A little more ADHD/Tylenol stuff.

I still have a few loose thoughts bouncing around in my head about the acetaminophen/ADHD thing, and about being pregnant and taking medicine. A fair amount of these loose ends came from comments on the original post, and in depth discussion with friends on the subject. I loooove these discussions.

1. I mentioned in the original post that there is research suggesting that NOT treating maternal illness/pain can ALSO lead to ADHD and other “negative” outcomes in offspring. The studies done in this area are smaller and less statistically powerful than the acetaminophen/ADHD study. In fact, some of the most interesting stuff isn’t even done in humans. So why am I willing to weigh these studies against each other to inform my choices? Because: there will never be a large scale epidemiological study that can adequately compare these “exposure” scenarios. It would be basically impossible to design and conduct a study that compares a reference group with no pain or illness of any kind to an exposure group with pain or illness, and to stratify the exposure group by intensity or duration or number of events. And to have these groups be big enough to yield statistical power to look at these subtle, low percentage outcomes. Much harder even than an imperfect, but interesting study on OTC drug use.

2. I want to also make a point about the overall study size, and the actual numbers of kids with the outcomes of interest. The overall study included over 64,000 pregnant women. That’s a ton! But it was broken down into reference group, and exposed groups, each of which were smaller than 64,322. The reference group for looking at ADHD-like behaviors included 18,188 total offspring, 458 of whom had ADHD-like behaviors and 17,730 of whom did not. That’s an incidence rate of 2.52%. In the exposure group for children of mothers who took acetaminophen for more than 20 weeks of their pregnancies, there were 1801 total offspring, 87 of whom had ADHD-like behaviors and 1714 of whom did not. That’s an incidence rate of 4.83%, which gets adjusted down to 3.67% based on the confounding parameters (demographic info and/or disease conditions as I mentioned in my previous post). Adjustments aside, that’s still… 87 kids. For a rate of 2.52%, it would have been 45 kids. 3.67% is 66 kids. That is both a lot of kids, and not that many, depending on your perspective (as usual, if you find yourself on the “wrong” side of a statistic, things suddenly get REAL). The difference in incidence is statistically significant, but I have trouble hanging my behavioral hat on a difference of 20ish kids, especially considering other flaws in the study.

3. I keep focusing on the ADHD-like behaviors, which is sort of a fuzzier endpoint than the ADHD medicines or the KHD diagnosis. Why? It’s because it’s a lot easier for me to talk about the math on this measure – it’s simple incidence. X kids with the outcome out of Y total kids. I don’t have to talk about person-time, which is a really confusing metric.

4. It seems like much of this is maybe a less discussed downside (or just a different side) of our incredible advance in knowledge and diagnostics – instead of “everyone’s different” we have names and syndromes, etc. And of course in isolation, you would rather your child not suffer. but does anyone really not have something? ADHD, asthma, celiac, depression, ASD, bad eyesight, poor coordination, shitty metabolism, mediocre IQ, janky heart, janky lungs, on and on and on. There are so many things to have. And so many degrees of severity for each of them. And I’m not saying we would CHOOSE any or all of these things, or that feeling negatively about them is necessarily bad or wrong or othering or whatever.

It just starts so early. “I want a healthy baby!” when what we really mean is “I want my baby to be healthy.” But that is slightly different. Do you want THIS baby? If he’s not “healthy”? What kind of disorders are acceptable in the abstract? What becomes acceptable when it’s part of your actual child? Where is the line between understanding the etiology of human .. disease is not the word I want. Human variation? The line between understanding what causes us all to be different, in so very many ways, and making value judgments about what is normal and what is not, and then… placing BLAME for (maybe) causing a deviation from that perceived norm?

This is heavy stuff, but I think the distinctions are important, as is considering the implications of these kinds of exposure studies, and the discussions that come out of them. Obviously everyone brings their own values to this subject, and I don’t think we can or should use a universal yardstick, but this has been a fruitful discourse for me, and maybe it will be for you too.

I should say that, especially for the last bit, this is a lot more stream of consciousness than I usually post here. And a lot heavier, and closer to divisive and charged issues. So. Uh. Ok.

This entry was posted in gestating, Grumpy Toxicologist, Science!. Bookmark the permalink.

7 Responses to A little more ADHD/Tylenol stuff.

  1. Robin says:

    “What kind of disorders are acceptable in the abstract? What becomes acceptable when it’s part of your actual child?”

    When I was pregnant, we decided not to do some additional test for some sort of abnormality (don’t ask me which one or how far along I was, I don’t remember, and it was in Spanish anyway so I really don’t remember). If you’d asked us before I was pregnant if we maybe would have chosen to abort a fetus had it shown that it had something-or-other, we probably would have said yes (and maybe still would have had that been the case, depending). But when faced with this decision of whether or not to go forward with this test, we ultimately decided against it because it’s only testing for that one thing, and the probability was so low. Plus, what happens if something happens to the baby later? Or there’s something that wasn’t “caught” early? At the end of the day we realized that by having a kid, there are so many unknowns and we would just learn to figure it out as we went along. And love him no matter what makes him weird or different and no matter what “caused” him to be so.

  2. Swistle says:

    My favorite part of the whole two-post series is that paragraph about the difference between wanting a healthy child and wanting a child who is healthy. And also the part at the end of the same paragraph about placing blame for deviations from a perceived norm, which I read several times just to enjoy it.

    • Swistle says:

      Crud, and I messed up my sentence. It should read “about the difference between wanting a healthy child and wanting the child to be healthy.”

  3. Chelle says:

    As a currently gestating woman who took Tylenol a few months back and was just steaming MAD at the media for being… the media, I want to say I could just kiss you on the face for posting about this. As you said, it’s a bit heavy and close to divisive, so thanks for tackling this for us. You’re the best.

  4. As a person who normally delights in abstractions and the different shades of something, I am surprised by how often I find myself desiring something black or white, right or wrong. And I am finding the gradations of parenthood so…confounding. And panic inducing. Your measured, detailed responses to the acetaminophen/ADHD stuff are so comforting in their calm breakdown of those gradations. Perhaps even more so is your editorializing on what our fears mean, in real life. I loved reading this.

  5. Matti says:

    Delurking to say thank you! This has been incredibly fruitful for me to think about. Especially the idea that women are not just vessels for babies, and that once we become pregnant, our own needs and desires must all be superseded by those of the baby. That was an idea I was struggling to put into perspective for quite a few of my relatives.
    I was wondering if you’ve even pointed your lasers at the toxic furniture debate. Are the flame retardants in things like upholstered furniture, foam, mattresses, etc. really that much to worry about, and do I have to get everything Danish modern? Or, can I buy, like stuff from Ikea?
    Thanks for taking up the gauntlet for science!

  6. Christine says:

    God, I love your posts. I still refer people (often on social media, usually after some BS article about BPA or non-organics will kill us) to your site and your great posts.

    Mothering is so tied up with so much BS as is, and the media just adds to it. So thank you!

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