Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Association of autism with lead poisoning in an environmental health clinic

Pediatric Research volume 94, pages 7–9 (2023)Cite this article

Lead poisoning can cause significant disturbance in the neurocognitive functioning of a developing child, including behavioral problems and lower intelligence quotient1,2. There has been variable evidence of increased lead exposure in children with autism spectrum disorder (ASD); if true, this could have implications for screening protocols and prevention of lead poisoning. In our exploratory retrospective study, we examined patients who presented to an environmental health clinic after screening venous lead levels resulted greater than or equal to 5 µg/dL, the reference level set to identify children at higher risk for lead poisoning by the Centers for Disease Control and prevention (CDC) at the time of this study (in October 2021, the CDC lowered their blood lead reference value to 3.5 µg/dL3). We hypothesized that children with ASD would be overrepresented compared to overall ASD incidence and would have higher lead levels than children without ASD.

This study was approved by the institutional review board of University of Massachusetts Chan School of Medicine—Baystate. We performed a cross-sectional study via retrospective chart review from a lead treatment program in Western Massachusetts, USA (see Supplement). Per Massachusetts regulations, all children have screening lead levels taken during the first three years of life, with an additional screen at age four if they live in a high-risk community4. Children were referred to this clinic for a screening venous lead level of 5 µg/dL or above. This was the only criterion for referral and was independent of developmental staging or concern.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: ASD diagnosis, but not sex, is associated with significant differences in lead.
Fig. 2: Children with ASD are overrepresented in the highest lead level category.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Hauptman, M., Bruccoleri, R. & Woolf, A. D. An update on childhood lead poisoning. Clin. Pediatr. Emerg. Med 18, 181–192 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Miracle, V. A. Lead poisoning in children and adults. Dimens Crit. Care Nurs. 36, 71–73 (2017).

    Article  PubMed  Google Scholar 

  3. Blood Lead Reference Value, https://www.cdc.gov/nceh/lead/data/blood-lead-reference-value.htm (2021).

  4. Massachusetts, C. o. Learn about lead screening and reporting requirements, https://www.mass.gov/service-details/learn-about-lead-screening-and-reporting-requirements (2021).

  5. Hauptman, M., Stierman, B. & Woolf, A. D. Children with autism spectrum disorder and lead poisoning: diagnostic challenges and management complexities. Clin. Pediatr. (Philos.) 58, 605–612 (2019).

    Article  Google Scholar 

  6. Neuwirth, L. S. Resurgent lead poisoning and renewed public attention towards environmental social justice issues: a review of current efforts and call to revitalize primary and secondary lead poisoning prevention for pregnant women, lactating mothers, and children within the U.S. Int J. Occup. Environ. Health 24, 86–100 (2018).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Latif, A., Heinz, P. & Cook, R. Iron deficiency in autism and Asperger syndrome. Autism 6, 103–114 (2002).

    Article  CAS  PubMed  Google Scholar 

  8. Goel, A. & Aschner, M. The effect of lead exposure on autism development. Int. J. Mol. Sci. 22, 1637–1648 (2021).

  9. Lord, C. et al. The autism diagnostic observation schedule-generic: a standard measure of social and communication deficits associated with the spectrum of autism. J. Autism Dev. Disord. 30, 205–223 (2000).

    Article  CAS  PubMed  Google Scholar 

  10. Schopler, E., Reichler, R. J., DeVellis, R. F. & Daly, K. Toward objective classification of childhood autism: childhood autism rating scale (Cars). J. Autism Dev. Disord. 10, 91–103 (1980).

    Article  CAS  PubMed  Google Scholar 

  11. Fields, V. L. et al. Pica, autism, and other disabilities. Pediatrics 147, e20200462 (2021).

Download references

Author information

Authors and Affiliations

  1. Boston Children’s Hospital, Boston, MA, USA

    Rajapillai L. I. Pillai

  2. Columbia Memorial Health, Hudson, NY, USA

    Maria Covington

  3. University of Massachusetts Chan School of Medicine - Baystate, Springfield, MA, USA

    Paul F. Visintainer & Hilary J. Branch

Authors
  1. Rajapillai L. I. Pillai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Covington
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul F. Visintainer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hilary J. Branch
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RLIP helped organize the data, drafted the initial manuscript, and reviewed and revised the manuscript. MC helped collect and organize the data and reviewed and approved the manuscript. PFV performed the statistical analysis and reviewed and revised the manuscript. HJB conceptualized the study, helped collect the data, provided supervision, and reviewed and revised the manuscript.

Corresponding author

Correspondence to Rajapillai L. I. Pillai.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pillai, R.L.I., Covington, M., Visintainer, P.F. et al. Association of autism with lead poisoning in an environmental health clinic. Pediatr Res 94, 7–9 (2023). https://doi.org/10.1038/s41390-022-02408-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41390-022-02408-x

Search

Advanced search

Quick links