Fish But Not Supplements Consumed in Pregnancy Associated With Lower Rates of Autism Diagnosis And Related Traits, ECHO Cohort Study Finds

Authors: Emily Oken, Kristen Lyall, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Fish consumption during pregnancy provides an important source of omega-3 fatty acids, an essential nutrient for supporting child health and neurodevelopment. However, in the U.S., people who are pregnant or can become pregnant are not eating enough fish or get enough omega-3 fatty acids through diet or supplements. Few studies have explored prenatal fish consumption and supplement use in association with autism spectrum disorder (ASD) diagnosis or autism-related traits. This study aims to investigate the relationship between fish consumption or omega-3 supplement use and an ASD diagnosis or the presence of autism-related traits.

What were the study results?

Fish consumption during pregnancy was associated with a 20% lower likelihood of ASD diagnosis and fewer autism-related traits in offspring. The associations were somewhat stronger for female offspring. Taking fish oil supplements containing omega-3 fatty acids during pregnancy was not associated with an ASD diagnosis or autism-related traits. However, supplement use was associated with a slight increase in scores on the Social Responsiveness Scale (SRS), a widely used survey completed by parents or caregivers to report on their child’s possible autism-related traits.

What was the study's impact?

These findings are consistent with current dietary guidelines that support fish intake during pregnancy and support continued public health efforts to encourage fish intake.

Who was involved?

The participants were children born between 1999 and 2019 and their parents at three of the Environmental influences on Child Health Outcomes (ECHO) Cohort research sites. The sites selected from samples considered a higher likelihood for autism, either due to family history or preterm birth.

What happened during the study?

The researchers studied the relationship between maternal fish intake and omega-3/fish oil supplement use during pregnancy and the occurrence of clinician-diagnosed autism and parent-reported autism-related traits. These traits were measured using the Social Responsiveness Scale (SRS), a widely used survey completed by parents or caregivers. Fish consumption and supplement use were assessed based on self-reported dietary information from participants.

Note: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Future research could examine how chemical contaminants found in some fish could potentially influence child health and development. Additional studies could look at the relationship between self-reported data on fish consumption and supplement use during pregnancy, biological markers of fish consumption, and child health outcomes. Combining biological data and self-reported data could provide a more complete picture of the overall benefits of fish consumption during pregnancy.

Where can I learn more?

Access the full journal article titled “Association of Maternal Fish Consumption and Omega-3 Supplement Use During Pregnancy with Child Autism-Related Outcomes: Results from a Cohort Consortium Analysis” in the American Journal of Clinical Nutrition.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published September 2024

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Fish But Not Supplements Consumed in Pregnancy Associated With Lower Rates of Autism Diagnosis And Related Traits, ECHO Cohort Study Finds

Eating Fish But Not Omega-3 Supplements During Pregnancy Associated With Lower Likelihood Of Autism Diagnosis, NIH-Funded Study Finds

Posted on September 3, 2024August 27, 2025 by Jodi Snare

FOR IMMEDIATE RELEASE

Eating any amount of fish during pregnancy was associated with about a 20% lower likelihood of autism spectrum disorder (ASD) diagnosis, particularly in females, and a slight reduction in autism-related traits in offspring, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health.

However, researchers did not find the same association with supplements containing omega-3 fatty acids.

Fish is an important source of omega-3 fatty acids, an essential nutrient during pregnancy for supporting maternal health and child neurodevelopment. A recent analysis of ECHO Cohort data revealed that about 25% of the pregnant participants reported never eating fish or consuming it less than once a month during their pregnancy. Even fewer participants reported taking omega-3 fish oil supplements.

ECHO Cohort researchers wanted to see whether low fish consumption and omega-3 supplement use during pregnancy might be associated with the occurrence of an autism diagnosis or parent-reported autism-related traits.

“Our study contributes to a growing body of evidence that demonstrates the role that prenatal diet can play in autism-related outcomes in offspring,” said ECHO Cohort researcher Emily Oken, MD, MPH, of Harvard Medical School.

Dr. Oken said the findings underscored the need for better public health messaging about guidelines for fish consumption for pregnant women, considering the low fish intake in the U.S. and the rising diagnoses of autism.

What happened during the study?

Researchers analyzed data from about 4,000 participants, examining the relationships among fish intake, supplement use, and neurodevelopmental outcomes related to autism.

Fish consumption and omega-3 supplement use were measured with dietary information reported by participants. Participants’ fish consumption was categorized as less than once a month, more than once a month but less than weekly, weekly, and two or more servings per week. About 20% of adult participants reported no fish intake, and most reported not using omega-3 or fish oil supplements.

The researchers then looked at the relationship between maternal fish intake and omega-3 fish oil supplement use during pregnancy and the occurrence of clinician-diagnosed autism and parent-reported autism-related traits. These traits were measured using the Social Responsiveness Scale (SRS), a widely used survey completed by parents or caregivers. Higher scores on the SRS indicate the presence of more autism-related behaviors.

Consuming fish during pregnancy was associated with a lower likelihood of offspring being diagnosed with autism and a slight decrease in total SRS scores compared to not eating fish. These results were consistent across all levels of fish consumption, from "any" amount or "less than once per week" to "more than twice per week." No significant associations were found between omega-3 fish oil supplements and autism diagnosis compared to no use.

Experts recommend that people consume additional omega-3 fatty acids during pregnancy. Prenatal fish intake is a key source of omega-3 fatty acids that are critical for fetal brain development. However, fish and omega-3 fatty acid supplementation in the U.S. is low.

“This study provides yet more evidence for the safety and benefit of regular fish consumption during pregnancy,” said Dr. Oken. “Other proven benefits include lower risk for preterm birth and improved cognitive development.”

Dr. Oken led this collaborative research published in the American Journal of Clinical Nutrition.

Oken, E. & Lyall, K. (2024) Association of maternal fish consumption and ω-3 supplement use during pregnancy with child autism-related outcomes: results from a cohort consortium analysis. American Journal of Clinical Nutrition. 10.1016/j.ajcnut.2024.06.013

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About ECHO: Launched in 2016, the Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

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Weight Gain During Infancy in Children Born Preterm Associated with Higher Risk of Obesity, According to New ECHO Research

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Weight Gain During Infancy in Children Born Preterm Associated with Higher Risk of Obesity, According to New ECHO Research

Authors: Michael O’Shea, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Infants born preterm typically have a period of poor growth in their first few months. After this stretch, they typically exhibit “catch-up” growth defined by an increase in weight z-score—a measure to classify a child’s nutritional status—during childhood and adolescence.

Prior research suggested that a “trade-off” may be associated with catch-up growth, such that individuals with more rapid weight gain during infancy have better neurodevelopmental outcomes than individuals with less weight gain. However, rapid catch-up growth during infancy has also been associated with a higher risk of becoming overweight or obese.

This study can help inform evidence-based guidelines for managing infant nutrition and growth monitoring after infants born very preterm (prior to 32 weeks of gestation) are discharged from a neonatal intensive care unit (NICU), to support rates of growth less likely to contribute to childhood overweight and obesity.

What were the study results?

In comparison to infants with low weight gain after birth, infants with very high weight gain after NICU discharge, which was experienced by 13.6% of participants, had higher body mass index (BMI) scores and a higher risk of obesity at 12-48 months.

The study team found no evidence that very high weight gain after NICU discharge was associated with better neurodevelopmental outcomes at 12 to 48 months of age. However, infants with very low weight gain after NICU discharge had lower scores on cognitive and language assessments. No significant differences were found between girls and boys.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was this study's impact?

The study’s findings suggest possible benefits of close monitoring of post-NICU growth and healthier feeding practices to prevent obesity, which is associated with multiple adverse health outcomes. However, as single studies rarely provide sufficient evidence to change clinical practice, the authors note that the current study should not be the sole basis for such changes.

Who was involved?

This study involved 1,400 children born before 32 weeks of gestation in hospitals in multiple states in the U.S. between 2002 and 2020. A majority of these children experienced neonatal complications—issues faced during the first 28 days of life—the most common of which was neonatal chronic lung disease.

What happened during the study?

After birth, the participants were followed for 1 to 4 years, at which point their BMI and neurodevelopmental outcomes were assessed. Data about each of the participants were shared, with appropriate informed consent from a parent or guardian, with the ECHO Cohort Consortium. This allowed for analyses of relationships between weight gain following NICU discharge and neurodevelopmental outcomes and BMI at 1 to 4 years of age.

What happens next?

Future studies are needed to evaluate the relationship between the pace of weight gain during early childhood, long-term developmental outcomes, and changes in children’s BMI. This study focused on weight gain among infants born very preterm after discharge from the NICU. Additional studies are needed to observe the effects of different rates of catch-up growth on infants born closer to term.

Where can I learn more?

Access the full journal article, titled “Association of Growth During Infancy with Neurodevelopment and Obesity in Children Born Very Preterm: The Environmental influences on Child Health Outcomes Cohort,” in the Journal of Pediatrics.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published August 2024

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Weight Gain During Infancy in Children Born Preterm Associated with Higher Risk of Obesity, According to New ECHO Research

Harsh Parenting and High Socioeconomic Stress May Be Associated with Higher Internalizing Problems Like Anxiety in Children, ECHO Study Finds

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Harsh Parenting and High Socioeconomic Stress May Be Associated with Higher Internalizing Problems Like Anxiety in Children, ECHO Study Finds

Authors: Lue Williams, Veronica Oro, Leslie Leve, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Internalizing problems in childhood such as chronic internal distress may be early indicators of problems associated with disorders such as depression and anxiety. Internalizing by children can be influenced by biological and environmental factors, including parent-child relationships and socioeconomic status.

This study examined the relationship between two early childhood stress factors, harsh parenting and socioeconomic stress, and children’s development from childhood through adolescence. For this study, the researchers characterized harsh parenting, or “parental hostility” as non-supportive and controlling parenting practices, displays of anger and disappointment in children, and discipline through punishment. Socioeconomic stress reflects disadvantages associated with factors like household income. Few studies have examined early childhood predictors of internalizing behavior development, so this research fills an important gap by examining the role of diverse risk factors in early life, between the ages of 18 months and 5 years, on patterns of internalizing symptoms later in childhood. The study design, which used data collected from participants over a long period, also allowed the research team to explore the long-range impact of early life influences across critical stages of children’s physical, social, and psychological development.

What were the study results?

Researchers observed that, within the study sample, children fell into three main groups based on the severity of their internalizing behaviors and how those behaviors progressed with age: low, moderate-increasing, and higher-increasing. Some of the internalizing behaviors reported include feeling anxious or depressed, being withdrawn, and complaining of aches and sickness. Parents who reported more negative interactions with children in early childhood had children who were more likely to be in the group with the highest internalizing behaviors. Children with more socioeconomic stress in their households were also most likely to be in the highest internalizing behaviors group, as compared with both the low- and moderate-internalizing symptoms groups.

Researchers also observed that household socioeconomic stress directly predicted children’s mental health. Study investigators did not find any significant relationship between child sex assigned at birth and how likely they would be to show internalizing behaviors.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was this study's impact?

The findings from this study suggest that in addition to focusing on children’s symptoms when treating internalizing problems, health service providers may also wish to consider the broader context of caregiver behavior and access to resources for care.

Who was involved?

The study included two samples—a nationwide sample of 481 children who were adopted at birth and a sample of 1,053 children from six predominantly low-wealth, rural communities in eastern North Carolina and central Pennsylvania. Adopted children from the Early Growth and Development Study (EGDS) have lived in their adoptive homes since birth and were recruited into the study between 2003 and 2009. Children from the Family Life Project (FLP) were raised by their biological parents and were recruited into the study at birth, between September 2003 and 2004. Results may not be representative of the general population.

What happened during the study?

The researchers analyzed data collected from children and families that participated in the EGDS and FLP. EGDS children and families completed assessments approximately every nine months when adoptees were under the age of 3, and every one to two years after that. FLP participant families completed an initial home visit assessment when children were 2 months old and participated in annual assessments thereafter.

What happens next?

Future studies are needed to further support programming and research efforts by exploring mechanisms that underlie the relationship between socioeconomic stress, parenting styles, and children’s internalizing behaviors identified in the current study.

Where can I learn more?

Access the full journal article, titled “Influence of Early Childhood Parental Hostility and Socioeconomic Stress on Children’s Internalizing Symptom Trajectories from Childhood to Adolescence,” in Frontiers in Psychiatry.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published April 16, 2024

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Harsh Parenting and High Socioeconomic Stress May Be Associated with Higher Internalizing Problems Like Anxiety in Children, ECHO Study Finds

ECHO Researchers Study the Relationship Between Maternal Education and Children’s Neurocognitive Development Over Time

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ECHO Researchers Study the Relationship Between Maternal Education and Children’s Neurocognitive Development Over Time

Author: Santiago Morales

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Previous research has found a relationship between maternal education and children’s neurocognitive functions, but many of these studies have focused on early childhood. In addition, many previous studies have treated maternal education as something that doesn’t change over time. Few studies have explored whether a mother’s education level over the course of their child’s development might associate with neurocognitive function. ECHO researchers wanted to examine the relationship between changes in a mother’s education over time and their children’s later neurocognitive functioning, such as executive function and language skills.

What were the study results?

A mother’s education level during pregnancy and infancy was associated with children’s language and executive function. Increases in maternal education were related to improved language performance but were not associated with executive functioning performance.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

The study suggests that early maternal education is strongly associated with later child neurocognitive outcomes. In the study, changes in maternal education were also associated with some of these outcomes. These results suggest that further examining these associations can provide important insights that can help inform policies and interventions designed to foster neurocognitive development.

Who was involved?

The study included 2,688 children, adolescents, and young adults from 3 to 20 years of age at ECHO research sites in 42 states across the U.S.

What happened during the study?

Mothers reported their own education levels during pregnancy and their child’s infancy, and again, years later when their children’s neurocognitive functions were also assessed. For both periods, the study categorized the mother’s education level into one of five groups—less than high school; high school or GED equivalent degree; some college, associate degree or trade school; bachelor’s degree; and graduate degree. The same categories were used to measure maternal education during childhood. Maternal education and income are two commonly used indicators of socioeconomic status. However, missing income data in this study prevented investigators from fully assessing the impact of socioeconomic status and income on neurocognitive skills.

Researchers also measured child participants' cognitive abilities during childhood, adolescence, or young adulthood using the NIH Toolbox Cognition Battery. These tests assess aspects of cognition including language, memory, and problem solving. Test results created scores that reflected language skills, executive function, and overall brain function. The analysis included child participants who contributed at least one score.

What happens next?

While this study suggests an association between maternal education and a child’s neurocognitive function, this research doesn’t necessarily explain the factors or mechanisms involved in that association. Future studies might further explore these factors to provide additional insights.

Where can I learn more?

Access the full journal article, “Maternal Education Prospectively Predicts Child Neurocognitive Function: An ECHO Study,” in Developmental Psychology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published February 26, 2024

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ECHO Researchers Study the Relationship Between Maternal Education and Children’s Neurocognitive Development Over Time

ECHO Study Suggests Early Breastfeeding May Be Linked to Lower Risk of Childhood Obesity

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ECHO Study Suggests Early Breastfeeding May Be Linked to Lower Risk of Childhood Obesity

Authors: Gayle Shipp, Adaeze Wosu, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Obesity in kids is becoming more common around the world. When children have obesity, they often carry it into adulthood, affecting their long-term health outcomes. While previous studies have shown that breastfeeding may protect children against obesity and other chronic conditions, this relationship has not been studied much in women with obesity. ECHO Cohort researchers wanted to explore the possible link between breastfeeding practices in women with obesity and overweight prior to pregnancy and a child’s BMIz score. Researchers use BMIz scores to compare children’s height and weight to those of their peers while the more familiar BMI assesses body weight in relation to height.

What were the study results?

This study found that consistently breastfeeding infants in any amount during their first three months was associated with lower BMIz scores during early childhood (between the ages of 2 and 6) and a lower risk of childhood obesity, regardless of the mother’s pre-pregnancy BMI. This protective association appeared stronger for children with mothers who had obesity before pregnancy (BMI of 30 or higher) compared to those categorized as overweight (BMI between 25 and 29.9) during the same time.

Exclusive breastfeeding at three months was associated with a lower child BMIz score only among women with a pre-pregnancy BMI in the normal range. Each additional month of any or exclusive breastfeeding correlated with a significantly lower child BMIz, particularly for mothers categorized as overweight (in the case of any breastfeeding) or as having obesity (for any or exclusive breastfeeding) prior to pregnancy.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was this study's impact?

The results of this study highlight that each additional month of breastfeeding, whether a consistent amount or exclusive, may contribute to a lower weight later in childhood, especially for mothers who had obesity before pregnancy. Health professionals can use this study’s findings as an opportunity to encourage and promote breastfeeding among all women, especially those who have obesity.

Who was involved?

The study looked at BMI measurements from 8,134 pairs of mothers and kids at 21 study sites in 16 states and Puerto Rico.

What happened during the study?

The researchers calculated BMI and BMIz scores from measurements taken at study visits, medical records, or self-reported data for the mother and child. Additionally, the study examined two breastfeeding situations: whether the mother ever breastfed or whether the mother was exclusively breastfeeding the infant at 3 months old. This continuous breastfeeding measure included the duration of any breastfeeding allowing for formula or other food and the duration of exclusive breastfeeding with no formula feeding or other food.

What happens next?

Future research and public health prevention efforts could continue to focus on addressing disparities in breastfeeding duration and obesity among mothers that can affect child health outcomes.

Where can I learn more?

Access the full journal article titled “Maternal Pre-pregnancy BMI, Breastfeeding, and Child BMI” in Pediatrics.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published December 19, 2023

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ECHO Study Suggests Early Breastfeeding May Be Linked to Lower Risk of Childhood Obesity

ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

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ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

Authors: Claudia Lugo-Candelas, Tse Hwei, Seonjoo Lee, Cristiane Duarte, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Sleep difficulties are common in pregnancy. Poor prenatal sleep may relate to negative outcomes for both parent and child, including pregnancy complications and certain birth outcomes. The impact of poor prenatal sleep may also extend beyond pregnancy and birth and may increase the risk for neurodevelopment disorders in offspring, particularly attention-deficit/hyperactivity disorder (ADHD).

In this study, ECHO researchers aimed to study potential associations between poor prenatal sleep and an increased risk of ADHD symptoms and sleep problems in offspring.

What were the study results?

Prenatal sleep quality and duration, particularly in the second trimester, appeared related to children’s risk for ADHD, emotional reactivity, and sleep problems at age 4. Longer sleep duration in the second trimester was associated with fewer ADHD symptoms in children. Poorer sleep quality scores in the second trimester were associated with greater offspring ADHD symptomatology. Shorter duration and poorer quality of sleep during the second trimester were also associated with more sleep difficulties in children.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was the study's impact?

This study extends prior work by examining the associations between self-reported prenatal maternal sleep health and offspring ADHD symptoms in early childhood in a large, socio-demographically diverse sample in the U.S., including Puerto Rico.

Who was involved?

The research team used data from 794 mother-child pairs across five ECHO research sites. All enrolled pairs with available prenatal sleep and offspring ADHD assessments before age seven were included. The pregnant participants were between 27 and 37 years old.

What happened during the study?

Pregnant participants reported on their sleep during pregnancy using self-report questionnaires and reported on children's symptoms and behaviors when children were between 3 and 5 years old. The study assessed the children’s ADHD symptoms and associated characteristics using the Child Behavior Checklist Preschool Version, a widely used parent report that measures behavior problems in children.

What happens next?

Future studies are needed to replicate these findings, as well as investigate the possible mechanisms. Poor sleep may impact inflammation in pregnancy and offspring development, but studies have not examined that association.

Where can I learn more?

Access the full journal article, titled “Prenatal sleep health and risk of offspring ADHD symptomatology and associated phenotypes: A prospective analysis of timing and sex differences in the ECHO Cohort,” in The Lancet Regional Health - Americas.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published October 9, 2023

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ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood

Caregiver-Reported Measures of Childhood Behavior May be Biased by the Demographic Traits of Caregivers and Children

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Caregiver-Reported Measures of Childhood Behavior May be Biased by the Demographic Traits of Caregivers and Children

Authors: Shuting Zheng, Maxwell Mansolf, Somer Bishop, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Behavior problems observed in a young child can provide information on that child’s risk for certain developmental conditions and later mental health issues. A valid and unbiased measure of childhood behavior is critical for helping researchers and clinicians answer questions about the development of behavior problems in children from different backgrounds.

What were the study results?

Scores from the Child Behavior Checklist (CBCL) 1.5–5—a commonly used, caregiver-reported measure of internalizing (e.g., anxious) and externalizing (e.g., aggressive) behavior problems in children ages 1.5 to 5 years—may be biased by demographic factors such as the child’s age or the caregiver’s sex, education level, and primary language. Researchers found that caregiver responses for a number of questions on the CBCL were affected by caregiver or child demographic factors. The language (English vs. Spanish) the caregiver used to complete the survey contributed most to measurement bias, followed by their education level and sex. The child’s age and race also influenced CBCL scores.

By determining the factors contributing to measurement bias, ECHO researchers identified a subset of questions on the CBCL that were less impacted by bias but still reliably captured childhood behavior problems.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

The results of this study highlight the need to carefully consider possible sources of bias when using caregiver-reported measures. This study was the first to use a large, diverse sample of families to examine how demographic factors influence the answers given for individual survey questions in the widely used CBCL. Developing surveys with less bias can help researchers and clinicians better measure and compare behavior problems across groups of children who differ in age and family background.

Who was involved?

The study included caregivers of 9,087 young children (ages 18 to 71 months) from 26 ECHO research sites across the United States.

What happened during the study?

The researchers used data from 26 ECHO research sites to evaluate how caregiver responses to the CBCL varied based on the characteristics (age, sex, race, bilingual status, and neurodevelopmental disorders) of the child and the characteristics (sex, education level, household income level, and depression diagnosis) of the caregiver. Researchers then selected the CBCL questions that showed the least amount of bias and compared how well this subset of questions worked for evaluating childhood behavior problems when compared to the full CBCL survey. Additionally, the researchers mapped the scores from the less biased question sets to the scores provided by the full item sets, allowing them to derive comparable scores to the original CBCL scale.

What happens next?

ECHO researchers plan to apply the newly identified subset of less biased CBCL survey questions, evaluating its reliability in identifying children with clinically significant behavior problems. The identification of question sets with little bias offers researchers and clinicians better alternatives for measuring and comparing behavior problems across groups of children who differ in age and family background.

Where can I learn more?

Access the full journal article, titled “Measurement Bias in Caregiver-Report of Early Childhood Behavior Problems across Demographic Factors in an ECHO-wide Diverse Sample,” in the Journal of Child Psychology & Psychiatry Advances.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published September 29, 2023

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Caregiver-Reported Measures of Childhood Behavior May be Biased by the Demographic Traits of Caregivers and Children

Prenatal Depression May Be Linked to Autism-Related Traits in Children

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Prenatal Depression May Be Linked to Autism-Related Traits in Children

Authors: Lyndsay A. Avalos, Lisa A. Croen, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health supported this research.

Why was this study needed?

Previous research suggests an association between prenatal depression or a history of depression prior to pregnancy and autism spectrum disorder (ASD) in children, but most studies have focused on a formal ASD diagnosis, rather than autism-related traits. Studying social communication and other autism-related traits can help researchers and clinicians understand how prenatal depression may be associated with these traits present in children at varying levels without a formal diagnosis. This is critical because autism‑related traits can impact children’s physical, social, and psychological development, regardless of whether they receive a clinical diagnosis.

What were the study results?

Children of mothers with prenatal depression had slightly more autism-related traits compared to those without. The association was similar among boys and girls. Prenatal depression also increased the likelihood of moderate to severe autism-related traits, indicating a higher likelihood of ASD diagnosis.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study adds to the understanding of how prenatal depression may be associated with neurodevelopment in children, such as social communication and behavioral characteristics that may not reach a clinical threshold but can still impact a child’s social and behavioral functioning. These findings highlight the need for early ASD screening for children whose parents had prenatal depression to promote early intervention and support their healthy development. Mental health screening and prevention efforts for depression in pregnant individuals could also be beneficial.

Who was involved?

The study involved 33 prenatal and pediatric research sites with information on depression in birth parents and autism-related traits in children. The primary analysis included 3,994 parent-child pairs with prenatal depression diagnosis data; a secondary analysis included 1,730 parent-child pairs with depression severity data.

What happened during the study?

Researchers measured the incidence and severity of prenatal depression and assessed autism-related traits using the Social Responsiveness Scale (SRS) for children up to 12 years of age.

What happens next?

While this study didn’t explore the reason for the association between autism-related traits in children and prenatal depression in mothers, future research may analyze parent and child genetic data to clarify whether certain genes increase the likelihood of depression and autism-related traits, or what other factors affect the findings.

Where can I learn more?

Access the full journal article, titled “Prenatal Depression and Risk of Child Autism-Related Traits Among Participants in the Environmental influences On Child Health Outcomes Program,” in Autism Research.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published August 1, 2023

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Prenatal Depression May Be Linked to Autism-Related Traits in Children

Shortened Social Responsiveness Scale (SRS) Observed to be Comparable to Full SRS in Autism Risk Factor Estimation

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Shortened Social Responsiveness Scale (SRS) Observed to be Comparable to Full SRS in Autism Risk Factor Estimation

Authors: Marisa Patti, Kristen Lyall, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

The Social Responsiveness Scale (SRS) is a questionnaire used to measure social communication and autism spectrum disorder (ASD)-related traits. Researchers have developed a shortened version of the SRS, which included only 16 questions out of the original 65. This shortened version is intended to provide a very similar summary of behaviors and traits as the longer version but takes less time to complete.

As a new tool, the short SRS has been previously tested to ensure that it measures autism spectrum-related traits. However, it was not clear prior to this study if the short SRS can measure associations in epidemiologic analyses of autism spectrum risk factors in the same way as the full SRS so that research findings can be comparable across studies using both versions. In other words, do scores from both the short and long versions suggest the same associations? Or does shortening the SRS reduce our ability to detect risk factors due to differences in measurement? In this study, the authors tested associations with an established risk factor for autism diagnosis, preterm birth, or gestational age, to see if patterns were consistent across versions.

What were the study results?

Younger gestational age and preterm birth were associated with higher full SRS scores. The same associations were seen with short SRS scores. These associations are also consistent with associations seen for autism diagnosis, suggesting the ability of both the full and short SRS to detect risk factor associations.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

Gathering meaningful information for research studies can be a lengthy and time-consuming process for participants. This study shows that in some studies information collected using shorter assessments can be as useful as that captured using longer assessments, helping to reduce the time participants spend answering questionnaires.

Who was involved?

The study included 2,760 child-parent pairs from 11 different research sites within the ECHO Program. Participating children were between 2.5 and 18 years in age. The study sample included participants from research sites drawn from the general population, pre-term birth research sites, and familial-autism research sites, the last consisting of participants with a child diagnosed with autism.

What happened during the study?

Researchers collected caregiver-reported responses from both the full and shortened SRS. Information on gestational age and pre-term birth were collected from maternal reports on standardized questionnaires and from medical records.

What happens next?

Future studies are needed to investigate how comparable estimates are between the full and short SRS using other types of risk factors, such as genetic factors, and in other study populations. Researchers may also consider using the short SRS in future studies as an efficient measure of social behaviors.

Where can I learn more?

Access the full journal article, titled “A Comparative Analysis of the Full and Short Versions of the Social Responsiveness Scale in Estimating an Established Autism Risk Factor Association in ECHO: Do we Get the Same Estimates?” in the Journal of Autism and Developmental Disorders.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published July 22, 2023

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Shortened Social Responsiveness Scale (SRS) Observed to be Comparable to Full SRS in Autism Risk Factor Estimation