No Neurotoxicants
for Me, Please!
Toxic Exposures and Developmental
Disabilities: What’s the Connection?
Laura Abulafia, Director
Environmental Health Initiative
American Association on Intellectual and Developmental
Disabilities
AAIDD’s Environmental
Health Initiative
• Raise awareness about the complex
connections between exposure to
neurotoxic chemicals and
developmental disabilities
• Raise awareness that those living with
developmental disabilities may be
more likely to suffer secondary health
effects than individuals without
disabilities
Overarching Theme
• Disability is a natural phenomenon
of the human condition
• Disability due to toxic chemical
exposure is not natural,
unnecessary, and most importantly
- preventable
The Concern
• Many toxic exposures cause
developmental disabilities
• Toxic exposures exacerbate
the health of persons living
with a developmental
disabilities
Concept of
Environmental
Exposure is Changing
Old paradigm….
Chemical exposures
happen at the factory, on
the farm
New …
Everyone carries a “body
burden” of toxic chemicals
In their blood, urine,
fat………..and breast milk
Courtesy: J. Peterson Myers, Environmental Health Sciences
A Child’s Widespread Exposure
d
Chemical Milieu Proven Harm (EtOH, Pb, Hg, PCBs,
DES, DDT, Dioxins, Thalidomide)
.
2-3,000 new
. chemicals each year
2,863 chemicals
> 1 million lbs/year
80,000+ registered
.
chemicals
Are Developmental
Disabilities on the Rise?
• Researchers estimate that between 3 and
8 percent of the babies born in the US
each year will be affected by
neurodevelopmental disorders
• Higher rates of DD among blacks 24.3 /
1000 versus 13.6 / 1000 for whites.
• Incidence of LBW on the rise
• The number of children with disabilities,
ages 3-21, served in the public schools
under the Individuals with Disabilities
Education Act (IDEA) Part B in Fall 2003
was 6,068,802 (in the 50 states, D.C., and
outlying areas).
Unknown Causes
• 60% of cases of intellectual
disabilities the causes are unknown
• 4 categories of etiological factors
can occur before, during, or after
birth:
– genetic disorders,
– chromosomal disorders,
– biological and organic causes, and
– environmental causes
The Developmental
Disabilities Community
A Vulnerable population?
A Vulnerable Population?
• Behavioral
• Physical
• Social
• Economic
Just because an individual has
a developmental disability does
not mean they are more
vulnerable to toxic exposures
Population-level
Unique Behavioral
Attributes
• Pica
• Hand to mouth activity
• Mouth or Chew on
objects
• Continue Mouth
Breathing
• Self-restrict Diet
Special Concerns of the
DD Community
• Use of special cups, bottles , or
eating utensils rather than
glass or metal
• Sit for long periods in a car
seat, special adaptive
equipment, or wheelchair seat
• Spend longer periods of time
indoors year round
Special Concerns of the
DD Community
• Be predisposed to respiratory
illness such as asthma or
reactive airway disease
• Be unable to remove oneself
from irritating fumes
• Have difficulty communicating
symptoms of exposure or
context of exposure to others
Physical and Neurological
Vulnerabilities
• Altered mobility and
compromised body systems.
• Pharmaceuticals
• Preventative health behaviors/
lifestyle factors
Mobility
• Require assistance when washing
hands
• Require assistance to move away
from irritating fumes
• Spend long periods of time indoors
year round
• Crawl, sit, lie on the floor when
indoors
Lifestyle Factors
• 23% of people with disabilities
exercise 20 minutes 3 days/week
• 32% of with disabilities smoke
• 52% of adults with disabilities aged
21-64 are employed
• Pharmaceutical use
Communication Skills
• Have difficulty communicating
how an exposure occurred
• Have difficulty communicating
symptoms of exposure
• Have difficulty connecting
exposure to symptoms
Health Disparities of DD
Population
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Depression Diabetes* Hypertension Obesity
Non DD DD
* per 1,000
Where are People
Exposed?
Risks at School, At Work
• Hazardous chemicals in schools:
– mold, cleaning supplies, products
used in employment settings, art
supplies
– AAIDD resource on Toxic exposures
in schools at www.aaidd.org/ehi
under Fact Sheets
Exposures in Schools
• Students with Disabilities are a special “at risk” population for
the harmful effects of exposures to environmental hazards at
school.
• Children in general are more vulnerable than adults to toxins
due to their smaller body size and faster metabolic rate.
Compared to their classmates, children whose immune
systems are compromised due to chronic health problems are
even more “at risk” immunologically to environmental
exposures in the classroom.
• Schools have many hazards. When a child with an intellectual
or developmental disability (IDD) sits at a desk that has been
treated with disinfectants and is in environmental conditions
with poor ventilation systems, the child may be more
vulnerable to adverse health outcomes. Poor indoor air quality
(IAQ) can impact the comfort and health of students and staff,
which, in turn, can affect concentration, attendance, and
student performance.
Exposures in Schools
How might the environment pose a health
risk?
Parents often worry about dangers such as drugs and
violence but they are not aware of significant hazards such
as toxic chemicals. Schools often are—
◗ built on contaminated land or near an industrial,
commercial, or municipal site (e.g., chemical plant, airport,
freeway, or landfill) that releases toxic chemicals into the
air and surrounding community daily;
◗ routinely sprayed with toxic pesticides to kill pests (e.g.,
ants, cockroaches, or rodents),
contaminating carpets and floors
and leaving toxic pesticide residue
throughout the sprayed area (e.g.,
on toys, supplies, and other items
children may access)
Exposures in Schools
How might the environment pose a health
risk?
◗ regularly applying weed killer and toxic
fertilizers throughout school grounds,
exposing children to residues as they play
sports, use playground equipment, or
traverse the campus;
◗ poorly maintained and cleaned, providing
habitats for pests, molds, and allergens,
and allowing toxic residues to accumulate;
and
◗ subject to poor air quality, due to
overcrowded classrooms, improper
ventilation of portable and makeshift
classrooms, and outdated, inefficient
heating and ventilation systems.
Why would a school ever be
sited on contaminated land?
• Money
– Contaminated land is cheap because it is unsuitable for
housing and most types of businesses
– School Districts seek out cheap land due to declining
school budgets and rising unfunded mandates (e.g. No
Child Left Behind)
– Urban school districts skimp on cleaning up
contaminated sites to save more money
• Availability of land
– School Districts in rural areas look to site schools on
cheap unused agricultural land contaminated with
pesticides
– Urban school districts often have few siting choices due
to shortage of undeveloped land and turn to abandoned
industrial sites
Water-damaged Ceiling Tiles : Picture
Courtesy of MDPH, Bureau of
Environmental Health Indoor Air Quality
Program
Damaged/Soiled Filters in Air Handling Unit:
Picture Courtesy of MDPH, Bureau of Environmental Health
Indoor Air Quality Program
Where Are People Exposed?
In Your Home
• It has been estimated that Americans
spend over 90% of their time indoors
( ALA, 2006, EPA 2006)
• Human exposure to pollutants is
influenced by both outdoor and indoor air
(Janssen et al, 2005)
• Pollution indoors is created from both
outdoor air coming inside and from
products and behavioral practices inside
the home
Risks in the Home
• Lead paint from older, deteriorating
housing
• Contaminated drinking water
• Pesticide exposure from foods and
home spraying
• Mercury
• Contaminated indoor air from ETS
radon, carbon monoxide,
household products
Common Household
Exposures
• Lead
• Mercury
• Radon
• Carbon Monoxide
• Pesticides
Lead in Homes
• 74% of homes built before 1980 contain lead
based paint (CDC, 1991)
• In adults, low dose cumulative lead exposure
is inversely associated with scores on
cognitive function tests ( Weisskopf et al,
2004, Shih et al, 2006)
• In non-occupationally exposed adults, blood
and bone lead levels are associated with
increased systolic blood pressure
(Bener, 2001, Cheng et al 2001, Glenn et al
2003, Martin et al 2006)
Household Exposures of
Mercury
• Medical thermometers,
BP cuffs, thermostats,
fluorescent lights.
• Dietary sources - Fish
Carbon Monoxide
Exposure
Pesticides
Household pesticides are
designed to kill by being
toxic to the nervous or
reproductive systems
Many commonly
available household
pesticides can be rapidly
absorbed through the
lungs and skin
A study done on
children in Mexico
exposed to multiple
pesticides, including
organophosphates,
organochlorines, and
pyrethroids, versus
children not exposed.
Effects of Common
Household Pesticides
Source: Beyond Pesticides http://www.beyondpesticides.org/lawn/factsheets/30health.pdf
X = adverse effect demonstrated
Cleaning Products
Sodium Chlorine Asthmatic and
Hypochlorite Bleach respiratory
Ammonia Glass Eye irritant,
Cleaner headaches
lung irritation
Nitrobenzene Furniture - Shallow
floor polish breathing,
vomiting
birth defects
Cleaning Products
Phenol Disinfectants Diarrhea
Cresol fainting
Dizziness
Perchloroethylene Spot remover Ingested –
111 trichloroethane Carpet liver & kidney
cleaner A carcinogen
Hydrochloric acid Toilet bowl Skin irritant
Sodium acid sulfate cleaner Ingested:
vomiting
diarrhea
Indoor Air and Dust
• 2-5 times more polluted than
outdoor air – Ventilate
• Polybrominated dipheyl ethers
(PBDEs) (Brominated Flame
Retardants)
• Phthalates
• Perfluorinated Organics
(PFOA/PFOS)
• Report: Sick of Dust: Chemicals in
Common Products – A Needless
Health Risk in Our Homes
Volatile Organic
Compounds
• General short term acute health effects of
exposure to these compounds cause respiratory,
eye and throat irritation, loss of coordination and
dizziness, and exacerbation of asthma and
respiratory conditions (EPA, 2006)
• Long term health effects of some of these VOCs
are cancer, liver, kidney and CNS damage (EPA,
2006)
• In a study of children, home formaldehyde
exposure was associated with increased risk of
allergic sensitization to other common allergens (
Garrett et al, 1999)
Air Freshener Use
Not daily
Continuous 23%
32%
4-6 times per 1-3 times per
day day
4% 41%
PCB Exposure
Developmental Effects
Infant
– Birth weight
– Head circumference
– Performance on Brazelton Neonatal Behavioral
Assessment (BNBA) - motor immaturity, inc. startle
Early Childhood
– Memory, attention, verbal ability, information
processing
– Delayed psychomotor development; changes in play
behavior
– Hyperactivity
Preteen
– Word and reading comprehension
– Full scale and verbal IQ
– Memory and attention
Reducing Pesticide
Usage
• Consider integrated pest
management strategies first.
• Consider the implications of
routine spraying
of all residential
homes.
Integrated Pest
Management (IPM)
A program of prevention,
monitoring and control which
offers the opportunity to
eliminate or reduce pesticides
in schools and to minimize the
toxicity of and exposure to any
products which are used.
Least Toxic Pesticides
• Boric acid and disodium
• Silica gels
• Diatomaceous earth
• Nonvolatile insect and rodent
baits
• Microbe-based pesticides
• Some essential oils
Cleaning Products
Alternatives
• BioShield
• Ecover
• Naturally Yours
• Seventh Generation
• Earth Friendly
• Bi-O-Kleen
• Bon Ami
Cleaning Products
Alternatives
• The Internet
• Whole Foods
• Trader Joe’s
• Wild Oats
• Natural Food Markets
Reduce Exposure to
PCBs
• Eat lower on the food chain
• Cut fat from meat and chicken
• Low fat and lean hamburger
• Eat more vegetables, fruits and
grains
Organic Foods
• Produced without the use of
synthetic fertilizers, pesticides,
herbicides, hormones or
antibiotics
• Certified OF are not irradiated
and do not contain genetically
modified organisms
Organic Food Sales
• Since 1997 growth of 17 to 21%
each year. In 2003 $10 Billion
• Represent 2% of US food sales
• Airlines (Delta)
• School lunches (CA)
• www.theorganicpages.com
• www.theorganicreport.org
• www.localharvest.org
• www.eatwellguide.com
Boric Acid
Boric acid (100%) powder is
odorless and non-staining.
Kills:
• Roaches • Bedbugs
• Termites • Fleas
• Fire ants • Boxelder bugs
• Palmetto bugs • Earwigs
• Ticks • Grasshoppers
• Carpet Beetles • Millipedes
• Centipedes • Scorpions
• Crickets • Slugs
Lindane Lice Treatment
• Known Neurotoxicant
• Similar to DDT and PCBs
• Banned in California
• Causes nervous system, liver
and kidney damage; seizures
or even death
Reduce Contaminants in
Indoor Air and Dust
• Ventilate
• Damp Mop
• Vacuum
• Hepa Filters
Avoid Nicotine
• Quit smoking
• No smoking during pregnancy
• If you smoke, smoke outdoors
• Second-hand smoke
Alcohol and Solvents
• Paint, lacquers, varnish, carpet
spot removers, glues and
thinners
• Use a face mask and goggles
• Use less toxic alternatives
• Citrus based cleaners
• Water-based paints Baking
soda and vinegar
Reduce Mercury
Exposure
• Avoid tuna and swordfish
• Follow Fish Advisories
www.epa.gov/ostwater/fish
• Avoid vaccines containing
thimerosal
• Properly dispose of mercury
thermometers and alkaline
batteries
Healthy Fish-Healthy Families
Wallet Guide
Defining a Framework of
Action
1. Be informed and know the
specific sources of risks
2. Prioritize –which problem
poses the greatest threat
3. Start small
4. Do the doable
Action and Advocacy
In order to minimize • Through education
health disparities and teaching on the
individual level
for people with
• Program development
developmental and primary
disabilities there prevention strategies
needs to be an at the community
increase in focus level
on the effect of • Advocacy,
the physical empowerment and
policy development at
environment on the regulatory level.
health.
The Precautionary
Principle
• "When an activity raises threats of
harm to human health or the
environment, precautionary measures
should be taken even if some cause-
and-effect relationships are not fully
established scientifically." from the
January 1998 Wingspread Statement
on the Precautionary Principle
Precautionary Principle
• Burden of Proof
• Innocent until proven guilty
• Organic agriculture, nontoxic
products, classes of chemicals
AAIDD Environmental
Health Initiative
For more information visit the AAIDD
website at www.ehinitiative.org
Thank You!