An Investigation of Delivery History, Duration of Breastfeeding, Age at First Exposure to Television, and Television, Mobile Phone and Tablet Use Times in Children with Autism

Öz

Objective: The increase in the prevalence of autism spectrum disorders over the last two decades has led to a renewed debate concerning the importance of the relationship between changes in environmental conditions and autism. The purpose of this study was to retrospectively examine various environmental risk factors in patients with autism.

Material and Methods: Patients being followed-up with diagnosis of autism at the Van Education and Research Hospital Pediatric Neurology Polyclinic, Turkey, were screened retrospectively. Healthy children in a similar age group were included as the control group. These two groups were then compared in terms of the presence of hypoxia and prematurity, breastfeeding and the duration thereof, age at first exposure to television, and television, mobile phone and tablet use times.

Results: A total of 126 children, 66 in the autism group and 60 in the control group, were included in the study. No difference was observed between the groups in terms of history of prematurity and hypoxic effects. Children who had never breastfed were more numerous in the autism group (p = 0.018). Duration of breastfeeding was shorter in patients diagnosed with autism (autism: 8.489.19-month, control: 13.188.64 month, p=0.001). No significant difference was observed between autism group and control group concerning age at first exposure to television. The rate of watching television for 4 h or more was significantly higher in the autism group (p = 0.020). Similarly, time spent on tablets and mobile phones was significantly longer in patients with autism (p = 0.001).

Conclusion: Absence of breastfeeding and a short duration of breastfeeding may be associated with an increased risk of autism. Increased duration of use of screens such as televisions, tablets and mobile phones may be a factor that facilitates or triggers the emergence of the clinical manifestation in children with a predisposition to autism.

Anahtar Kelimeler

• Autistic disorder
• breast milk
• mobile phone
• television
• prematurity

OTİZMLİ ÇOCUKLARDA DOĞUM ÖYKÜSÜ, ANNE SÜTÜ ALMA SÜRESİ, TELEVİZYON İLE TANIŞMA YAŞI, TELEVİZYON, AKILLI TELEFON VE TABLET KULLANIM ALIŞKANLIKLARININ İNCELENMESİ

Öz

Amaç: Otizm spektrum bozuklukları prevalansında son yirmi yıl içerisinde ortaya çıkan artış çevresel koşullardaki değişiklikler ile otizm arasındaki ilişkinin önemini yeniden tartışmaya açmıştır. Bu çalışma ile, çevresel bazı risk faktörlerini otizm hastalarında geriye dönük incelemeyi hedefledik.

Gereç ve Yöntemler: Sağlık Bilimleri Üniversitesi Van Eğitim ve Araştırma Hastanesi Çocuk Nöroloji Polikliniği’nde otizm tanısı ile takip edilmekte olan hastalar geriye dönük olarak tarandı. Benzer yaş grubundaki sağlıklı çocuklar kontrol grubu olarak alındı. Bu iki grup; hipoksi ve prematürite varlığı, anne sütü alımı ve süresi, televizyon ile tanışma yaşı, televizyon, akıllı telefon ve tablet kullanım süreleri açısından incelendi.

Bulgular: Çalışmaya otizm grubunda 66, kontrol grubunda 60 olmak üzere toplam 126 çocuk alındı. Gruplar arasında prematürite öyküsü ve hipoksik etkilenim açısından fark izlenmedi. Anne sütü hiç almayan çocuklar otizm grubunda daha yüksek sayıdaydı (p=0.018). Otizm tanısı alan hastaların daha kısa süre anne sütü almış oldukları görüldü (otizm:8.489.19 ay, kontrol:13.188.64 ay, p=0.001). Otizm grubunun ve kontrol grubunun televizyon ile tanışma yaşları arasında belirgin bir farklılık gözlenmedi. Otizm tanılı grupta dört saat ve üzeri televizyon izleme oranı belirgin derecede yüksekti (p=0.020). Benzer şekilde tablet ve akıllı telefon ile vakit geçirme süreleri otizm tanılı hastalarda anlamlı derecede yüksekti (p=0.001).

Sonuç: Anne sütü almamış olmak ya da kısa süre anne sütü ile beslenme, otizm riski ile ilişkilendirilebilir. Televizyon, tablet ve akıllı telefon gibi ekran maruziyetlerinde artmış süre, otizme yatkınlığı olan çocuklarda kliniğin ortaya çıkmasını kolaylaştıran ya da tetikleyen bir faktör olabilir.

Anahtar Kelimeler

• Otizm
• anne sütü
• akıllı telefon
• televizyon
• prematürite

Kaynakça

1. 1. Arlington VA. American Psychiatric Association Desk Refernce to the Diagnostic Criteria From DSM-5 Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington. Publisher Ltd, 2013.
2. 2. Mattila ML, Kielinen M, Linna SL, Jussila K, Ebeling H, Bloigu B et al. Autism spectrum disorders according to DSM-IV-TR and comparison with DSM-5 draft criteria: an epidemiological study. J Am Acad Child Adolesc Psychiatry. 2011;50(6):583-92. Doi:10.1016/j.jaac.2011.04.001.
3. 3. Kim YS, Leventhal BL, Koh YJ, Fombonne E, Laska E, Lim EC et al. Prevalence of autism spectrum disorders in a total population sample. Am J Psychiatry. 2011;168(9):904-12. Doi:10.1176/appi.ajp.2011.10101532
4. 4. Fombonne E. Epidemiology of autistic disorder and other pervasive developmental disorders. J Clin Psychiatry. 2005;66(10):3-8.
5. 5. Maenner M. J, Shaw K. A, Baio J, Washington A, Patrick M, Dirienzo M et al. Prevalence of autism spectrum disorder among children aged 8 years- autism and developmental disabilities monitoring Network, 11 Sites, United States, 2016. MMWR Surveillance Summaries. 2020;69(4):1–12. Doi: 10.15585/mmwr.ss6904a1.
6. 6. Karakoç Demirkaya S. Otizm spektrum bozukluğunda etiyopatogenez. In: Mukaddes NM, Ercan ES. eds. Nörogelişimsel Bozukluklar. First ed. İstanbul, Nobel Yayınevi, 2018:261-84.
7. 7. Fuentes J, Bakare M, Munir K, Aguayo P, Gaddour N, Öner Ö, Mercadante M. Autism spectrum disorders. In: Rey JM, ed. IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva. International Association for Child and Adolescent Psychiatry and Allied Professions, 2012:1-27.
8. 8. Demirkaya SK. Otizm neden artışta? Klinik Psikiyatri. 2019;22(2):123-4. Doi:10.5505/kpd.2019.84755

9. 9. Bölte S, Girdler S, Marschik PB. The contribution of environmental exposure to the etiology of autism spectrum disorder. Cellular and Molecular Life Science. 2019;76:1275-97. Doi:https://doi.org/10.1007/s00018-018-2988-4
10. 10. Johnson C.P, Myers S.M. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120(5):1183-215. Doi:10.1542/peds.2007-2361.
11. 11. Grayson DR, Guidotti A. Merging data from genetic and epigenetic approaches to better understand autistic spectrum disorder. Epigenomics. 2016;8(1):85-104. Doi:10.2217/epi.15.92.
12. 12. Tordjman S, Somogyi E, Coulon N, Kermarrec S, Cohen D. Bronsard G et al. Gene. Environment interactions in autism spectrum disorders: role of epigenetic mechanisms. Front Psychiatry. 2014;4(5):53. Doi:10.3389/fpsyt.2014.00053.
13. 13. Agrawal S, Rao S.C, Bulsara M.K, Patole S.K. Prevalence of autism spectrum disorder in preterm infants: a meta-analysis. Pediatrics. 2018;142(3):e20180134. Doi:10.1542/peds.2018-0134.
14. 14. Burstyn I, Wang X, Yasui Y, Sithole F, Zwaigenbaum L. Autism spectrum disorders and fetal hypoxia in a population-based cohort: Accounting for missing exposures via estimation-maximization algorithm. BMC Med Res Methodol. 2011;11(2):1-9. Doi:10.1186/1471-2288-11-2.
15. 15. Previc FH. Prenatal influences on brain dopamine and their relevance to the rising incidence of autism. Med Hypotheses. 2007;68(1):46-60. doi:10.1016/j.mehy.2006.06.041.
16. 16. Mueller BR, Bale TL. Sex-specific programming of offspring emotionality after stress early in pregnancy. J Neurosci. 2008;28(36):9055-65. Doi: 10.1523/JNEUROSCI.1424-08.2008.
17. 17. Newschaffer CJ, Croen LA, Daniels J, Giarelli E, Grether JK, Levy SE et al. The epidemiology of autism spectrum disorders. Annu Rev Public Health. 2007;28(1):235-58. Doi:10.1146/annurev.publhealth.28.021406.144007.
18. 18. Maramara LA, He W, Ming X. Pre- and perinatal risk factors for autism spectrum disorder in a New Jersey cohort. J Child Neurol. 2014;29(12):1645-51. Doi:10.1177/0883073813512899.
19. 19. Wang C, Geng H, Liu W, Zhang G. Prenatal, perinatal, and postnatal factors associated with autism: a meta-analysis. Medicine (Baltimore). 2017;96(18):6696.
20. 20. Al-Farsi YM, Al-Sharbati MM, Waly MI, Al-Farsi OA, Al- Shafaee MA, Al-Khaduri MM et al. Effect of suboptimal breast-feeding on occurrence of autism: a case-control study. Nutrition. 2012;28(7-8):27–32. Doi:10.1016/j.nut.2012.01.007.
21. 21. Shafai T, Mustafa M, Hild T, Mulari J, Curtis A. The association of early weaning and formula feeding with autism spectrum disorders. Breastfeed Med. 2014;9(5):275–6. Doi:10.1089/bfm.2013.0104.
22. 22. Steinman G. Can the chance of having twins be modified by diet? Lancet. 2006;367(9521):1461-2. Doi: 10.1016/S0140-6736(06)68623-6.
23. 23. Field SS. Interaction of genes and nutritional factors in the etiology of autism and attention deficit/hyperactivity disorders: a case control study. Med Hypotheses. 2014;82(6):654–61. Doi:10.1016/j.mehy.2014.02.021.
24. 24. Tseng PT, Chen YW, Stubbs B, Carvalho AF, Whiteley P, Tang CH et al. Maternal breastfeeding and autism spectrum disorder in children: A systematic review and meta-analysis. Nutr Neurosci. 2019;22(5):354-62. Doi:10.1080/1028415X.2017.1388598.
25. 25. Certain LK, Kahn RS. Prevalence, correlates, and trajectory of television viewing among infants and toddlers. Pediatrics. 2002;109(4):634-42. Doi:10.1542/peds.109.4.634.
26. 26. Chonchaiya W, Nuntnarumit P, Pruksananonda C. Comparison of television viewing between children with autism spectrum disorder and controls. Acta Paediatr. 2011; 100(7):1033-37. Doi:10.1111/j.1651-2227.2011.02166.x.
27. 27. Vandewater EA, Rideout VJ, Wartella EA, Huang X, Lee JH. Digital childhood: electronic media and technology use among infants, toddlers, and preschoolers. Pediatrics. 2007;119(5):1006-15. Doi:10.1542/peds.2006-1804.
28. 28. Zimmerman FJ, Christakis DA, Meltzoff AN. Television and DVD/video viewing in children younger than 2 years. Arch Pediatr Adolesc Med. 2007;161(5):473-79. Doi:10.1001/archpedi.161.5.473.
29. 29. Chonchaiya W, Nuntnarumit P, Pruksananonda C. Comparison of television viewing between children with autism spectrum disorder and controls. Acta Paediatr. 2011; 100(7):1033-7. Doi:10.1111/j.1651-2227.2011.02166.x