Smoking During Pregnancy Linked to Mental Health Challenges in Children, ECHO Study Finds

Authors: Kristine Marceau, et al.

Who sponsored this study?

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

Why was this study needed?

Previous research has shown that children whose mothers smoked during pregnancy are more likely to develop behavior problems, particularly difficulties with acting out or following rules. However, it has been less clear whether prenatal smoking also increases the risk of mental health problems generally, or if it’s a specific risk for difficulties with acting out or following rules alone. Researchers from this study wanted to understand whether prenatal smoking contributes to co-occurring emotional and behavioral symptoms or specifically behavioral symptoms, and whether its effects differ by age or sex. This study helps address these gaps by examining which developmental periods may be especially sensitive to prenatal smoking effects and whether boys or girls are more vulnerable.

What were the study results?

Children exposed to smoking before birth were more likely experience multiple co‑occurring emotional and behavioral symptoms, and also to show more externalizing problems—such as attention problems, aggressive behavior, and rule‑breaking. These associations were observed across nearly all age groups and remained even after accounting for family history, background, and other exposures.

The strongest effects on mental health symptoms were seen in early childhood (under age 7) and early puberty (ages 9 to 12). There were very few differences between boys and girls. Only at ages 13-14 did boys seem to have more co‑occurring emotional and behavioral symptoms and externalizing-specific problems than girls. In general, both boys and girls were affected in similar ways.

What was the study's impact?

These results suggest that prenatal exposure to nicotine may increase the risk of mental health and behavioral problems. Because this study included a large number of children from different backgrounds, it helps clarify past research and contributes new insight about when certain problems tend to appear and how different symptoms may occur together.

Who was involved?

The study included 16,335 children and adolescents ages 1 to 18 from 55 U.S. ECHO Cohort Study Sites. All participants completed Child Behavior Checklist (CBCL) and Strengths and Difficulties Questionnaire (SDQ) behavioral assessments.

What happened during the study?

Researchers gathered standardized information about children’s behavior and created a simple score to show how many symptoms a child had and whether those symptoms were more emotional (such as sadness, anxiety) or behavioral (such as acting out, rule breaking). They then looked at these patterns across different age groups, while taking into account important factors such as the mother’s age and education, family mental health history, and exposure to smoke or other substances during and after pregnancy.

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

What happens next?

Future work could help researchers understand how timing, dose, and frequency of smoking during pregnancy correlates with child mental health. Future research could also use methods to separate the effects of family background from the effects of smoking itself and look more closely at how nicotine and other chemicals in smoke might affect children’s development.

Where can I learn more?

Access the full journal article, titled “Prenatal Smoking and Child Psychopathology Associations by Age and Sex in the ECHO Cohort,” 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 April 6, 2026

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Smoking During Pregnancy Linked to Mental Health Challenges in Children, ECHO Study Finds

Stress During Pregnancy & Adverse Experiences in Mom’s Own Childhood May Be Associated with Child Mental Health, ECHO Study Finds

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Stress During Pregnancy & Adverse Experiences in Mom’s Own Childhood May Be Associated with Child Mental Health, ECHO Study Finds

Authors: Shaikh Ahmad, Alexandra Sullivan, Marie Churchill, Rosa Crum, Nicole Bush, 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 global rise in pediatric mental health problems has highlighted the importance of identifying factors that may affect children’s mental health. Previous research has suggested that maternal stress—both adverse experiences during the mother’s own childhood and stress during pregnancy—may affect child mental health, but large-scale, diverse studies examining both exposures together, and their effects across childhood and adolescence, are needed to help researchers identify effective screening and intervention strategies.

What were the study results?

The study found that mothers’ own adverse childhood experiences (ACEs)—such as abuse or neglect—and experiences of stress during pregnancy were each independently associated with a higher risk of mental health problems in their children, suggesting that maternal stressors during each period may have contributed to the child’s risk in a potentially accumulative manner. These effects on children included both internalizing (e.g., anxiety, depression) and externalizing (e.g., ADHD, behavior problems) mental health issues. The effects of maternal ACEs and pregnancy stress on child mental health problems were similar for boys and girls and were seen throughout childhood and adolescence.

What was the study's impact?

The findings from this diverse nationwide study strengthen the evidence showing that maternal stress before and during pregnancy can increase the risk for child mental health problems. These results also highlight the potential benefits across generations of early screening and intervention related to maternal stress and childhood adversity—not only in improving maternal health, but also in reducing mental health problems in children and teens.

Who was involved?

The study included 6,513 mother-child pairs enrolled in 34 ECHO Cohort Study Sites across 19 U.S. states, Washington, D.C., and Puerto Rico. Children ranged in age from 1.5 to 18 years old. The sample was racially, socioeconomically, and geographically diverse.

What happened during the study?

The researchers collected information from mothers on their childhood adverse experiences and stress during pregnancy. Later, a parent or caregiver provided information on the child’s mental health using either the preschool-age or school-age child behavior checklist (CBCL). Researchers then used statistical analyses to evaluate the relationship between maternal ACEs, pregnancy stress, and child mental health.

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 identify other factors that may influence the risk of child mental health problems (e.g., paternal ACEs) and factors that could buffer this risk. The authors of this paper also suggest that increased screening for ACE exposure and current social needs in pregnant populations and enhanced access to prenatal mental health support could help to improve mental health for both mothers and their children.

Where can I learn more?

Access the full journal article, titled “Maternal Adverse Childhood Experiences and Prenatal Stress: Intergenerational Transmission and Offspring Mental Health in the ECHO Cohort,” in Psychological Medicine.

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

Published March 11, 2026

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Stress During Pregnancy & Adverse Experiences in Mom’s Own Childhood May Be Associated with Child Mental Health, ECHO Study Finds

Sleep Habits Vary for Children Living in Medically Underserved Areas But Not in Rural Communities, ECHO Study Finds

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Sleep Habits Vary for Children Living in Medically Underserved Areas But Not in Rural Communities, ECHO Study Finds

Authors: Brittany Lancaster, Christy W. Hockett, Anna Wallisch, 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?

People who live in rural communities or in medically underserved areas often face challenges like long travel distances, limited medical services, and fewer health resources. A medically underserved area is defined as having too few primary care providers, high infant mortality, or high poverty and/or high elderly population. These barriers make it harder to get routine care and treatment, which can worsen existing health disparities between communities. Few studies have evaluated how living in a rural or medically underserved area shapes children’s access to health-promoting resources. Because these geographic and healthcare barriers can influence key behaviors such as sleep, this study aimed to clarify how these conditions could contribute to differences in youth sleep health across the United States. Learning about these differences could help identify which groups may need more support and guide efforts to reduce health disparities.

What were the study results?

Children living in medically underserved areas tended to have different sleep patterns than those in communities with more resources. They generally went to bed later, woke up later, and were less likely to get the recommended amount of sleep for their age, especially among children ages 1 – 12 years. By contrast, differences between rural and non‑rural children were small; rural children typically went to bed and woke up earlier, while preschoolers in non‑rural areas slept longer overall because they napped more often. Bedtime habits were also mostly similar across all groups, though toddlers and teens in well-resourced areas were more likely to follow a regular bedtime routine, and preschoolers in underserved areas were more likely to use electronics before bed.

What was the study's impact?

This study suggests that living in a medically underserved areas may contribute to differences in children’s sleep health, with youth in medically underserved areas reporting later bedtimes, later wake times, and lower rates of getting the recommended amount of sleep. In contrast, only small differences were observed between children from rural and nonrural communities, suggesting that rurality alone may play a smaller role in shaping sleep patterns. The slight differences in bedtime habits—such as routines and screen use—indicate that family practices may vary across communities but are not the primary drivers of these sleep disparities. Together, these findings highlight the need for targeted efforts to support healthy sleep in medically underserved communities and suggest that researchers should continue to examine rurality and medically underserved status separately to better understand how different environments influence children’s sleep.

Who was involved?

The study included 22,234 youth aged 1–17 years. Of these, 6,976 lived in a medically underserved area and 908 of them lived in areas that were both medically underserved and rural. Overall, 1,853 youth lived in rural communities, and roughly half (945) of these lived in rural areas that were not medically underserved.

What happened during the study?

Researchers used participants' residential addresses and federal guidelines to sort children into four groups based on whether they lived in rural areas, medically underserved areas, both, or neither. Using parent or self-completed questionnaires, they collected information about children’s sleep, such as how long they slept, what time they went to bed and woke up, and how long it took them to fall asleep. They also asked about bedtime habits such as routines and screen use. The researchers then compared these sleep patterns across the different groups and looked at whether the results varied by age, from toddlers through adolescents.

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 communities develop effective sleep health programs, especially in medically underserved areas, potentially through daycares, community centers, and schools.

Where can I learn more?

Access the full journal article, titled “Exploring Sleep Outcomes in Youth Across Settings: Are There Differences based on Rurality or Medically Underserved Status in the ECHO Cohort?” in Sleep Medicine.

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

Published December 27, 2025

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Sleep Habits Vary for Children Living in Medically Underserved Areas But Not in Rural Communities, ECHO Study Finds

Children in High Gun Violence Areas Less Likely to Report Excellent Health, ECHO Study Finds

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Children in High Gun Violence Areas Less Likely to Report Excellent Health, ECHO Study Finds

Authors: Aruna Chandran, Emily Knapp, Nandita Somayaji, 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?

Gun violence has been the leading cause of death in children and teens in the United States since 2021. In addition to fatalities, exposure to gun violence in communities has been linked to adverse mental health outcomes in children. However, most prior studies have focused on mental health effects in older children and have not fully examined developmental or physical health impacts in younger children. This study aimed to explore the association between neighborhood-level gun violence and the general health status of children nationwide.

What were the study results?

The study found that parents of children living in areas with high levels of gun violence were 20% less likely to report their child’s health as excellent or very good compared with children who had experienced less gun violence, even after accounting for age and neighborhood economic disadvantage. This association was consistent across age groups, with both younger and older children in high gun violence areas less likely to report excellent or very good health. The effect was strongest in children that lived in neighborhoods with high poverty and high gun violence, where they were 23% less likely to be reported as having excellent or very good health.

What was the study's impact?

The findings underscore the importance of community violence prevention efforts and the need to strengthen our understanding of community risk factors such as gun violence that hinder optimal child growth and development.

Who was involved?

The study included 13,450 children from birth to 17 years old from 56 ECHO Cohort Study Sites.

What happened during the study?

Researchers used data from the Gun Violence Archive to identify how much gun violence occurred in different neighborhoods, categorized into low, medium, and high levels. Then they looked at how parents rated their children’s overall health and compared it across neighborhoods. A statistical model was used to measure the link between children’s health and the amount of gun violence in their neighborhood.

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 following children over time could help researchers better understand how exposure to gun violence affects children's health as they grow. Additional studies could also help researchers separate the impacts of gun violence exposure from other factors and explore how and why this exposure influences children’s health.

Where can I learn more?

Access the full journal article, titled “Associations between neighborhood-level gun violence and child general health status An ECHO Cohort analysis,” in Injury.

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

Published November 2025

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Children in High Gun Violence Areas Less Likely to Report Excellent Health, ECHO Study Finds

ECHO Study Examines the Effects of COVID-19–Related Changes in Caregiver and Child Behavior on Youth Mental Health

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ECHO Study Examines the Effects of COVID-19–Related Changes in Caregiver and Child Behavior on Youth Mental Health

Authors: Amy Margolis, Andrew Law, 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 United States is facing a growing youth mental health crisis with a significant increase in mental or behavioral health conditions, partly linked to changes during the COVID-19 pandemic. This study examined changes in family hardships, behaviors, and coping strategies during the COVID-19 pandemic and evaluated whether these changes were associated with youth pandemic-related post-traumatic stress (PTS) symptoms.

What were the study results?

The study identified two groups of families based on their experiences of hardships, changes in daily behaviors, and coping strategies during COVID-19. The first group had minimal changes in their lifestyle and behaviors, while the second group had significant changes. The low change group included a higher proportion of Black families, single-parent households, and lower income and education levels.

Children and teens in the group with significant changes had higher Pandemic-related Traumatic Stress Scale (PTSS) scores compared to the group with minimal changes. Some aspects of parent or caregiver experiences, including their ability to isolate during the pandemic, were associated with lower PTSS scores in children. Youth whose parents or caregivers reported no change in their own behaviors were more likely to report lower PTSS scores. Changes in youth health behaviors (like eating, physical activity, and media use) and access to healthcare were important factors related to PTSS scores. Stability in these areas was linked to lower PTSS scores. The use of coping strategies by children and teens did not significantly reduce PTSS scores. Some coping strategies, like increased media use and substance use, were linked to higher PTSS scores.

What was the study's impact?

This study provides valuable insight that could help improve youth mental health now and in the wake of future public health emergencies. It demonstrates the importance of stability in health behaviors, access to healthcare, and the ability to isolate safely as key factors in reducing youth PTS symptoms.

Who was involved?

The participants included 9,139 youth and their parents or caregivers from across the United States, including 7,786 children (aged 2-12 years) and 1,353 teens and young adults (aged 13-21 years).

What happened during the study?

The study looked at information from ECHO families between April 2020 and August 2021 to understand how the pandemic affected them. Researchers grouped families into different categories based on their experiences and background characteristics from before the pandemic. The researchers then looked at symptoms of PTS in both children and teens within these family groups. The study explored how COVID-19 influenced family hardships, changes in parent and child behavior, and the ways families coped.

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 examine what factors contribute to ongoing PTS symptoms or the occurrence of mental health diagnoses. Interviewing participants about acute stress when collecting PTSS survey responses could also help researchers confirm the validity of the survey.

Where can I learn more?

Access the full journal article, titled “Changes to Family Life, Youth COVID-19 Pandemic-Related Traumatic Stress, and the Youth Mental Health Crisis,” in the Journal of Clinical Child & Adolescent Psychology.

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

Published October 17, 2025

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ECHO Study Examines the Effects of COVID-19–Related Changes in Caregiver and Child Behavior on Youth Mental Health

Strong Friendships Matter More than Time Spent on Social Media for Adolescent Mental Health, ECHO Study Finds

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Strong Friendships Matter More than Time Spent on Social Media for Adolescent Mental Health, ECHO Study Finds

Authors: Courtney K. Blackwell, 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?

Teens spend a significant amount of time using social media, raising questions about how their digital and social experiences intersect. Recent concerns outlined by the U.S. Surgeon General’s Advisory suggest potential negative influences of social media on youth mental health. A 2021 national survey of 8th and 10th graders, cited in the U.S. Surgeon General’s report on social media and youth mental health, found that teens spent an average of 3.5 hours per day on social media. More recently, a 2023 Gallup survey of 13- to 19-year-olds reported that the average had increased to 4.8 hours per day. While a large number of previous studies focus on negative mental health outcomes such as depression and anxiety, ECHO researchers examined teen social media use in relation to both positive and negative mental health effects.

What were the study results?

High-quality peer relationships were the strongest predictor of teen well-being, regardless of social media use, with a magnitude nearly three times as large as the association between social media use and poor mental health. Teens who reported high quality peer relationships were more likely to experience positive mental health, while teens who reported poor quality relationships were more likely to report worse mental health, even at similar levels of social media use.

What was the study's impact?

The study highlights the importance of improving the quality of peer relationships rather than merely limiting social media use to enhance teens’ mental health.

Who was involved?

The study included 963 teens aged 13 to 18 from three ECHO Cohort Study Sites across the United States.

What happened during the study?

Teens ages 13 to 18 reported how much time they spend on social media and whether they use it actively (like posting and commenting) or passively (like scrolling and browsing). Researchers used the PROMIS® assessment tools and the Strengths and Difficulties Questionnaire to measure teens’ mental well-being, including life satisfaction, sense of purpose, symptoms of depression, and the quality of their friendships.

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?

Studying social media use and mental health over the course of adolescence could help researchers better understand how these factors influence each other throughout this sensitive stage of development. Future research could also focus on finding ways to strengthen peer relationships to support teens' mental health.

Where can I learn more?

Access the full journal article, titled “Adolescent social media use and mental health in the Environmental influences on Child Health Outcomes (ECHO),” in the Journal of Adolescent Health.

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

Published February 5, 2025

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Strong Friendships Matter More than Time Spent on Social Media for Adolescent Mental Health, ECHO Study Finds

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

ECHO Study Finds Maternal Stress During and After Pregnancy May Be Linked to Child Sleep Problems

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ECHO Study Finds Maternal Stress During and After Pregnancy May Be Linked to Child Sleep Problems

Authors: Sarah Dee Geiger, Aruna Chandran, Marie L. Churchill, Susan Schantz 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?

This study aimed to explore the associations between perceived maternal stress during and after pregnancy and child sleep problems and disturbances. Previous research has suggested prenatal stress could be associated with negative child sleep outcomes, but less is known about how postnatal stress may contribute to this association. This study aimed to address these gaps and provide insights into the potential public health implications of stress during and after pregnancy.

What were the study results?

The study found that maternal stress during pregnancy showed a small but significant association with child sleep problems and sleep disturbance. This effect was seen even when the researchers accounted for the influence of maternal stress after pregnancy.

What was the study's impact?

Maternal stress during and after pregnancy and child sleep problems are both very common, so even small effects may have important public health implications. Interventions that can help mothers manage stress during and after pregnancy could have positive effects on their children’s sleep quality, setting them up for a healthier childhood and adulthood.

Who was involved?

This study used data from a diverse group of 1,965 mother-child pairs enrolled in ECHO Study Sites in 7 U.S. states and Puerto Rico. The study included mothers who reported their stress during and after pregnancy and their child’s sleep at least once between the ages of 4 and 8, resulting in a racially and ethnically diverse sample, with up to 50% of these children being reported as Hispanic by their parents.

What happened during the study?

During the study, researchers measured maternal perceived stress using the Perceived Stress Scale (PSS) and used statistical analysis to investigate the relationship between maternal stress during pregnancy and child sleep quality, adjusting for various factors such as the mother’s age at delivery and level of education and the child’s sex, gestational age at birth, and age when sleep was evaluated. The researchers also conducted an analysis to assess the degree to which stress after pregnancy affected the relationship between prenatal stress and child sleep quality.

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 can help researchers understand the relationship between prenatal stress and child sleep outcomes. Future studies could also investigate the biological mechanisms and social factors underlying the association between prenatal stress and sleep outcomes in childhood.

Where can I learn more?

Access the full journal article, titled “Association Between Maternal Stress and Child Sleep Quality: A Nationwide Environmental Influences on Child Health Outcomes Program Prospective Cohort Study,” 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 October 11, 2024

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ECHO Study Finds Maternal Stress During and After Pregnancy May Be Linked to Child Sleep Problems

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

COVID-19 Pandemic Altered Relationship Between Neighborhood Environment and Child Well-Being, ECHO Study Suggests

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COVID-19 Pandemic Altered Relationship Between Neighborhood Environment and Child Well-Being, ECHO Study Suggests

Authors: Xueying Zhang, 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?

Understanding how neighborhood characteristics affect child well-being is important. Prior studies have found an association between neighborhood characteristics and children’s health and development. During the COVID-19 pandemic, stay-at-home policies limited people’s interactions with their neighborhood environment. However, researchers have not considered how the pandemic might have changed these effects. ECHO researchers wanted to address this gap by exploring how the pandemic, as a natural experiment, may have changed the relationship between neighborhood characteristics and child well-being. Additionally, since COVID-19 has impacted racial and ethnic groups differently, this study examined these differences to identify potential disparities.

What were the study results?

The study found that the relationship between neighborhood characteristics and child well-being changed during the COVID-19 pandemic. It also revealed racial disparities, showing that the pandemic's impact on child well-being varied across different racial and ethnic groups.

For non-Hispanic White children, the number of people who lived in their homes and the diversity of their neighborhood were linked to lower well-being. For children of other races and ethnicities, living in areas with higher percentages of Hispanic residents and more adults working as essential workers were associated with lower well-being.

What was the study's impact?

These findings highlight how neighborhood characteristics, the pandemic, and child well-being interact, emphasizing the importance of addressing disparities during unique events like the pandemic.

Who was involved?

The study involved 1,039 children, mostly between the ages of 11 and 19, from more than 10 ECHO Cohort Study Sites across the U.S.

What happened during the study?

Researchers conducted an analysis of children who completed a well-being questionnaire called the Patient-Reported Outcomes Measurement Information System (PROMIS) before (2019 to March 1, 2020) and during (March 1, 2020 to August 31, 2021) the pandemic. The PROMIS survey measures children's mental and physical health and peer and family relationships.

The researchers then matched U.S. Census tract data with a child’s residential address to examine the neighborhood characteristics. They looked at factors including the race, education, and occupation composition of residents, as well as house capacities and property features. They analyzed how these factors were associated with child well-being, considering the impacts of the pandemic, as well as differences across child racial groups.

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 explore how specific aspects of neighborhoods affect children's well-being, especially when these factors interact.

Where can I learn more?

Access the full journal article, titled “Associations between neighborhood characteristics and child well-being before and during the COVID-19 pandemic: A repeated cross-sectional study in the Environmental influences on Child Health Outcomes (ECHO) program,” 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.

Read the associated article.

Published July 1, 2024

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COVID-19 Pandemic Altered Relationship Between Neighborhood Environment and Child Well-Being, ECHO Study Suggests