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Tylenol (Acetaminophen) Link to ADHD & Autism

Emerging research has uncovered a correlation between the use of Tylenol during pregnancy and neurodevelopmental disorders.

Tylenol is the most commonly recommended drug for pregnant women in need of pain relief and fever reduction. It is usually recommended as an alternative to non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil.

What is Tylenol?

Tylenol is a brand name for acetaminophen, also known as paracetamol throughout the world. Acetaminophen’s chemical name is N-acetyl para-aminophenol, or APAP for short. It is primarily prescribed as an analgesic (pain reliever) and antipyretic (fever-reducing agent). It is manufactured by McNeil Consumer Healthcare, a subsidiary of Johnson & Johnson.

What are the risks of Tylenol to mothers and their babies?

As many as 1 in 44

children in the United States is diagnosed with autism spectrum disorder (ASD) by the age of eight, and nearly nine percent of U.S. children have attention-deficit hyperactivity disorder (ADHD).

These numbers have been rising over the past several decades. Consequently, researchers have begun looking into prenatal factors in hopes of uncovering an explanation for the increases. So far, 26 studies have identified positive associations between acetaminophen exposure during pregnancy and neurodevelopment outcomes in the child.

Attention-Deficit Hyperactivity Disorder

Strong correlations between ADHD and prenatal acetaminophen exposure have been consistent among the studies.

The Journal of the American Medical Association published a 2014 study involving 64,322 mother-child pairs that demonstrated a 20 percent to 30 percent increase in neurodevelopmental disorders, especially ADHD and hyperkinetic disorder (HKD), a severe form of ADHD.

The study showed that acetaminophen crosses the placental barrier and noted a stronger association when acetaminophen was used in more than one trimester.

Authors of a 2021 study published in the European Journal of Epidemiology found that “children prenatally exposed to acetaminophen were 19 percent and 21 percent more likely to subsequently have ASC and ADHD symptoms within the borderline/clinical range, respectively, compared with non-exposed children.”

Johns Hopkins study funded by the National Institute of Health discovered that the highest levels of prenatal exposure to acetaminophen increased the risk for ADHD by 2.86 times compared to children with the lowest levels of exposure.

This study found an overall increased incidence of ADHD of 25 percent.

These results were consistent even when other maternal factors, such as substance abuse, body mass index and preterm birth, were considered.

The U.S. Food and Drug Administration acknowledges the link between ADHD and prenatal acetaminophen exposure.

What is ADHD?

Attention-deficit hyperactivity disorder is a neurodevelopmental disorder that is usually diagnosed during early childhood. It can continue into adulthood. While it is normal for children to have difficulty focusing occasionally, the issue does not improve in children with ADHD and may get worse. Symptoms include the following:

  • Difficulty paying attention
  • Poor impulse control
  • Frequent daydreaming
  • Forgetfulness
  • Excessive talking
  • Difficulty getting along with others
  • Frequent careless mistakes

Autism Spectrum Disorder

Prenatal acetaminophen exposure during pregnancy correlates to a 19 percent increase in ASD risk, according to a study involving 70,000 children. Children with the highest levels of prenatal acetaminophen exposure had a 3.62 times higher risk than children with the lowest levels of exposure.

What is ASD?

Autism spectrum disorder is a brain development disorder that impacts how a person perceives the world and socializes with others. This manifests as difficulties with social interactions and daily functioning. Symptoms occur on a spectrum from mild to severe and can include the following:

During infancy:
  • Lack of smiles or happy expressions by six months
  • Lack of babbling and cooing by 12 months
  • Lack of single words by 16 months
  • Lack of two-word phrases by 24 months
  • Loss of language or social skills at any age
Throughout childhood:
  • Social withdrawal and resistance to physical contact
  • Robot-like or sing-song speech
  • Poor eye contact and lack of facial expression
  • Repetitive movements, such as rocking or hand-flapping
  • Self-destructive activities, such as biting or head-banging
  • Unusual sensitivity to light, sounds or touch
  • Indifference to pain or temperature
  • Lack of make-believe play
  • Abnormal concentration or fixation on objects or details
  • Difficulty with coordination
  • Stiff or exaggerated body language
  • Repeating words or phrases but not understanding them
  • Difficulties in social interactions

Additional Risks

Prenatal acetaminophen exposure studies have uncovered additional risks, including the following:

  • Male urogenital and reproductive tract abnormalities
  • Early female puberty
  • Language delays in girls
  • Decreased IQ
  • Oppositional defiant disorder
  • Decreased executive function
  • Conduct disorders

How does acetaminophen cause harm?

Abnormal hormonal exposures during pregnancy have been shown to influence fetal brain development, and acetaminophen is a hormone disruptor. Hormone disruption can have the following effects on the fetus:

  • Stimulation of the endocannabinoid system, which regulates critical functioning such as learning, memory, emotional processing, eating and pain control
  • Oxidative stress due to inflammation-induced immune activation
  • Changes in neurotransmission

Are there safer alternatives to Tylenol?

The FDA warns pregnant women against taking ibuprofen, naproxen or other NSAIDs after the 20th week of pregnancy. Tylenol is still regarded as the safest option despite emerging evidence of neurodevelopmental risks for the baby. There are no medications that are 100 percent safe during pregnancy.

Recommendations During Pregnancy

When considering the use of medications during pregnancy, it is important to communicate with your physician and weigh the risks and benefits. In some cases, leaving a condition untreated could pose more serious risks to the developing fetus than acetaminophen or other medications.

Sometimes, medication is unavoidable. The following guidelines will help you protect your baby when medication is necessary:

  • Limit the use of acetaminophen to when it is medically necessary.
  • Consult your physician about whether acetaminophen is medically indicated and before using it long-term.
  • Use the lowest effective dose available and for the shortest time possible.

The FDA continues to monitor and evaluate the use of Tylenol and other pain medications during pregnancy. We at the Birth Injury Center will post updates regularly.

Legal Recourse if Your Child Has Been Impacted by Prenatal Tylenol Use

All patients have the right to be fully informed about the risks and benefits of any treatment they receive. This is called informed consent. Pregnant women are tasked with managing the health of two people—themselves and their babies—making informed consent all the more important.

When drugmakers and physicians recommend products without informing pregnant women of the potential risks, they cause irreparable damage. They, not you, are responsible for the resulting harm.

If you took acetaminophen because your doctor assured you it was safe but your child has developed ASD or ADHD, you may have legal recourse.