Perceived Stress During Pregnancy Associated with Autism-related Traits in Children, ECHO Study Finds

Authors: Luke Grosvenor, 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?

Many mothers experience higher levels of stress and other mental health challenges during pregnancy. Previous studies have found that pregnancy stress may be associated with increased risk of autism spectrum disorder (ASD) in children, but these studies have mostly focused on the occurrence of isolated adverse or stressful events that occur in the mother’s life during pregnancy. Fewer studies have measured general perceived stress among mothers during pregnancy. This study examined the potential association between perceived stress during pregnancy and autism-related traits in children and evaluated how that association may differ according to the child’s sex or the mother’s experience of depression during pregnancy.

What were the study results?

Higher perceived stress during pregnancy was associated with slightly more severe autism‑related traits in children. At higher prenatal perceived stress levels, children showed slightly higher scores on tests measuring social and behavioral traits related to autism. Children whose mothers had either moderate or high categorical stress scored higher than those whose mothers reported low or no stress. The link between pregnancy stress and autism‑related traits did not differ between boys and girls. The relationship between prenatal stress and autism‑related traits remained consistent even when the researchers accounted for mothers’ co-occurring prenatal depressive symptoms.

What was the study's impact?

Stress during pregnancy is normal and common to experience. While the results of this study indicate that there may be a small association between pregnancy stress and autism-related traits, they do not imply that stress during pregnancy causes autism spectrum disorder or autism-related traits to occur in children.

Who was involved?

The study included 4,115 mother–child pairs from 20 ECHO Cohort Study Sites across the United States. Children ranged in age from about 2.5 to 18 years old.

What happened during the study?

Mothers reported their stress levels during pregnancy using a standard questionnaire. Later, parents reported on their children’s autism-related traits using a validated survey. Researchers analyzed the data using statistical models that accounted for factors such as child age, sex, and study site.

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 happens next?

Future studies could help researchers better understand the specific periods in pregnancy when stress may have the greatest association with child health and development and how other related social and emotional factors may influence this effect.

Where can I learn more?

Access the full journal article, titled “Associations between Prenatal Perceived Stress and Child Autism-Related Traits in the ECHO 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 March 2, 2026

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Perceived Stress During Pregnancy Associated with Autism-related Traits in Children, ECHO Study Finds

Exposure to Certain Flame-retardant Chemicals During Pregnancy May Be Linked with Decreased Cognitive Function in Young Children, ECHO Study Finds

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Exposure to Certain Flame-retardant Chemicals During Pregnancy May Be Linked with Decreased Cognitive Function in Young Children, ECHO Study Finds

Authors: Akhgar Ghassabian, 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?

Organophosphate esters (OPEs) are chemicals widely used as flame retardants and plastic softeners in a variety of household and industrial products, and previous studies suggest they can affect child brain development. With increasing human exposure to these chemicals, especially during sensitive periods like pregnancy, there has been concern about the potential impact on child cognitive development. Previous studies have found mixed results, highlighting the need for a large, contemporary cohort study to clarify these associations and examine possible sex differences.

What were the study results?

When pregnant women had higher urine levels of diphenyl phosphate (DPHP), a compound produced during the breakdown of certain OPEs in the human body, their children tended to have slightly lower scores on tests of mental skills at ages 4–6. This pattern was seen in boys and girls. Boys whose mothers had higher levels of certain other chemicals linked to OPE exposure during pregnancy scored higher on these tests, but this was not true for girls. This finding was unexpected, so more research may be needed to understand the biological mechanism underlying this association.

What was this study's impact?

Results from this large contemporary cohort of mother–child pairs in the U.S. suggest that OPE exposure during pregnancy may be associated with minor decreases in cognitive functioning in children. Considering that DPHP is a widely detected marker of OPE exposure in the U.S. population, the overall impact of this effect may be significant.

Who was involved?

The study included 831 mother–child pairs from three ECHO Cohort Study Sites in the United States. The study population was predominantly non-Hispanic White and highly educated, which may limit generalizability.

What happened during the study?

Pregnant participants provided urine samples for measurement of nine OPE chemicals. Researchers assessed child mental skills using standardized intelligence scales when children were between 4 and 6 years old. Researchers then used statistical analyses to examine associations between OPE exposure and childhood cognition.

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 happens next?

Additional studies could help researchers better understand the biological pathways underlying these associations. Additional studies could also help clarify the association between some chemical markers of OPE exposure and higher cognitive scores among boys.

Where can I learn more?

Access the full journal article, titled “Prenatal exposure to organophosphate ester flame retardants and child cognition: findings from the environmental influences on child health outcomes cohort,” in Environmental Pollution.

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

Published February 1, 2026

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Exposure to Certain Flame-retardant Chemicals During Pregnancy May Be Linked with Decreased Cognitive Function in Young Children, ECHO Study Finds

PFAS Exposure During Pregnancy Not Associated with Behavior Issues in Children, ECHO Study Finds

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PFAS Exposure During Pregnancy Not Associated with Behavior Issues in Children, ECHO Study Finds

Author(s): Catherine Bulka, Rebecca Fry, 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?

Per- and polyfluoroalkyl substances (PFAS) are a class of thousands of man-made chemicals used in some consumer and industrial products like cookware, stain-resistant fabrics, and foams used to fight fires. These substances are often referred to as “forever chemicals” because they don’t break down easily, causing them to build up in water, soil, and air. Previous findings on the effects of prenatal PFAS exposure on child behavior have been inconclusive due to small sample sizes, limited exposure variability, and differing measures of child behavior. This study looked at the relationship between PFAS exposure during pregnancy and child behavior using harmonized measurements collected from many mother-child pairs from across the United States.

What were the study results?

Most of the PFAS detected in pregnant mothers were not clearly linked to behavior problems in their children overall. Children whose mothers had medium levels of exposure to perfluorohexane sulfonate (PFHxS) during pregnancy showed more emotional problems, like being easily upset or withdrawn, especially when they were preschoolers. However, this pattern was not seen at very high or low levels of PFHxS exposure. There were no strong connections between PFAS exposure before birth and behavior problems when the children were older (school-age). Looking at combined exposures to multiple PFAS also did not show any clear relationship with child behavior.

What was the study's impact?

While most PFAS showed no association with behavioral problems, some suggestive, non-linear relationships emerged, indicating that these exposures may influence brain development in complex and unexpected ways. Overall, the study did not find strong or steady links between PFAS exposure during pregnancy and child behavior problems. More research may be needed, especially about newer PFAS replacement chemicals and exposures that happen after birth.

Who was involved?

The study included children from nine ECHO Cohort study sites across the U.S., including 1,723 preschool-age children (1.9-5.9 years) and 627 school-age children (6-15 years).

What happened during the study?

During the study, researchers measured PFAS levels in blood samples collected from mothers between 2- and 42-weeks’ gestation. Later, the researchers assessed children’s behavior using the Child Behavior Checklist (CBCL) when they were preschool- or school-aged. They then used statistical methods to evaluate potential associations between prenatal exposure to PFAS and PFAS mixtures and child behavioral 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 happens next?

Future studies could help researchers assess the effects of PFAS exposures during the postnatal period, which may be a more relevant window for childhood brain development and behavioral issues. Additionally, as some PFAS are being phased out of consumer products and replacements are emerging, future studies could help researchers understand the potential effects of exposures to these newer replacement chemicals.

Where can I learn more?

Access the full journal article, titled “Prenatal Exposure to Per- and Polyfluoroalkyl Substances: Association with Child Behavior in the Environmental influences on Child Health Outcomes (ECHO) Cohort,” in Environment International.

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

Published September 5, 2025

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PFAS Exposure During Pregnancy Not Associated with Behavior Issues in Children, ECHO Study Finds

Toddler Emotional and Behavioral Problems Decreased Slightly During Pandemic, ECHO Study Finds

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Toddler Emotional and Behavioral Problems Decreased Slightly During Pandemic, ECHO Study Finds

Authors: Lauren Shuffrey, Anahid Akbaryan, 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 COVID-19 pandemic disrupted family patterns and children’s environments, both of which play a role in early brain development. Early childhood is a period of rapid brain growth and increased sensitivity to environmental influences, making the early social environment important for children's health and well-being. Previous research raised concerns about the development of infants born during the pandemic, but there is limited evidence on how the pandemic affected the behavioral and emotional well-being of toddlers. In this study, researchers wanted to look at the association between growing up during the pandemic and behavioral outcomes in toddler-aged children.

What were the study results?

The study found that children who experienced the pandemic had fewer emotional and behavioral problems compared to children born and assessed before the onset of the pandemic, based on results from the Preschool Child Behavior Checklist (CBCL). Specifically, their scores for internalizing problems, such as anxiety or sadness, were about 1.5 to 2 points lower, and their scores for externalizing problems, such as aggression or hyperactivity, were about 1.7 to 3.2 points lower than those born and assessed before the pandemic.

Although these differences were small, researchers report that they were consistent. The study also found that these links between growing up during the pandemic and lower emotional and behavioral problems were significantly stronger for children whose mothers did not have a bachelor’s degree.

What was the study's impact?

The study suggests that toddler-age children may have shown resilience despite the disruptions of the pandemic. These findings could help identify potential protective factors that could have buffered the impact of the pandemic on child behavior and inform future interventions to support children's well-being during and after global crises.

Who was involved?

The study included 3,438 toddlers (average age of 2 years) across the U.S. and Puerto Rico. Researchers grouped children based on when they were born and when they were assessed: before the pandemic, born before but assessed after March 2020, or both born and assessed during the pandemic.

What happened during the study?

During the study, researchers compared young children’s behavior and emotions before and during the pandemic using data from the ECHO Cohort collected between September 2009 and July 2023. Parents filled out the Preschool CBCL, a commonly used tool to assess the child’s emotions and behaviors, like anxiety, sadness, or hyperactivity. Researchers then analyzed these results to see how the pandemic may have affected children’s emotional and behavioral well-being.

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 happens next?

Further research could help researchers identify potential protective factors that may have promoted resilience among children whose daily life was disrupted by the COVID-19 pandemic.

Where can I learn more?

Access the full journal article, titled “COVID-19 pandemic exposure and toddler behavioral health in the ECHO Program,” in JAMA Network Open.

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

Published September 3, 2025

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Toddler Emotional and Behavioral Problems Decreased Slightly During Pandemic, ECHO Study Finds

Exposure to Common Flame-retardant Chemicals During Pregnancy May Be Associated with Behavioral Issues in Young Children, ECHO Study Finds

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Exposure to Common Flame-retardant Chemicals During Pregnancy May Be Associated with Behavioral Issues in Young Children, ECHO Study Finds

Author(s): Jiwon Oh, 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?

Organophosphate esters (OPEs) are chemicals commonly used as flame retardants and plastic softeners in a variety of household and industrial products, including furniture, electronics, infant products, and fabrics. Previous research has linked exposure to OPEs during pregnancy with potential adverse effects on child brain development, but more evidence is needed. In this study, researchers investigated the association between prenatal exposure to OPEs and child behaviors.

What were the study results?

Among the nine OPEs measured, diphenyl phosphate (DPHP) was detected in almost all pregnant women (99.5%) and had the highest median concentration. Other frequently detected OPEs included dibutyl phosphate/di-isobutyl phosphate (DBUP/DIBP), bis (1,3-dichloro-2-propyl) phosphate (BDCPP), bis(2-chloroethyl) phosphate (BCETP), bis(2-butoxyethyl) phosphate (BBOEP), and bis(1-chloro-2-propyl) phosphate (BCPP).

Prenatal exposure to BBOEP (at moderate concentrations rather than high concentrations) was associated with more internalizing behaviors (e.g., anxiety, depression, emotional reactivity), externalizing behaviors (e.g., aggression, inattention), and total behavior issues in young children. Exposure to BCPP was associated with more externalizing behaviors and total behavior issues. In contrast, detectable dipropyl phosphate (DPRP) was associated with slightly fewer externalizing behaviors. Boys showed more behavior issues associated with prenatal BDCPP and BCPP exposure. Children from highly vulnerable neighborhoods—defined by community-level demographics, socioeconomic status, housing, access to transportation, and other factors—exhibited more behavior issues associated with prenatal BCPP exposure.

What was the study's impact?

Use of OPEs is increasing, with widespread exposure observed in pregnant women. While further research is needed, this study suggests that reducing exposure to certain chemicals during pregnancy may help mitigate emotional and behavioral problems in young children.

Who was involved?

The study included 2,948 mother–child pairs from 12 ECHO Cohort study sites across the United States. Non-Hispanic White (40.2%), non-Hispanic Black (28.6%), and Hispanic (21.3%) mothers were included in the study. Most participating mothers (85.2%) did not experience major pregnancy complications and most of their children (93.2%) were born after at least 37 weeks of pregnancy.

What happened during the study?

During the study, researchers collected urine samples from pregnant participants and analyzed them for nine chemical markers of OPE exposure. Later, researchers assessed the child’s behaviors using the Child Behavior Checklist for Ages 1½–5. The researchers then used statistical methods to examine associations between each OPE exposure during pregnancy and behavioral issues in children. The study also evaluated how other factors, like the child’s sex and their social vulnerability, may have influenced the effect of prenatal OPE exposure on their behavior.

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 happens next?

Future studies could help researchers better understand the effects of prenatal OPE exposure on child brain development and determine whether reducing these exposures could be beneficial to children’s health and development.

Where can I learn more?

Access the full journal article, titled “Prenatal Exposure to Organophosphate Ester Flame Retardants and Behavioral Outcomes in Early Childhood in the Environmental influences on Child Health Outcomes (ECHO) Cohort,” in Environment International.

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

Published August, 2025

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Exposure to Common Flame-retardant Chemicals During Pregnancy May Be Associated with Behavioral Issues in Young Children, ECHO Study Finds

Prenatal Exposure to Phthalates, But Not Phthalate Replacements, Linked to Children’s Behavior, ECHO Study Finds

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Prenatal Exposure to Phthalates, But Not Phthalate Replacements, Linked to Children’s Behavior, ECHO Study Finds

Author(s): Jiwon Oh, 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?

Phthalates are widely used chemicals that make plastics more flexible. During pregnancy, these chemicals can cross the placenta and may affect brain development. Although exposure to some phthalates has decreased over the past two decades, these chemicals and their replacements—such as DINCH and DEHTP—are still common, and little is known about their effects on children’s brain development. In this study, researchers examined many chemicals that form when the body breaks down phthalates and other plasticizers to see if exposure to these chemicals during pregnancy might be associated with behavioral problems in young children, including emotional reactivity, anxiety, depression, aggression, and attention problems.

What were the study results?

Researchers found that higher levels of two phthalate metabolites, mono-benzyl phthalate (MBzP) and mono-hexyl phthalate (MHxP), during pregnancy were associated with small to modest increases in externalizing behaviors (aggression and attention problems) in children aged 1.5–5 years. They did not find strong links between phthalate exposure and internalizing behaviors (emotional reactivity, anxiety, and depression), or between prenatal exposure to the phthalate replacement DINCH and any behavioral outcomes. The impact of these chemicals varied between boys and girls and depended on the neighborhood where the children lived. Some chemicals had stronger associations in kids from neighborhoods with more resources, while others were more impactful in areas with fewer resources.

What was the study's impact?

The study suggests that prenatal exposure to certain phthalates, but not to the alternative chemical DINCH, may be associated with increased externalizing behaviors in young children.

Who was involved?

Participants included 2,617 mother–child pairs from 13 ECHO Cohort study sites. Children’s behaviors were assessed at ages 1.5–5 years, and maternal urine samples were collected mostly during mid- to late-pregnancy.

What happened during the study?

During the study, prenatal maternal urine samples were analyzed for 27 chemical markers of phthalate exposure and six markers of exposure to non-phthalate replacements. Later, the children's behaviors were assessed using the Child Behavior Checklist for Ages 1½–5 (CBCL/1½–5). The researchers then used statistical methods to explore how levels of specific chemicals in the pregnant women’s body were linked to behaviors like emotional reactivity, anxiety, depression, aggression, and attention problems, and whether these links differed by child sex and neighborhood opportunity.

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 happens next?

Future studies could show how much pregnant women are exposed to di-n-hexyl phthalate (the parent compound of MHxP) and its effects on children’s brain development across different populations. Researchers may also study how different newer plasticizers affect brain development by looking at more recent participants and testing samples taken from mothers at several stages during pregnancy.

Where can I learn more?

Access the full journal article, titled “Prenatal exposure to phthalates and alternative plasticizers and emotional and behavioral outcomes in early childhood in the Environmental influences on Child Health Outcomes (ECHO) Cohort,” in Environment International.

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

Published August, 2025

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Prenatal Exposure to Phthalates, But Not Phthalate Replacements, Linked to Children’s Behavior, ECHO Study Finds

Prenatal Exposure to Air Pollution Associated with Higher Risk for Autism-related Outcomes, ECHO Study Finds

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Prenatal Exposure to Air Pollution Associated with Higher Risk for Autism-related Outcomes, ECHO Study Finds

Author(s): Heather Volk, Akhgar Ghassabian, 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?

Air pollution is a significant environmental health concern and contributes to many illnesses and early deaths worldwide. Ambient air pollution can have detectable effects on the brain. Recent studies show that being exposed to air pollution during pregnancy and early life can affect how a child’s brain develops. This can happen through several pathways, such as causing inflammation in the brain, disrupting hormones, or changing how genes work. Previous research has suggested potential links between air pollution and neurodevelopmental disorders, but the relationship between exposure to air pollution, even at low levels, during pregnancy and ASD has been unclear. This study examined the associations between prenatal air pollution exposure and autism spectrum disorder (ASD) in children.

What were the study results?

The study team observed that higher prenatal exposure to ozone was associated with autism-related traits and increased risk of ASD diagnosis. Exposure to fine particulate matter (PM_2.5) and nitrogen dioxide was also associated with a higher risk of autism, but associations varied by geographical regions. There was little evidence for differences between boys and girls in the association between prenatal air pollution exposure and autism outcomes.

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's findings suggest that even low levels of air pollution exposure during pregnancy might be associated with autism-related outcomes. This highlights the importance of understanding the risks associated with air pollution exposure during pregnancy and its effects on child neurodevelopment.

Who was involved?

The study involved 8,035 mother-child pairs from 44 ECHO study sites across the United States. This sample included over 1,000 child participants who were potentially at higher risk for ASD due to being born preterm or having siblings with autism. The remaining participants were recruited from samples representative of the general population.

What happened during the study?

This study looked at scores from the Social Responsiveness Scale (SRS), a parent-report tool that measures autism-related traits in children, with higher scores indicating higher autism-related traits. During the study, researchers estimated daily exposure to particulate matter, nitrogen dioxide, and ozone at the residential addresses of pregnant women. They then analyzed the associations between these air pollutants and autism-related traits using the Social Responsiveness Scale (SRS) and physician-diagnosed ASD.

What happens next?

The study results suggest that even small changes in prenatal air pollution exposure could have a significant impact on child neurodevelopment. Future studies are needed to understand why these connections exist and to look at the impact of specific air pollution components.

Where can I learn more?

Access the full journal article, titled “Prenatal Air Pollution Exposure and Autism Spectrum Disorder in the ECHO Consortium,” in Environmental Health Perspectives.

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

Published June 11, 2025

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Prenatal Exposure to Air Pollution Associated with Higher Risk for Autism-related Outcomes, ECHO Study Finds

Prenatal Exposure to Organophosphate Esters Associated with Increased Autism-Related Outcomes, ECHO Study Finds

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Prenatal Exposure to Organophosphate Esters Associated with Increased Autism-Related Outcomes, ECHO Study Finds

Author(s): Jennifer Ames, 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?

Organophosphate esters (OPE) replaced harmful polybrominated diphenyl ethers (PBDEs) as flame retardants and plastic softeners in the mid-2000s. They are now present in various household and industrial products, including polyurethane foam, furniture, electronics, construction materials, infant products, textiles, and fabrics. Health officials and researchers currently know little about how OPEs affect child development. Earlier studies have suggested a link between prenatal exposure to these chemicals and birth outcomes and cognitive and behavioral problems in children. This study investigated the potential effects of prenatal exposure to nine OPEs on child autism-related outcomes.

What were the study results?

The study found generally small associations between three OPEs and child autism-related outcomes. Specifically, high exposure to bis(butoxyethyl) phosphate (BBOEP) was associated with higher scores for autism-related traits and greater odds of autism diagnosis. Another OPE, bis(1-chloro-2-propyl) phosphate (BCPP) showed associations with higher autism-related trait scores. High exposure to bis(2-chloroethyl) phosphate (BCETP) was associated with lower odds of autism diagnosis. The study also found that the association between BBOEP and higher autism-related traits scores was stronger in boys than in girls.

What was the study's impact?

This study underscores the need to better understand and address the potential developmental toxicity of these widely used chemicals.

Who was involved?

The study included 4,159 mother-child pairs with children born from 2006 to 2020 from 15 study sites in the ECHO Cohort.

What happened during the study?

Researchers analyzed urine samples from pregnant mothers for nine OPE biomarkers. The researchers then assessed child autism-related traits via the Social Responsiveness Scale (SRS) and collected information on whether they received a clinical autism diagnosis to examine associations between prenatal OPE exposure and child neurodevelopment.

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 happens next?

Future research could replicate these findings in different populations and use multiple measures of OPEs throughout pregnancy to better understand the critical exposure windows and long-term effects of OPEs on child neurodevelopment. Additionally, further studies could help researchers explore the potential sex-specific effects of prenatal OPE exposure.

Where can I learn more?

Access the full journal article, titled “Exposure to organophosphate ester flame retardants and plasticizers during pregnancy and autism-related outcomes in the ECHO Cohort,” in Environmental Health Perspectives.

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

Published June 11, 2025

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Prenatal Exposure to Organophosphate Esters Associated with Increased Autism-Related Outcomes, ECHO Study Finds

Executive Functioning May Be Connected to Child Health Behaviors, ECHO Cohort Study Suggests

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Executive Functioning May Be Connected to Child Health Behaviors, ECHO Cohort Study Suggests

Author(s): Nichole Kelly, Derek Kosty, Leslie Leve et al.

Who sponsored this study?

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

Why was this study needed?

Executive functioning refers to the cognitive processes that relate to a person’s ability to shift attention (cognitive flexibility), control impulsive actions (behavioral inhibition), and remember multiple pieces of information while solving a problem (working memory). Studies with adults suggest that lower executive functioning is related to less engagement in health-promoting behaviors, which increases risk for chronic disease. This study aimed to understand how these three domains of executive functioning relate to health behaviors in different age groups (early childhood, middle childhood, and adolescence). The goal was to inform more specific and developmentally tailored intervention strategies that target executive functioning to improve health behaviors and ultimately reduce chronic disease risk in children.

What were the study results?

Across all age groups, children with higher working memory also had more health-promoting eating behaviors, such as less frequent intake of sugary drinks and saturated fats. In middle childhood, children who showed more cognitive flexibility and behavioral inhibition also ate more fruits and vegetables and engaged in more physical activity. In adolescence, children with higher scores in all three executive function domains reported more engagement in physical activity. Researchers did not find significant connection between child sleep and executive functioning in this study.

What was the study's impact?

The results of this study can help researchers and clinicians plan better interventions that target children’s executive functioning to improve their health behaviors and, ultimately, their risk for chronic disease. For example, the results of this study suggest that early intervention targeting children’s working memory may help improve their dietary behaviors throughout childhood. However, associations with executive functioning observed in this study were small, so other interventions may be needed to support families in developing health-promoting behaviors. Additionally, because this study looked at this association at only one point in time for each child, it isn’t clear whether executive functioning influences health behaviors or vice versa.

Who was involved?

The study included children and their parents/caregivers from 38 ECHO Cohort Study Sites across 78 locations in the U.S. and Puerto Rico. Children from three life stages participated in the study: 2,074 in early childhood (age 5–8 years), 3,230 in middle childhood (age 8–12 years), and 1,416 in adolescence (age 12–18 years).

What happened during the study?

During the study, participating children completed computer tasks to measure their executive functioning. Participants also shared details about their diet, physical activity, and sleep through parent- and/or child-reported questionnaires. Additionally, information on income, positive parenting, neighborhood crime, and greenspace was collected.

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 happens next?

To continue identifying the best health intervention strategies, researchers could continue to explore how executive functioning relates to health behaviors by collecting data on how these effects change over time.

Where can I learn more?

Access the full journal article, titled “Children’s executive functioning and health behaviors across pediatric life stages and ecological contexts,” in the Journal of Behavioral Medicine.

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

Published January 9, 2025

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Executive Functioning May Be Connected to Child Health Behaviors, ECHO Cohort Study Suggests

Black Children and Especially Black Girls May Be Less Likely to Receive an Autism Diagnosis

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Black Children and Especially Black Girls May Be Less Likely to Receive an Autism Diagnosis

Authors: Kristen Lyall, Bob Joseph, 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?

Research suggests that autism spectrum disorder is diagnosed less often in minority groups, possibly due to limited access to healthcare, potential biases, and delays in diagnosis. This study explored how sociodemographic factors like race, ethnicity, and education relate to autism diagnoses and parent-reported autism-related behaviors. Researchers wanted to learn whether these factors showed similar patterns in diagnosis and behavior scores and whether they might help explain why some children are less frequently diagnosed.

What were the study results?

The study found that non-Hispanic Black children had lower odds of receiving an autism diagnosis compared to non-Hispanic White children, despite similar levels of autism-related traits. Additionally, Black girls were less likely to be diagnosed with autism but more likely to have high SRS scores, indicating potential under-recognition of autism in this group. Separately, higher maternal education was also associated with reduced odds of both autism diagnosis and autism-related traits, as measured by the Social Responsiveness Scale (SRS).

What was the study's impact?

The study highlighted potential differences in how autism is recognized in children, particularly among non-Hispanic Black children. The results suggest a need to address clinical inequalities and consider ways to ensure accurate identification of autism across all sociodemographic groups.

Who was involved?

The study included 8,224 children from diverse backgrounds, with data gathered from 46 ECHO sites across the United States.

What happened during the study?

The study used data from the ECHO Cohort to examine relationships between demographic factors, autism diagnoses, and parent-reported autism-related traits. Researchers focused on two main outcomes—autism diagnoses and scores on the Social Responsiveness Scale (SRS), a parent-report questionnaire capturing autism-related traits. They used statistical methods to compare associations between sociodemographic characteristics and the likelihood of autism diagnosis and high SRS scores. The goal was to understand whether these factors influenced the two outcomes differently.

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 happens next?

Additional research could address strategies to reduce barriers to diagnosis and consider increased screening for minority and low-education groups. Efforts to help doctors and healthcare providers better recognize autism in underserved communities and ensure equitable access to diagnostic resources may improve early diagnosis and reduce disparities in care.

Where can I learn more?

Access the full journal article, titled “Demographic Correlates of Autism: How Do Associations Compare Between Diagnosis and a Quantitative Trait Measure?,” 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 January 8, 2025

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Black Children and Especially Black Girls May Be Less Likely to Receive an Autism Diagnosis