Is Autism In the Water?

COULD AUTISM SPECTRUM DISORDER in children be related to a mother’s exposure to lithium in tap water? A new Dutch study hints at such a relationship but does not establish a causal relationship.

About one in 36 children in the United States is diagnosed with autism spectrum disorder (ASD) each year, according to data from the US Centers for Disease Control and Prevention. ASD is more than four times more common among boys than among girls.

Today, we will briefly examine autism spectrum disorder (AS) symptoms. We will then turn to the provocative new study.

The most interesting people you’ll find are ones that don’t fit into your average cardboard box. They’ll make what they need; they’ll make their boxes. — Temple Grandin, Ph.D.

Autism spectrum disorder

Autism Spectrum Disorder (ASD) is a neurological and developmental disorder that affects communication, social interaction, and behavior. It is called a “spectrum” disorder because the symptoms and severity can vary widely among individuals with the condition.

The United States Centers for Disease Control (CDC) explains that common symptoms include the following:

• Avoids or does not keep eye contact
• Does not respond to name by nine months
• Doesn’t show facial expressions like happy, sad, angry, and surprised by nine months
• Doesn’t play simple interactive games such as pat-a-cake by one year
• Uses few (or no) gestures by one year (for instance, doesn’t wave bye)
• Doesn’t share interests with others by 15 months (e.g., shows you an object they enjoy)
• Doesn’t point to show you something interesting by 18 months
• Doesn’t notice when others are upset or hurt or upset by two years
• Doesn’t notice other children and join them to play by three years
• Doesn’t pretend to be something else (for example, a teacher or superhero) during play by four years
• Doesn’t dance, sing, dance, or act for you by five years

Autism spectrum disorder – Other symptoms

The CDC offers that individuals with an autism spectrum disorder may demonstrate restricted or repetitive behaviors or interests. Here are some selected examples:

• Lines up objects (e.g., toys) and gets upset when the order is changed
• Repeats words or phrases over and over (known as echolalia)
• Plays with toys the same way each time
• Focuses on object parts (for instance, wheels)
• Becomes upset by small changes
• Obsessive interests
• Must follow certain routines
• Flaps hands, spins self in circles, or rocks body
• Has unusual reactions to the way things smell, sound, taste, look, or feel

Finally, the majority of those with ASD have related characteristics; for example:

• Delayed language skills
• Delayed movement skills
• Delayed cognitive or learning skills
• Inattentive, hyperactive, or impulsive behavior
• Seizure disorder
• Unusual sleeping and eating habits
• Gut issues (for instance, constipation)
• Unusual emotional reactions or mood
• Stress, anxiety, or excessive worry
• More fear than expected (or lack of fear)

Of course, children with ASD may not have any (or all) of these behaviors.

Autism spectrum disorder causes

Autism spectrum disorder has no single cause. Given the disease’s complexity, there are likely many causes. The environment and inherited genetics are likely contributants:

• Genetics. Several genes are involved in autism spectrum disorder. Mutations (genetic changes) may increase the risk of autism spectrum disorder. For some, ASD is associated with genetic disorders like Rett syndrome or Fragile X syndrome. Still, other genes may affect brain cell communication or symptom severity. Some genetic mutations are inherited, while others occur spontaneously.
• Environmental factors. Viral infections, medicines, or pregnancy complications might trigger autism spectrum disorder.

No reliable study has shown an association between autism spectrum disorder and any vaccine. The historical debate about the relationship was sparked by a study that has been retracted due to poor design and questionable research methods.

Autism Speaks explains that risk factors for ASD include advanced age (of either parent). Birth complications (including birth before 26 weeks), low birth weight, and multiples (twins or triplets, for instance) raise the risk. Pregnancies spaced less than one year apart can also increase risk.

Prenatal vitamins with folic acid (before and at conception and through pregnancy) can decrease ASD risk.

There is no cure for autism spectrum disorder, but early management can improve quality of life and other outcomes.

Lithium: Is autism in the water?

A new study reports a slightly higher risk of autism spectrum disorder in children born to pregnant individuals exposed to tap water containing higher lithium levels.

Lithium is an alkali metal occurring naturally in some groundwater where that water interacts with lithium-containing minerals or salt water. We use lithium in air conditioners, batteries, and grease. In the medical realm, some individuals with bipolar and some with blood disorders take lithium.

Do you know that water lithium levels are not regulated in the United States? A 2021 US Geological Survey study reported that about 45 percent of public-supply wells and about 37 percent of domestic supply wells have lithium concentrations that might pose a human health risk.

The USGS compiled data for lithium measured in untreated groundwater from 1,464 public-supply wells and 1,676 domestic-supply wells from 1991 to 2018.

Lithium in drinking water and autism risk

A new study in the journal JAMA Pediatrics found a small association between lithium and autism diagnosis in Denmark. Researchers note that drinking water lithium levels are similar to those in America.

The researchers examined a database (of people with psychiatric disorders) for children born from 2000 to 2013. They discovered 8.842 cases of ASD and 43,864 participants without the condition.

They then mapped the location where the mothers of these children lived while they were pregnant — down to five meters resolution— to groundwater lithium levels. This water serves over half of the Danish population.

The researchers then asked this question: Would mothers pregnant in areas with higher groundwater lithium levels be more likely to have children with Autism Spectrum Disorder? Here‘s what the researchers discovered:

There appeared to be a rather steady and consistent association between higher lithium levels in groundwater and the prevalence of ASD in children.

As lithium levels in the water rose, there was a modestly increased risk of an ASD diagnosis. Specifically, compared with people at the lowest exposure level, those with the second and third highest exposure during pregnancy had about a one-quarter increase in ASD risk. The group with the highest exposure had a nearly 1.5 times (46 percent) higher risk than those at the lowest level of exposure.

The researchers didn’t know how much water the pregnant women consumed, but they picked Denmark partly because residents there drink some of the lowest bottled water amounts in Europe.

In summary, the researchers discovered that naturally occurring lithium in drinking water might be a novel environmental risk factor for Autism Spectrum Disorder development.

My take – Is autism in the water?

The study demonstrates an interesting association between lithium exposure and Autism Spectrum Disorder risk. The study does not establish a causal relationship. In addition, women who take medicinal lithium for bipolar disorder do not appear to have a higher risk of ASD.

Moreover, even though a single ASD case is too many, the numbers are not large: The mothers living in areas of the highest quartile of lithium were 46 percent more likely to have a child with ASD. Translating this relative risk into absolute numbers yields this estimate: There would be an increase from one in 100 children to 1.5 in 100.

I have some other issues with the study. First, is the groundwater concentration of lithium the same as the amount a woman ingests? While much of the Danish water is from groundwater sources, not all lithium comes from drinking water. Numerous diet sources (potatoes, tomatoes, cereal, cabbage, and other legumes) and medical lithium exist.

Second, the researchers measured lithium in 2013, after the children were born. They argue that the levels seem consistent with previous studies, hinting that they are stable. Then why are autism cases increasing?

I hope we get answers soon. This study is hypothesis-generating but does not establish a causal relationship between lithium in groundwater and autism.

Some studies suggest that air pollution is a risk factor for giving birth to a child with ASD. Could it be that that is the relevant variable rather than lithium? I look forward to additional studies. We need to understand better the basic science to understand whether exposures to agents such as environmental lithium are causal. Automobile electrification (with lithium batteries) makes the subject more pressing.

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The information I provided in this blog is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider for medical advice, diagnoses, or treatment. I am not liable for risks or issues associated with using or acting upon the information in this blog.

Thank you for reading “Is Autism In the Water?’