Children's Voice July/August 2007

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Poisonous Predator

Lead is gone from gasoline and paint but continues to pose danger to kids, particularly in older neighborhoods.

By John Pekkanen

Jonathan Harrison is 8 years old and has no friends. He struggles to read and do basic arithmetic.

"No one likes me," he tells his mother. "I just want to die."

A little boy with somber brown eyes, Jonathan began life with promise. He weighed 10 pounds at birth, walked at 1, began speaking before 2, and always seemed to be smiling, recalls his mother, Connie Royster. "Jonathan was a beautiful baby, happy all the time. He was a child anyone would want."

Born in October 1997, Jonathan lived the first 10 months of his life in Fort Washington, Maryland. Then the family moved to the District of Columbia, renting a turn-of-the-century house.

Jonathan did the things little boys do. He played with trucks, watched Sesame Street, went shopping with his mother. But around age 2, his personality changed. He became temperamental and hard to control--almost a different child.

"Jonathan cut all the cables in the house," his mother says. "To the TV, VCR, to everything. Cut them to pieces." The mother of three older children, Royster knew Jonathan's behavior was not normal, even for the terrible twos.

She took Jonathan to a Kaiser health clinic and was surprised when tests revealed a blood-lead level of 20 micrograms per deciliter (mcg/dl)--twice the "action level" for lead poisoning established by the Centers for Disease Control and Prevention (CDC). A repeat test put the level at 22 mcg/dl.

Like most lead-poisoned children, Jonathan exhibited no physical symptoms. But his mother, a DC native and registered nurse, knew of lead's toxicity to the brain and believed his high level explained his behavior change.

Notified of Jonathan's lead poisoning, the DC Department of Health sent inspectors to the home, where tests detected lead in the interior paint and paint dust. Royster remembered occasionally removing paint chips from Jonathan's mouth when he was a toddler and how he liked to play and crawl in the corner room where all the windows let sunlight in. Leaded dust often results from the opening and closing of windows.

The health department ordered Jonathan and his family not to live in the house until a lead-abatement contractor, to be hired by the landlord, rehabbed the house. The abatement was supposed to take three months but lasted six.

Kaiser doctors referred Jonathan to a pediatric neurologist and a psychiatrist at Children's National Medical Center, where Jonathan was diagnosed with attention deficit/hyperactivity disorder (ADHD). Doctors prescribed two drugs--one for ADHD, and one to prevent Jonathan from sleepwalking. The medication helped calm Jonathan for periods of time, but when it wore off he sometimes threw tantrums and became impulsive and aggressive.

At age 4, while riding the Metro subway with older brother Gregory, Jonathan bolted out at a station just as the doors opened. Gregory, now 20 and a junior at the University of the District of Columbia, ran after him, yelling, "Move, move," as he pushed aside incoming passengers. He found Jonathan on the Metro platform, laughing.

One day Jonathan set his mother's bed on fire.

"I knew Jonathan did not act in any way like my other children or like any child I ever knew," Royster says. "He was getting more and more uncontrollable, and there didn't seem to be anything anyone could do to stop it."

Toxic Legacy

Variations of Jonathan's story occur too often in this country. Hundreds of children are harmed by lead poisoning every year in Washington, DC. Nationwide, 310,000 children under age 5 are lead-poisoned each year, according to CDC; the World Health Organization (WHO) reports up to 18 million are harmed worldwide.

What is remarkable about lead poisoning is how destructive it has been to children and society over many decades, yet how slowly we are working to eliminate it.

This disconnect persists despite scientific evidence of lead's harm that goes back centuries and is as convincing as that linking cigarette smoking to lung cancer. Lead is a powerful neurotoxin. From the turn of the 20th Century to the 1970s, thousands of children died from acute lead poisoning, many misdiagnosed with TB or other illnesses.

Although a child died of lead poisoning in Minneapolis last year, lead now seldom kills children; it only damages their brains, and the damage is irreversible. Scores of studies link childhood lead exposure to diminished intelligence, school failure, behavioral disorders, violence, and criminality.

Lead exposure offers a largely unexamined explanation for some of what continues to go wrong in this country.

"Lead's impact on public health and social functioning is such that I think in a hundred years we will look back and recognize that lead, tobacco, and air pollution were the choleras and typhoids of the 20th Century," says Bruce Lanphear, one of the country's top lead researchers.

Carl Shy, Professor Emeritus of Epidemiology at the University of North Carolina, told WHO, "The mining and production of lead and lead products is the mistake of the 20th Century."

Some people assume lead poisoning went away with the total ban on leaded gas in 1995, 23 years after its phaseout began and almost 50 years after lead was first added to gasoline as an antiknock agent. National health surveys in the 1970s had revealed high lead levels among children and adults but showed a 75% decrease by 1991. As the tide of childhood lead poisoning ebbed, there were declarations of victory; a 1995 Atlantic Monthly article hailed America's "triumph over lead."

But lead poisoning remains the most significant environmental- health disease of children; it's especially prevalent among inner-city kids. Even though environmental lead levels caused by gasoline have dropped, lead poisoning is a pressing issue now because we've discovered much more about its capacity for human harm.

Children from all levels of society are at risk of lead poisoning, but those at the bottom, who are more apt to live in older, poorly maintained housing, are most often harmed. African American children have two and a half times the risk of white children, and Latino children about one and a half times the risk, according to CDC. Ellen Silbergeld, Professor of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health, refers to this as the "ghettoization" of lead poisoning.

In DC, as in other cities, some children grow up in lead traps. They may drink lead-contaminated water from their taps. They play in, and sometimes eat, lead-contaminated soil in their yards and playgrounds, a decades-old legacy from leaded-gasoline automobile exhaust and lead paint. They inhale lead-paint dust and eat lead-paint chips in their homes. Children living near waste sites breathe lead particles from the burning of batteries, computers, and other leaded products.

Lead can harm children before birth: It leaches from the bones of expectant mothers exposed during their own childhoods and crosses the placental barrier to enter the fetal brain. The May 2006 issue of Environmental Health Perspectives confirmed earlier findings that very low lead exposure during gestation may cause "lasting and possibly permanent effects" on a child's cognitive development.

The toxic legacy of early lead exposure extends into adulthood. Analyzing census and health-survey data on more than 20,000 Americans, Silbergeld, and Mark Lustberg of the University of Maryland, reported in 2002 in Archives of Internal Medicine that more than 29 million adult Americans may be at increased risk of premature death because of lead exposure in the 1970s, before the use of leaded gas began to drop. The authors found that premature mortality occurred at lead levels above the current CDC action level of 10 mcg/dl and rose sharply as the levels went higher. When childhood lead levels reached 30 mcg/dl, adult cancer deaths increased 68%.

Early lead exposure is also linked to vascular and kidney disease, hypertension, Alzheimer's disease, stroke, and diabetes.

Houses of Poison

The greatest risk of lead exposure today comes from housing stock built before 1978, the year the federal government, after earlier restricting the amount of lead in paint, eliminated it entirely. Up until 1950, paint used in houses contained as much as 50% lead by weight. Even though it may have been put on 60 or more years ago and painted over many times since, old paint remains a hazard. If the newer paint chips off, the old paint can, too.

Lead-paint dust and chips appeal to children because they taste sweet, and even a dime-size chip of pre-1950 lead paint contains enough lead to poison a 2-year-old. Toddlers are especially vulnerable because their brains are developing. Like Jonathan, they crawl on the floor and put all manner of things in their mouths. In fact, lead poisoning is most prevalent in 1- and 2-year-olds, the ages kids are most apt to put their fingers in their mouths after crawling on floors with lead-paint dust.

The U.S. Department of Housing and Urban Development estimates that 38 million American housing units contain lead-based paint, and more than half are in dilapidated condition. CDC estimates 90% of American preschoolers with elevated blood-lead levels live in pre-1978 housing. Children are especially sensitive to lead's harmful effects in part because their stomach and intestines absorb up to 50% of ingested lead, whereas adults absorb about 10%. Children deficient in certain nutrients, especially iron and calcium, are even more disposed to absorbing lead.

In DC, according to the best estimates, about three-fourths of the housing stock was built before 1978. Although housing in the Washington suburbs is generally newer and freer of lead contamination, suburban children are not immune, especially when lead dust is generated during renovations of older homes.

The Brain Drain

Until the 1970s, lead poisoning was defined by a blood-lead level of 60 mcg/dl, six times the current action level--and then only when there were overt symptoms such as anemia, stomach ailments, convulsions, and seizures. By 1991, when it was clear that children were harmed at much lower lead levels, CDC lowered its threshold to 10 mcg/dl.

"Lowering the threshold to 10 was a very important step in public health," says Jerome Paulson, Codirector of the Mid-Atlantic Center for Children's Health and the Environment. "But no one should have assumed that kids with blood-lead levels below 10 were safe."

Studies by Lanphear and others have found that children's brains are impaired at lead concentrations of 5 mcg/dl--half the CDC's standard--and lower. This came to light recently, Lanphear explains, "because until the last decade, we couldn't find children with levels low enough to study them in this way." Lanphear says this evidence proves there is no such thing as a safe level of lead exposure for children.

Children with lead levels below 10 mcg/dl are not considered lead-poisoned by city or state health departments or CDC, so no official numbers exist on children damaged by supposedly harmless levels. But lead researchers believe many more children have been harmed by lead levels below the action level. A reasonable estimate is that a million or more mostly minority children nationwide are at risk each year of preventable cognitive or behavioral impairments from lead exposure, perpetuating what Silbergeld calls "the social tragedy of lead poisoning in the United States."

This may help explain why so many urban schools have so many young children who don't meet academic standards and why more than half of young African American men do not finish high school. In DC, 90% of fourth graders do not read at grade level; some 11,000 District youngsters are in special-education programs. Only 1 in 4 DC high school freshmen graduates from high school.

Blame is assigned to educators, parents, and students themselves, but it may well be that lead has so impaired the brains of many young urban children that they cannot succeed in school.

A 2002 study of school failure, A Strange Ignorance, conducted by analyst Michael T. Martin for the Arizona School Boards Association, said of lead: "The fact that most 'failing schools' are in low-income neighborhoods where children live in housing known to be laced with a brain damaging neurotoxin is not just a coincidence."

An Uncertain Future

Jonathan became more aggressive as he grew older. In a swimming pool, he pushed his brother Gregory's girlfriend's head underwater and held it there as she struggled to break free. As she reached the surface gasping for air, Jonathan laughed.

At a shopping mall with Gregory, Jonathan waited at the door for a woman walking in. He suddenly slammed the door against her, pinning her between the door and the frame. She screamed, but Jonathan kept pushing on the door until Gregory pulled him away and freed the woman.

"You don't know from one second to the next what Jonathan will do," says Gregory, who has great affection for his little brother. "He can be sitting next to you quietly watching TV, and the next second shove popcorn in your face and try to start a fight. With Jonathan, you always have to expect the unexpected."

Jonathan's half-sisters, both in their 20s, told their mother they're afraid to take Jonathan on outings because he dashes into the street. His mother says he can't be trusted to tell the truth.

Jonathan throws things without provocation. His mother says she cannot allow Jonathan to be around a younger child if no adults are present. "If he's alone with young kids, he'll hurt them."

Jonathan once told his mother if he had a gun he would shoot his father. When she asks why he says and does these things, he answers, "I don't know why. I just do them." Jonathan often paces until daybreak. He's been prescribed sleeping medication, but his mother uses it sparingly. "I don't want to turn him into a zombie."

Jonathan resists going to school and taking ADHD medication, so Royster, who works part time to be home with him, grinds it up and puts it in applesauce. Jonathan's father, Clayton, a teacher at the elementary school Jonathan attends, no longer lives with Royster but often arrives in the morning to take his son to school. Royster says Jonathan has had violent outbursts at school.

"The fact that his father teaches at that school and helps with Jonathan is why Jonathan is still there," Royster says. "Otherwise, I think the school might have already expelled him."

On medication, Jonathan is cooperative with his teachers and friendly to his classmates. He can be affectionate and loving to his family. But neither medication nor the group therapy he attends with his mother has diminished his emotional eruptions when the medication begins to wear off.

Royster, who gave birth to Jonathan when she was 43, despairs for his future and her own. "He keeps getting bigger and stronger," she says, "and I keep hoping he'll get better, but the older he gets, it seems, the worse he gets."

This article was excerpted and adapted, with permission, from the August 2006 issue of Washingtonian magazine. A Contributing Editor with Washingtonian, John Pekkanen has been writing about health and medicine for three decades. For more information about lead poisoning and advocacy efforts, visit the Coalition to End Childhood Lead Poisoning at www.leadsafe.org.
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