Gestational Diabetes and Postpartum Depression May Be Linked With Early Childhood Behavior Problems

Authors: Lauren C. Shuffrey, 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?

Previous research has linked gestational diabetes (a type of diabetes mothers develop during pregnancy) to prenatal and postpartum depression in mothers. However, studies have not examined how the combination of gestational diabetes, prenatal depression, and postpartum depression affect early childhood behavior.

What were the study results?

The study found that gestational diabetes, prenatal maternal depressive symptoms, and postnatal maternal depressive symptoms were each associated with increased child externalizing (e.g., acting out, aggression, hyperactivity) and internalizing (e.g., anxiety, depression) behavior problems. This study also found that gestational diabetes was associated with increased autism behaviors only among children exposed to above average perinatal maternal depressive symptoms. Finally, the researchers observed gestational diabetes was only associated with child behavioral problems for male children, and not for female 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 was the impact?

These findings suggest that children born to mothers who had both gestational diabetes and symptoms of depression during pregnancy should receive additional monitoring for behavioral problems during early childhood.

Who was involved?

This study included 2,379 children from ECHO cohorts located in Colorado, Massachusetts, New York, Pennsylvania, and Tennessee. More than half of participants were male, and 216 participants were born to mothers with gestational diabetes during pregnancy.

More than half of maternal participants were from an underrepresented minority group with 32% self-identifying as Black, 23% as Hispanic, 15% as mixed race, and 4% as Asian.

What happened during the study?

ECHO researchers used the Preschool Child Behavior Checklist (CBCL) to examine the behavior of children ages 2 to 5. They also collected information from the mothers including gestational diabetes diagnosis and self-assessments of depression symptoms during and after pregnancy. The study evaluated how gestational diabetes, prenatal depression, and postpartum depression affected children’s behavioral outcomes using the CBCL.

What happens next?

ECHO researchers are currently analyzing blood samples collected during pregnancy to investigate potential inflammatory mechanisms that may influence the associations between gestational diabetes, maternal depression, and early childhood behavior.

Where can I learn more?

Access the full journal article titled, “Gestational Diabetes Mellitus, Perinatal Maternal Depression, and Early Childhood Behavioral Problems: An Environmental Influences on Child Health Outcomes (ECHO) Study” in Child Development.

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

Published May 2, 2023

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Gestational Diabetes and Postpartum Depression May Be Linked With Early Childhood Behavior Problems

Preterm Birth and Family Hardship May Associated With Childhood Behavior Problems

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Preterm Birth and Family Hardship May Associated With Childhood Behavior Problems

Authors: Julie A. Hofheimer, Monica McGrath, Rashelle Musci, 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?

Emotional and behavioral difficulties during early childhood can predict later problems such as anxiety, depression, attention deficits, and aggression. This study aims to describe children’s behavioral development from 18 to 72 months of age, examining risk factors for continuing behavioral problems that can inform early interventions to improve behavioral and emotional regulation.

What were the study results?

Children born preterm, males, and those exposed to more family hardships had more behavioral difficulties that persisted over time, including anxiety/depression, attention deficits, and aggression. Other factors that increased the risk for behavioral difficulties in children were prenatal substance exposure and higher maternal psychosocial and economic difficulties during pregnancy. Some children who experienced fewer family hardships showed improved behavior over time when receiving early support. The researchers were able to identify early life factors that may increase a child’s risk for experiencing behavioral and emotional difficulties later in childhood.

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 suggested that support and services for families to help them cope with newborn health challenges and other family hardships may help improve young children’s behavioral and emotional difficulties. Specifically, preterm births and prenatal substance exposures may be used to identify children who may benefit from early support. Individualized support to meet the specific needs of children may prevent later behavioral problems and improve future outcomes for vulnerable children and their families.

Who was involved?

The study included 3,934 children born between 1990 and 2019 and their mothers from 20 ECHO cohorts across the United States. About 80% of the children were born at term (at or beyond 37 weeks of gestation), and about 20% were born preterm (before 37 weeks of gestation).

What happened during the study?

The researchers collected caregiver self-reports, demographics, and medical and social environment information about the mothers and children before and during pregnancy and from infancy through age 6. Caregivers also completed the Child Behavior Checklist at multiple study visits to describe their child’s behavior at different ages. Researchers compared the trajectory of children’s scores for dysregulation behaviors (anxiety, depression, attention, and aggression) across the first six years of life. Researchers described three patterns of behavioral trajectories observed in these children 1) high and increased dysregulation (2.3%); 2) borderline and stable dysregulation (12.3%); and 3) low and decreasing dysregulation (85.6%).

What happens next?

Future ECHO studies may examine how the behavior of children continues to develop after six years of age. These new studies could focus on identifying additional risk and protective factors for emotional and behavioral well-being and patterns across middle childhood and adolescence.

Where can I learn more?

Access the full journal article, titled “Psychosocial and Neonatal Risk Factors Associated with Behavioral Dysregulation Trajectories Among Young Children from 18 through 72 Months of Age,” 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 April 26, 2023

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Preterm Birth and Family Hardship May Associated With Childhood Behavior Problems

Shorter Questionnaire Shown Effective for Measuring Autism-Related Traits in Children

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Shorter Questionnaire Shown Effective for Measuring Autism-Related Traits in Children

Authors: Aaron Kaat, 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?

Prior research has developed and examined shortened versions of the SRS questionnaire, but this has been mostly done with school-age participants with autism and their family members. Researchers haven’t been able to evaluate the reliability of shortened versions of the SRS for capturing broader traits in the general population or for preschool-age participants. In addition, prior studies have not developed a shortened version of the questionnaire that uses computer-adaptive testing to select relevant questions based on a participants existing answers.

What were the study results?

The Social Responsiveness Scale (SRS) is frequently used to measure autism-related traits and social impairments. The full 65-question SRS can create more burden for participants, so many researchers have attempted to shorten the questionnaire. In this study, ECHO researchers evaluated the SRS questionnaire across two different versions for preschool and school-age groups, comparing the questions used on each and developing a comparable scoring method for both forms. They then used computer-adaptive testing, where a computer program tailors the questionnaire in real-time to each participant, and found that a median of 14 questions was sufficient to reach a reliable score.

What was the study's impact?

The results of this work suggest opportunities to reduce the amount of time participants spend completing questionnaires like the SRS without sacrificing accuracy. Additionally, the results suggest computer-adaptive questionnaires can be used to evaluate autism-related traits in a way that is comparable to standard fixed questionnaires, improving testing efficiency and reducing participant burden.

Who was involved?

This study included 7,030 children from multiple ECHO research sites and other large studies across the United States. Participants included children ranging from ages 2.5-18 years, most of whom did not have an autism diagnosis.

What happened during the study?

The researchers collected data on the preschool and school-age SRS forms from multiple different sources. They then conducted several analyses to assess a variety of factors that may affect how the full SRS and shortened versions of the SRS are scored. The researchers then used these data to simulate how computer-adaptive testing would score each individual after completing the minimum number of questions required to reach a comparable result.

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?

The researchers’ follow-up analyses to this work compared the computerized version developed in this study to other versions of the questionnaire. Future research is needed to examine how these different questionnaires perform in different groups of people, and if results differ when captured according to self vs parent report.

Where can I learn more?

Access the full journal article, titled “Modifying the Social Responsiveness Scale for Adaptive Administration,” in Quality of Life Research.

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

Published March 21, 2023

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Shorter Questionnaire Shown Effective for Measuring Autism-Related Traits in Children

ECHO Study Links Younger Pregnancies, Tobacco Use During Pregnancy, and Depression During Pregnancy With Poorly Regulated Behavior in Newborns

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ECHO Study Links Younger Pregnancies, Tobacco Use During Pregnancy, and Depression During Pregnancy With Poorly Regulated Behavior in Newborns

Authors: Marie Camerota, 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, and a career development award from the National Institute of Mental Health.

What were the study results?

ECHO researchers used the neurobehavioral scores to classify babies into one of six groups based on different patterns of behavior. While each group exhibited different characteristics, 4 of these groups contained infants with normal patterns of behavior. Only two of the six groups were characterized as poorly regulated. The first of these groups was hyper-aroused, or too excitable. The other group was hypo-aroused, or slow to respond.

Babies with poorly regulated behavior were more likely to be male, have younger mothers, and have mothers who were depressed or used tobacco during pregnancy. Babies born at all different gestational ages were found in each of the six groups.

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 describes a possible link between demographic and health characteristics of mothers and babies with patterns of behavior in newborns. Previous studies conducted in single cohorts have described similar patterns of poorly regulated behavior in infants. The current study replicated those findings using a larger and more diverse population. If these patterns of behavior continue to be found in other large studies, this might suggest that these patterns could generalize to babies outside these studies. This information could be used to identify babies at risk for poorly regulated behavior who might benefit from early interventions and prevention services to help promote positive health outcomes for children.

Why was the study needed?

Behavior patterns in newborns can be used as indicators of long-term developmental outcomes. Previous studies have looked at the link between demographic and medical characteristics of mothers and their infant’s behavior shortly after birth, but these studies were conducted with smaller groups of babies who were very similar to one another (e.g., studies with babies who were all born full term). There is a need for studies that include a larger sample representing more diverse pairs of mothers and their babies, including babies who were born all across the gestational age spectrum.

Who was involved?

This study included 1,112 mother-infant pairs from 5 ECHO cohorts across the United States. Infants were born at gestational ages from 22 to 42 weeks.

What happened during the study?

The babies received a neurobehavioral exam shortly after they were born to test their responses to objects and people, their reflexes, and their movement. Either mothers reported information about their own and their babies’ demographic characteristics and health information or it was collected from their medical records. ECHO researchers looked at how the mothers’ demographic characteristics and health during pregnancy were related to their newborns’ behavior patterns.

What happens next?

More research is needed to determine which of the characteristics studied are stronger predictors of babies’ neurobehavior patterns, and whether the impact of these factors changes in babies born at different gestational ages. Further research is also needed to learn more about how babies’ neurobehavior shortly after birth is related to their health and development later in childhood.

Where can I learn more?

Access the full journal article, titled “Prenatal and perinatal factors associated with neonatal neurobehavioral profiles in the ECHO Program," in Pediatric Research.

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

Published February 25, 2023

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ECHO Study Links Younger Pregnancies, Tobacco Use During Pregnancy, and Depression During Pregnancy With Poorly Regulated Behavior in Newborns

ECHO Researchers Investigate Whether Prenatal Chemical Exposures Affect the Development of Autism-related Traits in Children

Posted on January 26, 2023October 25, 2024 by Jodi Snare

Collaborative ECHO research led by Jennifer Ames, PhD of the Kaiser Permanente Northern California Division of Research and Ghassan Hamra, PhD of Johns Hopkins Bloomberg School of Public Health, investigates whether exposures to per- and polyfluoroalkyl substances (PFAS) during pregnancy were associated with the development of autism-related traits in children. The researchers looked at data from 1,224 mother-child pairs and found that prenatal exposure to one specific PFAS chemical, perfluorononanoic acid (PFNA), may be associated with an increase in autism-related traits in children. Prenatal exposure to the mixture of all PFAS chemicals combined was not associated with increased autism-related traits in children. This research, titled “Prenatal exposure to per- and polyfluoroalkyl substances and childhood autism-related outcomes,” is published in Epidemiology.

PFAS are widely used, long lasting chemicals, the components of which break down very slowly over time. Previous studies that have investigated the association between prenatal PFAS exposure and childhood autism spectrum disorder (ASD) have been inconsistent and mostly involved small sample sizes. This study leveraged the large, diverse ECHO-wide cohort to evaluate how prenatal PFAS exposure affects the development autism-related traits, even when a child does not receive a clinical ASD diagnosis.

This study included children born between 2011 and 2018 from 10 racially and ethnically diverse ECHO cohorts across the United States, including one cohort that enrolls children from families with an increased likelihood of ASD. The researchers measured the levels of eight different PFAS in blood samples collected from mothers during pregnancy. Later, when their children were aged 2.5 years or older, researchers asked caregivers to report on their child’s autism-related traits using a questionnaire called the Social Responsiveness Scale (SRS). The research team tracked the associations between these data to examine child SRS scores in relation to each individual PFAS as well as the combination of the PFAS.

“In the U.S. population, exposures to perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) have dropped substantially since the industry voluntarily phased out these chemicals in the early 2000s,” said Dr. Ames. “However, other PFAS exposures have increased over time, including thousands with unknown toxicity. These so-called ‘forever chemicals’ continue to pose risks to health even after they are phased out because they persist in the environment and inside people’s bodies and don’t break down easily.”

These results underscore the need for more research on whether PFAS chemicals might have more significant effects on child neurodevelopment, and whether factors such as genetics, underlying health conditions, or nutritional status may change the effect of PFAS exposure on brain development.

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ECHO Study Suggests Prenatal Exposure to Perfluorononanoic Acid (PFNA) May Be Linked to Autism-Related Traits in Children

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ECHO Study Suggests Prenatal Exposure to Perfluorononanoic Acid (PFNA) May Be Linked to Autism-Related Traits in Children

Authors: Jennifer Ames, Ghassan Hamra, 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.

What were the study results?

The researchers found that prenatal exposure to one specific PFAS chemical, perfluorononanoic acid (PFNA) may be associated with an increase in autism-related traits in children. Prenatal exposure to the mixture of all PFAS chemicals combined was not associated with increased autism-related traits in 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 was the study's impact?

This study draws attention to the potential risks of PFAS chemicals on child neurodevelopment. In the U.S., exposures to some specific PFAS, such as PFOA and PFOS, have dropped substantially since the industry voluntarily phased these chemicals out in the early 2000s. However, other PFAS exposures have increased over time, including thousands of these substances with unknown toxicity. These so-called “forever chemicals” continue to pose risks to health even after they are phased out because they persist in the environment and inside people’s bodies and don’t break down easily. While the estimated effects of PFAS chemicals on child autism-related traits are relatively small in this study, future studies may investigate whether early childhood exposure to PFAS chemicals are associated with effects on other neurodevelopmental outcomes.

Why was this study needed?

Per- and polyfluoroalkyl substances (PFAS) are widely used, long lasting chemicals, the components of which break down very slowly over time. Previous studies looking at associations between prenatal PFAS exposure and childhood autism spectrum disorder (ASD) are inconsistent and mostly conducted in small sample sizes. The objective of this research was to determine whether blood concentrations of PFAS during pregnancy were linked to the development of autism-related traits in children. The researchers in this study were able to examine this question by continuously measuring the development of autism-related traits in a large number of children across the U.S, independently of whether a child received a clinical ASD diagnosis.

Who was involved?

The participants of this study included 1,224 mother-child pairs from ten cohorts across the United States. The participants were geographically, racially, and ethnically diverse, and one of the cohorts included families with an increased genetic likelihood of ASD. Most of the participating children were born between 2011 and 2018.

What happened during the study?

The researchers measured the levels of eight different PFAS in blood samples collected from mothers during pregnancy. Later, when their children were aged 2.5 years or older, researchers asked caregivers to report on the child’s autism-related traits using a questionnaire called the Social Responsiveness Scale (SRS). The research team tracked the relationship between child SRS scores and prenatal exposure to each individual PFAS as well as the combination of the eight PFAS.

What happens next?

Additional research is needed to continue studying the effect of early life exposure to PFAS on child neurodevelopment, including cognition, attention, and other neurobehaviors. Future studies can also investigate whether biological sex and other factors—such as genetics, underlying health conditions, and nutritional status—may change the effect of PFAS exposure on brain development.

Where can I learn more?

Access the full journal article, titled “Prenatal exposure to per- and polyfluoroalkyl substances and childhood autism-related outcomes,” in Epidemiology.

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

Published January 12, 2023

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ECHO Study Suggests Prenatal Exposure to Perfluorononanoic Acid (PFNA) May Be Linked to Autism-Related Traits in Children

ECHO Study Suggests COVID-19 Pandemic Contributed to Developmental Delays in Infants, Toddlers

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ECHO Study Suggests COVID-19 Pandemic Contributed to Developmental Delays in Infants, Toddlers

Authors: Sara Nozadi, Johnnye Lewis, 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.

What were the study results?

In this study, up to 15% of infants and toddlers who were developmentally on track prior to the COVID-19 pandemic showed signs of developmental delays during the pandemic. Male children showed more delays than female children, and language was the most affected developmental area. Families from minority communities and those with lower socioeconomic status were more likely to experience pandemic-related hardships. However, financial and social pandemic-related hardships were not associated with the individual changes observed in children’s developmental progress.

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 highlights the importance of early developmental screening during times of adversity, such as pandemics, in order to identify delays and connect children to supportive services. Previous studies have shown negative impacts of the pandemic on overall child development but have not looked at the effects of the pandemic on individual children’s development over time.

Why was this study needed?

Many studies have focused on the COVID-19 pandemic’s effects on the development of school-aged children, evaluating the effects of the pandemic on academic performance and behavior problems. Fewer studies have examined the pandemic’s effects on the developmental progress of infants and toddlers, whose needs are different than those of school-aged children. During this study, researchers examined whether the negative developmental effects observed in school-aged children over the course of the pandemic could also be seen in infants and toddlers.

Who was involved?

The study included 684 children between the ages of 2 months and 4 years from 8 ECHO cohort research sites across the United States. Researchers included children whose parents had filled out the Ages and Stages Questionnaire (ASQ), which uses parent-reported information to pinpoint a child’s developmental progress, within the 18-month period before and after March 2020. Parents of participating children were also asked about financial hardship, defined as at least one parent experiencing job loss or change, or social hardships, defined as families’ quarantining from household members or extended family and friends, during the pandemic.

What happened during the study?

Parents answered 30 questions before and during the pandemic to determine whether their child had achieved developmental milestones in language, motor, cognitive or problem solving, and socioemotional development. Researchers also used the ECHO COVID-19 survey that was developed in April 2020 to gauge pandemic-related financial and social stress on families.

What happens next?

Future research can follow the developmental patterns in these children over time to determine if COVID-19 related delays are lasting or reversible. Studies may also focus on pandemic-related stressors that could particularly effect infants and toddlers, such as family dynamics, parent-child interactions and parental stress.

Where can I learn more?

Access the full journal article, titled “Effects of COVID-19 financial and social hardships on infants’ and toddlers’ development in the ECHO program,” in the International Journal of Environmental Research and Public Health.

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

Published January 5, 2023

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ECHO Study Suggests COVID-19 Pandemic Contributed to Developmental Delays in Infants, Toddlers

No Association Between Antidepressant Use During Pregnancy, Child’s Risk for Autism-Related Traits

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No Association Between Antidepressant Use During Pregnancy, Child's Risk for Autism-Related Traits

Authors: Patricia 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.

What were the study results?

This study found that prenatal use of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), did not increase a child’s risk for ASD or related traits.

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?

Pregnant women who are diagnosed with depression must weigh a number of risks when making decisions about treatments. Sometimes medical providers may recommend treatment with antidepressants. This study suggests that maternal use of antidepressants, including SSRIs, during pregnancy does not increase a child’s risk for autism-related traits. This information can be valuable in helping pregnant women and their physicians decide whether antidepressant treatment is right for them.

Why was this study needed?

Previous studies have reported mixed findings on the relationship between prenatal antidepressant use and child autism. Pregnant women and the physicians that treat them need more data to inform their decisions about whether to take certain medications during pregnancy.

Who was involved?

This study included 3,129 mothers and their children enrolled in ECHO cohorts across the United States. Participants provided data on prenatal exposure to antidepressants as well as measures of autism-related traits collected when the child was between 1 and 12 years of age. About 5% of the participating mothers took antidepressants during pregnancy.

What happened during the study?

The researchers used medical records and maternal self-reports to determine what medicines mothers used during pregnancy. Mothers reported on whether their child received an autism spectrum disorder (ASD) diagnosis and also completed rating scales about their child’s behavior, including social, language, and other traits related to autism.

What happens next?

Future studies might consider whether the dose or timing of antidepressant use during pregnancy changes its effect on child health outcomes.

Where can I learn more?

Access the full journal article, titled “Prenatal Antidepressant Exposures and Autism Spectrum Disorder or Traits: A Retrospective, Multi-Cohort Study,” in Research on Child and Adolescent Psychopathology.

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

Published November 22, 2022

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No Association Between Antidepressant Use During Pregnancy, Child's Risk for Autism-Related Traits

Exposure to Certain Phthalates During Pregnancy May Affect Brain Development in Infant Girls

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Exposure to Certain Phthalates During Pregnancy May Affect Brain Development in Infant Girls

Authors: Leny Matthew, Craig Newschaffer, 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.

What were the study results?

In this study, researchers found that certain phthalates measured in the infant’s meconium, or first stool, were associated with lower scores on a common test that measures motor, visual, and language skills in girls under age 5.

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 suggests that prenatal exposure to certain types of phthalates may worsen early childhood learning outcomes for girls but have a neutral or slightly positive effect on boys. By studying meconium, instead of maternal urine, the researchers may be able to capture a longer timeframe of potential pre-natal exposure.

Why was the study needed?

Phthalates are widely used in personal care products, cosmetics, plastics, and other household items. These chemicals can cause the body to make substances that are thought to reduce a mother’s level of thyroid hormones, which are critical for fetal brain development. Phthalates are also associated with a reduction in the hormones necessary for sex-specific fetal brain development. Therefore, it is important to test the levels of prenatal phthalate exposure and the potential effects on developing fetuses.

Who was involved?

The study involved 956 mother and child pairs from two ECHO research sites—the Safe Passage study (SPS) and the Early Autism Risk Longitudinal Investigation (EARLI). Researchers focused on children who were higher risk for brain and nervous system disorders based on a family history of Autism or exposure to alcohol during pregnancy.

What happened during the study?

ECHO researchers measured phthalate levels in meconium from children who had a higher risk for developing brain and nervous system disorders. When the children were 12 months old, researchers tested their motor, visual, and language skills. Researchers used meconium samples rather than the mother’s urine to capture longer-term fetal exposure to phthalates.

What happens next?

Future prenatal phthalate exposure studies using meconium samples from newborn infants could investigate the differing effects of phthalate exposure on male versus female infants in order to better understand the reasons why these differences may occur.

Where can I learn more?

Access the full journal article, titled “The associations between prenatal phthalate exposure measured in child meconium and cognitive functioning of 12-month-old children in two cohorts at elevated risk for adverse neurodevelopment,” in Environmental Research.

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

Published November 2022

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Exposure to Certain Phthalates During Pregnancy May Affect Brain Development in Infant Girls

ECHO Study Compares Cross-Cultural Patterns of Attention Linked to Underlying Behavior Problems in Children

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ECHO Study Compares Cross-Cultural Patterns of Attention Linked to Underlying Behavior Problems in Children

Authors: Sara Nozadi, Andréa Aguiar, 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.

What were the study results?

Patterns of attention were similar across the two groups of children despite the differences in their cultures, demographics, or assessment settings. Overall, children paid more attention to emotional faces compared to neutral faces. They were particularly quick to identify angry faces, which might be an adaptive response to a perceived threat. These findings replicate previous research results with both adults and children.

Indigenous children with socially withdrawn behaviors avoided emotional faces—a response observed in children with higher levels of socially withdrawn behaviors from other populations.

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 work suggests that eye tracking can be used as an objective measure of attention patterns in children across different settings and cultures, which can help researchers and clinicians more reliably identify children with early behavior problems. Because eye tracking technology does not rely on clinical observations or parents’ reports, it can be used as an unbiased measure across different communities to validate data collected through clinical assessments and parent reports in hard-to-reach communities.

Why was this study needed?

Humans tend to give more attention to emotional information than neutral information. Past research indicates departures from this pattern typically occur in children with socially withdrawn behaviors. However, this research is limited because it has been conducted mostly in controlled settings among primarily White children from urban areas.

In this study, ECHO researchers examined the extent to which two eye-tracking–based measures could be used cross-culturally to assess attention biases and how these biases might relate to children’s socially withdrawn behaviors.

Who was involved?

To evaluate whether eye-tracking technology could be applied effectively across cultures, researchers compared information from two ECHO cohorts that were very different demographically, geographically, racially, and culturally.

The researchers analyzed data from 125 children from the Navajo Birth Cohort Study, a cohort of indigenous children with relatively low socioeconomic status (SES) living in rural tribal lands, and 70 children from the Illinois Kids Development Study (IKIDS), a primarily Non-Hispanic White and high-SES cohort living around the University of Illinois at Urbana-Champaign campus in central Illinois.

What happened during the study?

Children between the ages of 3.5 years to 5.5 years completed two eye-tracking tasks that measured their attention to photos of human faces with positive, negative, and neutral expressions. Indigenous children were assessed in different locations in the Navajo territory, whereas IKIDS children came to a research laboratory in the University campus. Mothers also reported on children’s socially withdrawn behaviors, such as avoiding eye contact, using the Child Behavioral Checklist—a survey commonly used in research and clinical settings to evaluate risk for behavioral and emotional problems in children.

What happens next?

The researchers will look at how the responses they see in these young children change with age and determine whether eye tracking continues to be an unbiased tool for assessing attention throughout development.

Where can I learn more?

Access the full journal article titled “Cross-Cultural Applicability of Eye-Tracking in Assessing Attention to Emotional Faces in Preschool-Aged Children” published in the Emotion Journal.

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

Published: September 15, 2022

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ECHO Study Compares Cross-Cultural Patterns of Attention Linked to Underlying Behavior Problems in Children