ECHO Study Suggests Children with Autism Are More Likely to Experience Emotional & Behavioral Challenges Like Anxiety, Depression, & ADHD

Authors: Heather E. Volk, 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?

The study aimed to understand how common behavioral and emotional problems are in children with autism spectrum disorder (ASD), using a large national group of participants and looking at differences between boys and girls. It also explored whether children with greater difficulties in social communication related to ASD tend to have more behavioral and emotional challenges.

What were the study results?

Children with ASD had higher scores on the Child Behavior Checklist (CBCL)—a questionnaire that helps identify emotional and behavioral problems in children and adolescents. Higher CBCL scores among children with ASD indicate a possible connection to greater emotional and behavior problems overall—including depression, anxiety, and ADHD—compared to children without ASD. Conversely, higher CBCL scores were strongly linked to the likelihood of receiving an ASD diagnosis, especially for children scoring in the top 30%. Among children with ASD, girls showed significantly higher levels of anxiety and depression compared to boys, with differences depending on their age. As autism-related traits measured by the Social Responsiveness Scale (SRS) increased, CBCL scores also rose, suggesting that children with more autism-related traits might also experience other emotional or behavioral challenges.

What was the study's impact?

This study suggests that increased monitoring of behavioral and emotional problems may be beneficial for children with ASD. The results of this study indicate that children with ASD may be more likely to experience these issues throughout their early life.

Who was involved?

The study included 7,998 children from 37 ECHO Cohort Study Sites across the United States. This included 553 children who had a clinician diagnosis of ASD, including 432 boys and 121 girls.

What happened during the study?

The study surveyed parents of children aged 2.5 years to 18 years to collect information about their child's demographics, ASD diagnoses from a doctor, and scores from two behavior assessments: the SRS and the CBCL. Researchers compared average CBCL scores, which measure emotional and behavioral problems, based on whether the child had ASD and whether they were male or female. They also used statistical methods to see if children with ASD were more likely to have higher CBCL scores and to understand how SRS scores related to CBCL scores.

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 help researchers understand what kinds of support and interventions could be effective for children with ASD, who may be more likely to experience emotional and behavioral challenges.

Where can I learn more?

Access the full journal article, titled “Co-occurring Psychopathology in Children with and without Autism Spectrum Disorder (ASD): Differences by Sex in the ECHO Cohorts,” in 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 January 6, 2025

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ECHO Study Suggests Children with Autism Are More Likely to Experience Emotional & Behavioral Challenges Like Anxiety, Depression, & ADHD

ECHO Cohort Study Finds Amount of Time Spent in Childcare Not Associated With Mental Health Risks in Young Children, Including Those Facing Family Challenges

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ECHO Cohort Study Finds Amount of Time Spent in Childcare Not Associated With Mental Health Risks in Young Children, Including Those Facing Family Challenges

Authors: Michelle Bosquet Enlow, 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?

Children who face early life adversity—such as parental mental illness and household economic hardship—may be at a higher risk for mental health difficulties. Researchers in this study wanted to examine the extent to which attending out-of-home childcare might buffer or magnify the effects of those experiences.

In the U.S., many children under age 5 spend some time in nonparental childcare. However, previous findings on the role of childcare in child mental health have produced mixed results. While many studies highlight positive associations with attending childcare, some raise concerns that childcare may increase the risk for poor child developmental outcomes.

What were the study results?

The study found that children with higher exposure to factors such as family stress and mental illness were more likely to have higher levels of internalizing symptoms (such as anxiety or depression) and externalizing symptoms (such as aggression and hyperactivity), especially if their families also faced socioeconomic hardship. However, researchers also found that the number of hours in childcare did not seem to change the effects of these risks on children’s mental health, nor was childcare attendance significantly associated with improvement or worsening of their symptoms overall. This was true whether they looked at all types of non-parent childcare that were included in the study—including center-based care, home-based non-relative care, and care by a relative—or looked at just center-based care.

What was the study's impact?

The study found that the amount of time spent in childcare didn’t have a clear positive or negative effect on children’s mental health. The findings suggest that challenges like social or emotional stressors and financial hardships should be looked at separately to better understand the risks to children’s mental health in early life.

Who was involved?

The participants in the study were a diverse sample of 2,024 parent-child pairs from three ECHO Cohort Study Sites. Participants were recruited from hospitals in North Carolina, Pennsylvania, and Tennessee, as well as from U.S. adoption agencies across the United States.

What happened during the study?

The study collected data on the type and frequency of childcare attendance from birth to age 3 years. It also looked at early life challenges during that time, such as whether parents had experienced difficult childhood events, showed signs of depression, or had certain factors like age, education, or relationship status that could affect their child’s well-being. Between ages 3 and 5.5 years, the study evaluated children’s symptoms such as anxiety, depression, aggression, or hyperactivity. By following these children over time, researchers could explore the associations among early adversity, childcare attendance, and child mental health outcomes.

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 work could examine how and whether childcare quality is associated with child mental health, including whether high-quality care may be associated with a reduction of any adverse effects of early adversity on child outcomes.

Where can I learn more?

Access the full journal article titled “The Influence of Early Childhood Education and Care on the Relation between Early Life Social Adversity and Children’s Mental Health in the Environmental influences for Child Health Outcomes Program” in Development and Psychopathology.

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

Published December 2024

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ECHO Cohort Study Finds Amount of Time Spent in Childcare Not Associated With Mental Health Risks in Young Children, Including Those Facing Family Challenges

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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ECHO Study Finds Children with Autism at Higher Risk for a Range of Diverse Health Outcomes

Authors: Elizabeth Kaplan-Kahn, Kristen Lyall, Heather Volk, 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?

Approximately 3% of children in the United States have a diagnosis of autism spectrum disorder (or autism). A large proportion of autism research focuses on understanding the factors that influence the development of autistic traits. However, many people on the autism spectrum report that they would rather prioritize research into the factors that influence their overall health and well-being. This study addresses that priority by investigating the physical, emotional, and overall health outcomes of children on the autism spectrum.

What were the study results?

This study showed that autistic children are at higher risk than non-autistic children for poorer health outcomes indicated by lowest scores in Global Health and highest dysregulation scores (e.g. attention problems, aggressive behavior, and anxious-depressive symptoms). However, there is variability in health outcomes within autistic youth as shown by a group of autistic participants who showed high scores on positive health outcomes across domains. Additionally, compared to non-autistic children, more autistic children were born prematurely, had diagnoses of intellectual disability and ADHD, and had a sibling with autism.

What was the study's impact?

The results of this study offer a glimpse into the diversity of emotional, physical, and overall health outcomes for children on the autism spectrum. A deeper understanding of the range of health outcomes children with autism experience, and the factors that can affect these outcomes, may help families and practitioners identify and target areas for support or intervention.

Who was involved?

The study included over 4,500 children and adolescents at 29 ECHO research sites across the United States, including 286 participants with autism. The participants varied in age from 5 to 20 years old.

What happened during the study?

The researchers compared the health outcomes and demographic characteristics of a large sample of children, with 286 participants with autism and 4,225 participants without. They then used a subsample of 1,809 participants, of which 116 were autistic, to group children with similar physical health, emotional health, and overall well-being outcomes into one of three categories, “positive health,” “poorer health,” and “mixed health.” These categories were mostly determined by the results of multiple Patient-Reported Outcomes Measurement Information System (PROMIS) scales and other reports that evaluated participants’ peer relations, life satisfaction, behavior dysregulation, sleep disturbances, physical activity, etc. The three profiles of participants were then further analyzed to study differences in health outcomes between children on the autism spectrum to non-autistic children.

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 work may focus on understanding the factors that influence poor or positive health for children with autism and how those factors change over time. This work might identify opportunities to support these children and promote positive health outcomes.

Where can I learn more?

Access the full journal article, titled “Describing Multidomain Health Outcomes in Autistic Children in the ECHO Program,” in the Journal of the American Academy of Child and Adolescent Psychiatry.

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

Published August 27, 2024

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ECHO Study Finds Children with Autism at Higher Risk for a Range of Diverse Health Outcomes

ECHO Cohort Study Finds No Significant Evidence that Prenatal Cannabis Exposure Increases Likelihood of Child Autism Spectrum Disorder

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ECHO Cohort Study Finds No Significant Evidence that Prenatal Cannabis Exposure Increases Likelihood of Child Autism Spectrum Disorder

Authors: Chaela Nutor, Patricia A. Brennan, et al.

Who sponsored this study?

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

Why was this study needed?

With the legalization of cannabis in some areas of the U.S., there has been a decrease in the perception of risk and an increase in cannabis use among pregnant women. While fetal exposure to cannabis has been linked to poorer neonatal and cognitive outcomes, relatively few studies have examined the association between prenatal cannabis exposure and neurodevelopmental outcomes, including autism spectrum disorder (ASD).

What were the study results?

The investigators found no evidence that prenatal cannabis exposure increased the likelihood for ASD in the group of children included in the study. There was also no evidence that child sex or gestational age at birth affected how prenatal cannabis exposure related to likelihood of ASD. No other aspects of brain or child development were evaluated in the study.

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 was this study's impact?

Although no significant associations were found with ASD outcomes in this study, other studies have found that prenatal cannabis exposure may still be associated with ASD traits or other facets of child development and behavior that were outside of the scope of this study.

Who was involved?

This study included 11,570 school-age children from 34 ECHO Cohort research sites across the U.S., including three sites that enrolled children with a higher likelihood of ASD and three sites that enrolled children from neonatal intensive care units (NICU).

What happened during the study?

ECHO Cohort researchers gathered data on cannabis use during pregnancy directly from mothers and indirectly from their medical records. They also collected information on ASD diagnosis, as well as caregiver-reported data on the children’s autism-related traits from the ages of 1 to 18 years. The researchers used this information to test whether prenatal cannabis use might be associated with ASD.

What happens next?

The researchers are planning another large national study to further examine the relationship between prenatal cannabis exposure and autism traits. Other work could examine whether exposure to cannabis in utero alters brain functioning.

Where can I learn more?

Access the full journal article, titled “Examining the Association Between Prenatal Cannabis Exposure and Child Autism Behaviors: A Multi-cohort Investigation in the Environmental influences on Child Health Outcomes (ECHO) 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 2024

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ECHO Cohort Study Finds No Significant Evidence that Prenatal Cannabis Exposure Increases Likelihood of Child Autism Spectrum Disorder

New ECHO Cohort Research Suggests No Significant Association Between Prenatal Cannabis Exposure and Child Autism-Related Outcomes

Posted on August 27, 2024March 31, 2025 by Jodi Snare

Collaborative ECHO research led by Chaela Nutor, MA and Patricia A. Brennan, PhD of Emory University investigates the association between prenatal cannabis exposure and autism spectrum disorder (ASD). The study looked at data from 11,570 school-aged children from across the United States and found no evidence that prenatal cannabis exposure increases the likelihood of ASD, regardless of the child’s sex or gestational age at birth. This research, titled “Examining the Association Between Prenatal Cannabis Exposure and Child Autism Traits: A Multi-cohort Investigation in the Environmental influences on Child Health Outcomes (ECHO) Program,” is published in Autism Research.

This study included children and their mothers from 34 ECHO cohorts across the United States. ECHO researchers gathered data on cannabis use during pregnancy directly from mothers and from their medical records. They also collected information on ASD diagnosis, as well as caregiver-reported data on the children’s autism traits when the children were 1 to 18 years. The researchers used these data and reports to test whether prenatal cannabis use might be associated with ASD.

“With the legalization of cannabis in some areas of the United States, there has been a decrease in the perception of risk and an increase in cannabis use among pregnant women,” said Chaela Nutor. “While fetal exposure to cannabis has been linked to poorer neonatal and cognitive outcomes, relatively few studies have tested the association between prenatal cannabis exposure and autism spectrum disorder.”

The results of this study supported the findings from previous studies showing that initial unadjusted associations between prenatal cannabis exposure and ASD behaviors in school-aged children are no longer significant when controlling for other factors, such as maternal use of other substances during pregnancy.

The researchers are planning another large national study to further investigate the relationship between prenatal cannabis exposure and autism-related behaviors. Future work could examine the role of continued exposure to cannabis after mothers are aware of pregnancy, and other studies could investigate combined exposure to tobacco and cannabis and associated risk for ASD.

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ECHO Researchers Investigate Association of Early Childhood Phthalate Exposures with ADHD Behaviors in Childhood and Adolescence

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ECHO Researchers Investigate Association of Early Childhood Phthalate Exposures with ADHD Behaviors in Childhood and Adolescence

Authors: Jiwon Oh, Julie B. Schweitzer, Deborah H. Bennett, 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 found in many everyday items such as food packaging, flooring, building materials, medicine coatings, medical supplies, cosmetics, and personal care products. When phthalates enter the body, they are metabolized and converted into various smaller molecules, known as metabolites.

Animal studies suggest that exposure to phthalates during early life may negatively affect the nervous system, but there has been limited investigation into potential associations between early childhood phthalate exposure and attention-deficit/hyperactivity disorder (ADHD) behaviors in later childhood and adolescence.

For this study, ECHO researchers wanted to investigate whether exposure to phthalates in children at ages 2-5 years was associated with ADHD symptoms when these children were ages 8-18 years.

Learn how to say phthalate.

What were the study results?

ECHO Cohort researchers evaluated the levels of several metabolites that result from phthalate exposure. They saw that in children ages 2-5 years, most of these molecules were not associated with ADHD behaviors in these children at ages 8-18 years.

However, among children who had been diagnosed with autism spectrum disorder (ASD), one of these metabolites—mono-2-heptyl phthalate (MHPP)—was associated with more ADHD behaviors. Among typically developing children, a different small molecule—mono-carboxy isooctyl phthalate (MCiOP)—was associated with more hyperactive/impulsive behaviors.

What was this study's impact?

This study suggests that early childhood exposure to certain phthalates may be associated with having both ASD and ADHD traits. Since ADHD behaviors are more commonly found in children with ASD, deepening the understanding of how exposure to environmental chemicals, such as phthalates, could contribute to this comorbidity may be important for managing and treating these conditions effectively.

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

Who was involved?

This study included 243 children living in Northern California and taking part in the ReCHARGE (Revisiting Childhood Autism Risks from Genetics and Environment) study. This study included both neurotypical and neurodiverse children, with about 60% of them having ever had neurodevelopmental concerns. Therefore, the children included in the study tended to have more ADHD behaviors compared with children in the general population.

What happened during the study?

Phthalate metabolites can be measured in biological samples, such as urine, to assess exposure to phthalates. In this study, the researchers measured 15 phthalate metabolites in urine samples of young children ages 2-5 years. Parents answered questions about each child’s ADHD symptoms at ages 8-18 years.

What happens next?

While the metabolite MHPP and the phthalate it’s derived from, di-n-heptyl phthalate (DHPP), are commonly found in children’s urine, their influence on neurodevelopment has not been studied as much as other phthalates. Since exposure to DHPP has been linked to problems with development and behavior in animals, further studies need to look more closely at this compound to understand its effects on how the brain develops in children.

Where can I learn more?

Read the full research article, titled “Early childhood exposures to phthalates in association with attention-deficit/hyperactivity disorder behaviors in middle childhood and adolescence in the ReCHARGE study,” in the journal International Journal of Hygiene and Environmental Health.

Learn more about ECHO’s other chemical exposure research.

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

Published June 2024

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ECHO Researchers Investigate Association of Early Childhood Phthalate Exposures with ADHD Behaviors in Childhood and Adolescence

No Significant Correlation Found Between Labor-inducing Drug During Childbirth and Future Risk of ADHD and Autism Spectrum Disorder in Children, Study Finds

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No Significant Correlation Found Between Labor-Inducing Drug During Childbirth and Future Risk of ADHD and Autism Spectrum Disorder in Children, Study Finds

Synthetic oxytocin was associated with lower ADHD risk among children born to mothers with pre-pregnancy obesity. Mothers with pre-pregnancy obesity were more inclined to receive labor-inducing medication.

Authors: Lisa Kurth, PhD, et al.

Who sponsored this study?

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

Why was this study needed?

More than 50% of U.S. childbirths are assisted with synthetic oxytocin (sOT)—known by trade names such as Pitocin or Syntocinon—a drug that promotes labor by stimulating the muscles in the uterus to contract. As rates of child ADHD and autism spectrum disorder (ASD) diagnoses are steadily rising, researchers have attempted to identify risk factors that might be contributing to these increases. There have been conflicting results from previous studies investigating the link between sOT exposure and childhood risk of ADHD and ASD. Additionally, the potential effect of the mother’s pre-pregnancy body mass index (BMI) on this association has not yet been studied.

What were the study results?

Analysis of data from a large and diverse ECHO Cohort sample suggests that maternal exposure to sOT during childbirth was not associated with an increased risk for ADHD or ASD in offspring. Associations did not differ by sex. Unexpectedly, sOT was associated with lower ADHD risk among children born to mothers with pre-pregnancy obesity.

The study also found that 48% of laboring mothers received sOT. Researchers saw slightly higher usage of sOT in mothers with pre-pregnancy obesity.

What was this study's impact?

The findings raise questions about how these drugs might affect health outcomes, especially when combined with maternal obesity during pregnancy. Additionally, the findings indicate that maternal obesity may influence the need for interventions during childbirth. These results do not currently support a need to modify the clinical use of sOT during childbirth.

What happened during the study?

A team of researchers used statistical analysis to examine the association between sOT exposure during labor and child ADHD or ASD diagnosis. Investigators also evaluated whether maternal pre-pregnancy BMI and child sex affected this correlation.

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.

Who was involved?

This study included over 12,000 mother-child pairs from 44 ECHO Cohort research sites across the U.S. Of the mothers participating in this study, 48% were exposed to sOT during childbirth.

What happens next?

More research is needed to evaluate if the dosage and duration of sOT has any influence on children's neurodevelopment. Future studies may clarify how environmental exposures and other contributing factors, such as delivery method and maternal obesity at delivery, influence a child’s neurodevelopment. Examining maternal/fetal biospecimens could also reveal how this exposure affects mothers and babies.

Where can I learn more?

Access the full journal article, titled “Intrapartum Exposure to Synthetic Oxytocin, Maternal BMI, and Neurodevelopmental Outcomes in Children within the ECHO Consortium” in the Journal of Neurodevelopmental Disorders.

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

Published May 26, 2024

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No Significant Correlation Found Between Labor-Inducing Drug During Childbirth and Future Risk of ADHD and Autism Spectrum Disorder in Children, Study Finds

ECHO Cohort Research Investigates Relationship Between Infant Gut Microbiome and Childhood Autism-related Traits

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ECHO Cohort Research Investigates Relationship Between Infant Gut Microbiome and Childhood Autism-related Traits

Authors: Vanja Klepac-Ceraj, Juliette C. Madan, 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 relationship between a person’s gut bacteria and the brain during early childhood, especially from birth to around age three years, helps the immune and nervous systems develop and function. The gut microbiome could be a promising area of research to understand the development of autism-related traits. Previous studies have found links between gut bacteria and social traits, but the results are not the same in different populations. To include a broader population of children in the U.S., researchers in this study sought to identify gut bacteria linked to social traits and brain development in two ECHO Cohort Study Sites.

What were the study results?

Researchers found that certain features of the gut microbiome of infants were associated with higher scores on the Social Responsiveness Scale-2 (SRS-2), a questionnaire that measures autism-related traits. Specifically, certain bacteria and their functional genes, particularly those related to the production of short-chain fatty acids, were linked to autism-related traits. These associations varied between sex and age groups.

Note: 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 this study's impact?

Understanding the potential likelihood of autism-related traits through the lens of the gut-brain axis opens new avenues for targeted interventions in early life.

Who was involved?

Researchers studied 481 samples from 304 healthy child participants from two ECHO Cohort study sites in New Hampshire and Rhode Island. The children were between 6 weeks old and 2 years old when they provided stool samples and between 3 and 19 years old when social traits were assessed.

What happened during the study?

The researchers compared groups of participants from two different study sites, focusing on their gut microbiomes when they were younger and social traits related to ASD at a later age. Both study sites contributing to this analysis had previously sequenced bacterial DNA from fecal samples collected from infants or toddlers. They calculated how common certain bacteria were in each sample and related that to the participant’s social behavior scores.

What happens next?

Future studies could explore interventions that could change the gut bacteria and potentially influence how the brain develops. Researchers also plan to investigate the influence of the developing gut microbiome on other neurobehaviorial outcomes, such as anxiety and depression.

Where can I learn more?

Access the full journal article, titled “Prospective Association of the Infant Gut Microbiome with Social Behaviors in the ECHO Consortium,” in Molecular Autism.

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

Published May 17, 2024

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ECHO Cohort Research Investigates Relationship Between Infant Gut Microbiome and Childhood Autism-related Traits