIDs) are also unsafe during pregnancy. It doesn't seem like there's anything safe to take.
- rattray 7y ago
  source/explanation?
  - wil421 7y ago
    Right here from the CDC[1]. My wife gave birth last month and was not allowed to take ibuprofen, she gets headaches and it was difficult for her. Other medicine does not work as well for her. [1] https://www.cdc.gov/pregnancy/meds/treatingfortwo/features/pain-med-usage.html https://www.cdc.gov/pregnancy/meds/treatingfortwo/features/p...
  - boomskats 7y ago
    It is understandably considered unethical to carry out drug safety research on pregnant mothers due to the risk to the child, so almost all medicines are considered unsafe as there is no ethical way to prove otherwise.
    - jdashg 7y ago
      Usually you'd gather data from subjects that broke the rules anyways, just like how we gather info about illicit substances or gunshot wounds. Just because you're not supposed to drink alcohol during pregnancy doesn't mean we have any shortage of data about it.
romaaeterna 7y ago
My guess would be that ADHD diagnoses in children would be associated with (legal) drug-seeking behavior in parents. Serious classic autism, on the other hand, is not affected by any sort of physician-seeking behavior.
- cma 7y ago
  It may already be controlled for, but if not, the increased Acetaminophen intake could be from narcotic painkillers, which are often combined with Acetaminophen in prescription preparations to help prevent abuse. The same people seeking and using those around birth may later seek to get an ADHD diagnosis for a child for access to amphetamines, as narcotics use and amphetamine use are highly correlated together.
  - thrower123 7y ago
    > the increased Acetaminophen intake could be from narcotic painkillers, which are often combined with Acetaminophen in prescription preparations to help prevent abuse This is just evil. Congratulations, now we have opiate addicts with needlessly destroyed livers as well...
    - cma 7y ago
      I believe it allowed them to illicitly claim lower addictiveness in their clinical studies, since they could throw out people who removed the Acetaminophen with a filter (as is common in real abuse), as people not taking the prescribed combination (or the techniques for removing it only got broad use after it was already approved).
    - golf3 7y ago
      Acetaminophen is a miracle for pain relief, why wouldn't it be used in combinations?
arcticbull 7y ago
Interesting and I wonder if it has to do with that finding that Tylenol is a generalized emotion suppressant [1]. [1] https://www.npr.org/sections/health-shots/2017/12/04/567762087/tylenol-may-help-ease-the-pain-of-hurt-feelings https://www.npr.org/sections/health-shots/2017/12/04/5677620...
- oasisbob 7y ago
  Maybe not that specifically, but there is growing evidence that acetaminophen has pretty serious effects on adult brain function.
  - pizza 7y ago
    What do you mean? Is there a source on this?
    - bb88 7y ago
      Again subjective, but here's one study. https://academic.oup.com/scan/article/11/9/1345/2224135 https://academic.oup.com/scan/article/11/9/1345/2224135
      - advaita 7y ago
        I know HN is place where anecdotes are not appreciated but here is one nonetheless. I just caught flu a few days ago and my dad being my dad kept thrusting acetaminophen tablets to me (His way of showing love/care) and I relented after 24 hours of suffering with cold + fever + body aches. I am 100% convinced that acetaminophen impaired my ability to work with tasks that required deep thinking. e.g: refactoring a feature that is spread across multiple services/repos.
        bradstewart 7y ago
        Impaired your ability temporarily/while you were taking it, or permanently/after you stopped?
oasisbob 7y ago
The primary author of this study (Yuelong Ji) did their dissertation on this and other possible early causes of ADHD. It's freely available and seems like an interesting read: https://jscholarship.library.jhu.edu/handle/1774.2/61026 https://jscholarship.library.jhu.edu/handle/1774.2/61026
skissane 7y ago
[1] argues that ASD lacks validity – in other words, "ASD" is not something which actually exists in nature, it is simply a largely arbitrary grouping of symptoms, and those symptoms have a diverse array of unrelated causes. Given this, [1] argues that the use of the ASD diagnosis as a basis for research should be abandoned. Instead, researchers should look for the causes and associations of each individual symptom included in the ASD diagnostic criteria, irrespective of whether the individuals having that symptom have been diagnosed with ASD or not, and irrespective of whether they meet the overall diagnostic criteria for ASD or not. If [1] is right that the validity of ASD is dubious, then any research based on the diagnosis of ASD is also dubious, this study included. [1] https://link.springer.com/article/10.1007/s40489-016-0085-x https://link.springer.com/article/10.1007/s40489-016-0085-x
- lazyguy2 7y ago
  The same can be said of probably most disorders listed in the DSM. Mental disorder diagnostics are all 'Design by committee'. People get together and vote and they are argue and they create categorizations based on that. They do their compromises every time they need to update the book. Diagnosis is then based on observed behavior and interviews. They don't do some sort of blood test, MRI scans, or X-rays or any other kind of medical diagnosis. Yeah, sure, there is some sort of questionable neuroimaging scan they can do, but none of that stuff ever gets used to actually diagnose people. In terms of a science it's much closer to the 'sociology' side of things then 'search for the cure for cancer'. The original purpose of DSM was so that psychologists and the lot have categorizations handy for filling out claims with patient's insurance. It's a lot easier to convince insurance companies to pay for treatments when the diagnosis is 'Attention deficit disorder' rather then 'Little Timmy is having a hard time sitting still in class and occasionally gets completely out of control'. That doesn't mean these disorders don't exist or that DSM diagnoses are invalid or useless. It just means that it's all a bit 'hand wavy'.
  - skissane 7y ago
    > The same can be said of probably most disorders listed in the DSM. True. Although, it is plausible that some DSM-5 disorders may have greater validity issues than others, and ASD may be one of those disorders with greater-than-average validity issues. The paper I cited built an extensive case, based on 14 separate research findings, to support the conclusion that ASD lacks validity. I wouldn't presume that if you repeated the same exercise for some other DSM-5 disorder you'd necessarily get an equally negative result. > The original purpose of DSM was so that psychologists and the lot have categorizations handy for filling out claims with patient's insurance. Which makes its use in research especially questionable. And this is part of why NIMH announced back in 2013 [1] that they were shifting research funding away from research based on DSM categories. If research based on the DSM-5 is dubious, then funding such research is not a good use of limited research funding resources. (It is worth noting this study was funded by NICHD not NIMH; I'd question whether NIMH would fund a study like this given its current funding criteria.) > That doesn't mean these disorders don't exist or that DSM diagnoses are invalid or useless. It just means that it's all a bit 'hand wavy'. What do you mean by "invalid"? If by "valid" one means biological validity and/or construct validity, then the whole point of the paper I cited was to argue that ASD lacks both forms of validity, and hence that in those senses of "valid", the diagnosis of ASD is invalid. [1] https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2...
ac29 7y ago
> "By the time the children were an average of 8.9 years, 25.8% had been diagnosed with ADHD only, 6.6% with ASD only and 4.2% with ADHD and ASD" This seems very high - I'd call in to question the validity of the diagnosis (these diagnoses are obviously somewhat subjective). Given that those numbers are for the total cohort, that suggests that something like a full half of the upper third of children were diagnosed with ADHD.
- Engineering-MD 7y ago
  I agree, this is not representative of the normal population and calls the results into question.
sigmaprimus 7y ago
Interesting thing I learned from a European nurse when my Dad was in the hospital: What is called "Acetaminophen" in North America is called "Paracetamol" in Europe. Anyone know why this is?
- jammaloo 7y ago
  I did a quick dig into the wikipedia article, and it has the roots for the names as follows: Both acetaminophen and paracetamol come from a chemical name for the compound: para-acetylaminophenol and para-acetylaminophenol. No real reason for why one took off in one area, versus the other, just what happened to stick! https://en.wikipedia.org/wiki/Paracetamol#History https://en.wikipedia.org/wiki/Paracetamol#History
- skissane 7y ago
  > What is called "Acetaminophen" in North America is called "Paracetamol" in Europe Not just in Europe, actually in most of the world. The international standard name (International Nonproprietary Name or INN approved by the WHO) is paracetamol. For some drugs, instead of using the international standard name, the United States uses its own alternate naming system, the United States Adopted Name (USAN). A handful of other countries (most notably Canada and Japan) follow the US naming convention and call it acetaminophen too; the vast majority of the planet follows the WHO standard and calls it paracetamol.
ThrustVectoring 7y ago
Like many other studied effects, this is less likely to be a specific cause of ADHD and autism spectrum symptoms, and more a generator of broad brain malfunction. The diagnostic criteria for these conditions has two parts - the underlying symptoms themselves, and a severity test that indicates whether the person with them is unable to handle the symptoms well enough to do without treatment. This is explicitly in ADHD and autism spectrum diagnostic criteria, but to a good extent is an unavoidable part of it; if someone is quite brilliant and successful but a little strange, there's no reason for them to ever seek some kind of diagnosis. I'd be very curious to see IQ test results here, as I suspect that it is an explanatory factor.
ggm 7y ago
I really want to see critique of this work by competent epidemiologists and statisticians. Anything both OTC and ubiquitous has to discount thousands of confounding equally widely distributed cofactors: diesel fumes, poverty, Coca-Cola drinking, exposure to cats...
pcvarmint 7y ago
Paracetamol (Acetaminophen / Tylenol) should always be taken with N-Acetyl Cysteine (NAC).

100 points by Wald76 7y ago

This study draws data from a broader project called the Boston birth trial. It is a really interesting project that has the potential to teach us a lot about development and health for a long time to come.

mamato 7y ago

How does one exposed to acetaminophen?

ars 7y ago
It's a pain pill, you probably know it as paracetamol.
arkades 7y ago
It’s Tylenol. One is exposed by ingesting it.
- Taniwha 7y ago
  "tylenol" is a US brand name, not used much elsewhere. ("acetaminophen" is a name only used in a few countries, including the US)
catalogia 7y ago
It's a over the counter drug also known as paracetamol or tylenol (a brand name.) All three names are derived from the chemical name para-acetylaminophenol.
base3 7y ago
Tylenol and generic equivalents
emmelaich 7y ago
Also sold as Panadol in Aus and the UK. Also generically sold under a range of names.
markdown 7y ago
It's called Paracetamol in other parts of the world.
bb88 7y ago
Tylenol, as well as many over the counter cold and flu medicines.

ars 7y ago

ibuprofen (and all NSAIDs) are also unsafe during pregnancy. It doesn't seem like there's anything safe to take.

rattray 7y ago
source/explanation?
- wil421 7y ago
  Right here from the CDC[1]. My wife gave birth last month and was not allowed to take ibuprofen, she gets headaches and it was difficult for her. Other medicine does not work as well for her. [1] https://www.cdc.gov/pregnancy/meds/treatingfortwo/features/pain-med-usage.html https://www.cdc.gov/pregnancy/meds/treatingfortwo/features/p...
- boomskats 7y ago
  It is understandably considered unethical to carry out drug safety research on pregnant mothers due to the risk to the child, so almost all medicines are considered unsafe as there is no ethical way to prove otherwise.
  - jdashg 7y ago
    Usually you'd gather data from subjects that broke the rules anyways, just like how we gather info about illicit substances or gunshot wounds. Just because you're not supposed to drink alcohol during pregnancy doesn't mean we have any shortage of data about it.

romaaeterna 7y ago

My guess would be that ADHD diagnoses in children would be associated with (legal) drug-seeking behavior in parents. Serious classic autism, on the other hand, is not affected by any sort of physician-seeking behavior.

cma 7y ago
It may already be controlled for, but if not, the increased Acetaminophen intake could be from narcotic painkillers, which are often combined with Acetaminophen in prescription preparations to help prevent abuse. The same people seeking and using those around birth may later seek to get an ADHD diagnosis for a child for access to amphetamines, as narcotics use and amphetamine use are highly correlated together.
- thrower123 7y ago
  > the increased Acetaminophen intake could be from narcotic painkillers, which are often combined with Acetaminophen in prescription preparations to help prevent abuse This is just evil. Congratulations, now we have opiate addicts with needlessly destroyed livers as well...
  - cma 7y ago
    I believe it allowed them to illicitly claim lower addictiveness in their clinical studies, since they could throw out people who removed the Acetaminophen with a filter (as is common in real abuse), as people not taking the prescribed combination (or the techniques for removing it only got broad use after it was already approved).
  - golf3 7y ago
    Acetaminophen is a miracle for pain relief, why wouldn't it be used in combinations?

arcticbull 7y ago

Interesting and I wonder if it has to do with that finding that Tylenol is a generalized emotion suppressant [1]. [1] https://www.npr.org/sections/health-shots/2017/12/04/567762087/tylenol-may-help-ease-the-pain-of-hurt-feelings https://www.npr.org/sections/health-shots/2017/12/04/5677620...

oasisbob 7y ago
Maybe not that specifically, but there is growing evidence that acetaminophen has pretty serious effects on adult brain function.
- pizza 7y ago
  What do you mean? Is there a source on this?
  - bb88 7y ago
    Again subjective, but here's one study. https://academic.oup.com/scan/article/11/9/1345/2224135 https://academic.oup.com/scan/article/11/9/1345/2224135
    - advaita 7y ago
      I know HN is place where anecdotes are not appreciated but here is one nonetheless. I just caught flu a few days ago and my dad being my dad kept thrusting acetaminophen tablets to me (His way of showing love/care) and I relented after 24 hours of suffering with cold + fever + body aches. I am 100% convinced that acetaminophen impaired my ability to work with tasks that required deep thinking. e.g: refactoring a feature that is spread across multiple services/repos.
      - bradstewart 7y ago
        Impaired your ability temporarily/while you were taking it, or permanently/after you stopped?

oasisbob 7y ago

The primary author of this study (Yuelong Ji) did their dissertation on this and other possible early causes of ADHD. It's freely available and seems like an interesting read: https://jscholarship.library.jhu.edu/handle/1774.2/61026 https://jscholarship.library.jhu.edu/handle/1774.2/61026

skissane 7y ago

[1] argues that ASD lacks validity – in other words, "ASD" is not something which actually exists in nature, it is simply a largely arbitrary grouping of symptoms, and those symptoms have a diverse array of unrelated causes. Given this, [1] argues that the use of the ASD diagnosis as a basis for research should be abandoned. Instead, researchers should look for the causes and associations of each individual symptom included in the ASD diagnostic criteria, irrespective of whether the individuals having that symptom have been diagnosed with ASD or not, and irrespective of whether they meet the overall diagnostic criteria for ASD or not. If [1] is right that the validity of ASD is dubious, then any research based on the diagnosis of ASD is also dubious, this study included. [1] https://link.springer.com/article/10.1007/s40489-016-0085-x https://link.springer.com/article/10.1007/s40489-016-0085-x

lazyguy2 7y ago
The same can be said of probably most disorders listed in the DSM. Mental disorder diagnostics are all 'Design by committee'. People get together and vote and they are argue and they create categorizations based on that. They do their compromises every time they need to update the book. Diagnosis is then based on observed behavior and interviews. They don't do some sort of blood test, MRI scans, or X-rays or any other kind of medical diagnosis. Yeah, sure, there is some sort of questionable neuroimaging scan they can do, but none of that stuff ever gets used to actually diagnose people. In terms of a science it's much closer to the 'sociology' side of things then 'search for the cure for cancer'. The original purpose of DSM was so that psychologists and the lot have categorizations handy for filling out claims with patient's insurance. It's a lot easier to convince insurance companies to pay for treatments when the diagnosis is 'Attention deficit disorder' rather then 'Little Timmy is having a hard time sitting still in class and occasionally gets completely out of control'. That doesn't mean these disorders don't exist or that DSM diagnoses are invalid or useless. It just means that it's all a bit 'hand wavy'.
- skissane 7y ago
  > The same can be said of probably most disorders listed in the DSM. True. Although, it is plausible that some DSM-5 disorders may have greater validity issues than others, and ASD may be one of those disorders with greater-than-average validity issues. The paper I cited built an extensive case, based on 14 separate research findings, to support the conclusion that ASD lacks validity. I wouldn't presume that if you repeated the same exercise for some other DSM-5 disorder you'd necessarily get an equally negative result. > The original purpose of DSM was so that psychologists and the lot have categorizations handy for filling out claims with patient's insurance. Which makes its use in research especially questionable. And this is part of why NIMH announced back in 2013 [1] that they were shifting research funding away from research based on DSM categories. If research based on the DSM-5 is dubious, then funding such research is not a good use of limited research funding resources. (It is worth noting this study was funded by NICHD not NIMH; I'd question whether NIMH would fund a study like this given its current funding criteria.) > That doesn't mean these disorders don't exist or that DSM diagnoses are invalid or useless. It just means that it's all a bit 'hand wavy'. What do you mean by "invalid"? If by "valid" one means biological validity and/or construct validity, then the whole point of the paper I cited was to argue that ASD lacks both forms of validity, and hence that in those senses of "valid", the diagnosis of ASD is invalid. [1] https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2...

ac29 7y ago

> "By the time the children were an average of 8.9 years, 25.8% had been diagnosed with ADHD only, 6.6% with ASD only and 4.2% with ADHD and ASD" This seems very high - I'd call in to question the validity of the diagnosis (these diagnoses are obviously somewhat subjective). Given that those numbers are for the total cohort, that suggests that something like a full half of the upper third of children were diagnosed with ADHD.

Engineering-MD 7y ago
I agree, this is not representative of the normal population and calls the results into question.

sigmaprimus 7y ago

Interesting thing I learned from a European nurse when my Dad was in the hospital: What is called "Acetaminophen" in North America is called "Paracetamol" in Europe. Anyone know why this is?

jammaloo 7y ago
I did a quick dig into the wikipedia article, and it has the roots for the names as follows: Both acetaminophen and paracetamol come from a chemical name for the compound: para-acetylaminophenol and para-acetylaminophenol. No real reason for why one took off in one area, versus the other, just what happened to stick! https://en.wikipedia.org/wiki/Paracetamol#History https://en.wikipedia.org/wiki/Paracetamol#History
skissane 7y ago
> What is called "Acetaminophen" in North America is called "Paracetamol" in Europe Not just in Europe, actually in most of the world. The international standard name (International Nonproprietary Name or INN approved by the WHO) is paracetamol. For some drugs, instead of using the international standard name, the United States uses its own alternate naming system, the United States Adopted Name (USAN). A handful of other countries (most notably Canada and Japan) follow the US naming convention and call it acetaminophen too; the vast majority of the planet follows the WHO standard and calls it paracetamol.

ThrustVectoring 7y ago

Like many other studied effects, this is less likely to be a specific cause of ADHD and autism spectrum symptoms, and more a generator of broad brain malfunction. The diagnostic criteria for these conditions has two parts - the underlying symptoms themselves, and a severity test that indicates whether the person with them is unable to handle the symptoms well enough to do without treatment. This is explicitly in ADHD and autism spectrum diagnostic criteria, but to a good extent is an unavoidable part of it; if someone is quite brilliant and successful but a little strange, there's no reason for them to ever seek some kind of diagnosis. I'd be very curious to see IQ test results here, as I suspect that it is an explanatory factor.

ggm 7y ago

I really want to see critique of this work by competent epidemiologists and statisticians. Anything both OTC and ubiquitous has to discount thousands of confounding equally widely distributed cofactors: diesel fumes, poverty, Coca-Cola drinking, exposure to cats...

pcvarmint 7y ago

Paracetamol (Acetaminophen / Tylenol) should always be taken with N-Acetyl Cysteine (NAC).