ECHO Review Finds Air Pollution May Be Associated with Child Brain Development, Behavior

Author(s): Heather E. Volk, Frederica Perera, Joseph M. Braun, Samantha L. Kingsley, Kim Gray, Jessie Buckley, Jane E. Clougherty, Lisa A. Croen, Brenda Eskenazi, Megan Herting, Allan C. Just, Itai Kloog, Amy Margolis, Leslie A. McClure, Rachel Miller, Sarah Levine, Rosalind Wright

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?

ECHO provides a unique opportunity to study how air pollution can affect children’s brain development and behavior in a large, diverse study population. It also has the ability to study pollutant exposures by geographic area, which has been a limitation in previous research.

What was the study's impact?

This study sets up the possibility of future work in ECHO on the effect of prenatal air pollution exposure on brain development in children.

Why was this study needed?

This study summarized information on different ways to measure prenatal air pollution exposure and what we know about how air pollution affects children’s behavior and brain development. It also helps create a plan for ECHO to study how being exposed to air pollution in the womb may affect children’s behavior.

Who was involved?

This paper uses summary data from ECHO to learn if there may be enough participants in the future to study how air pollution can affect children’s brain development and behavior.

What happened during the study?

Researchers reviewed earlier papers on air pollution and child development to summarize what those studies found. Then, they used that information to develop a plan that ECHO might use to fill gaps in that earlier work to advance children’s health.

What happens next?

Future studies will do the work described here – to examine air pollution exposure in ECHO participants by geographic area to determine how air pollution can affect the brain.

Where can I learn more?

Access the full journal article , titled “Prenatal air pollution exposure and neurodevelopment: A review and blueprint for a harmonized approach within ECHO.”

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

Published: May 2021

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ECHO Review Finds Air Pollution May Be Associated with Child Brain Development, Behavior

ECHO Study Outlines How Researchers Can Combine Datasets With Different Confounders*

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ECHO Study Outlines How Researchers Can Combine Datasets With Different Confounders*

Author(s): Ghassan B. Hamra, Bryan Lau, Catherine Lesko, Jessie Buckley, Daniel Tancredi, Irva Hertz-Picciotto, Elizabeth Jensen

*Confounders are factors in a study that can lead to bias. These factors must be adjusted so researchers can accurately understand the information.

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?

Most of the time, the estimators showed similar numeric values of the estimates. The exception is when using a model known as logistic regression, which did not give similar estimates. Logistic regression provides an odds ratio, which is a non-collapsible quantity, or one that cannot be reliably combined.

What was the study's impact?

This study can help researchers understand and combine information across ECHO groups. When the same confounders are not available, or when study designs are different, researchers should avoid logistic regression. Other estimators provide estimates that can be reliably combined.

Why was this study needed?

A type of graph, called Directed Acyclic Graphs (DAG), guide decisions on choosing confounders that need to be adjusted. These graphs also suggest how to get unconfounded (unbiased) effect estimates. These estimates are based on different statistical models and do not always provide the same actual numeric values. The research team explored when they do and do not correspond.

Who was involved?

Researchers from the John Hopkins University Data Analysis Center (JHU DAC), Wake Forest University, and University of California Davis joined together to explore this problem.

What happened during the study?

All study data are simulated, and Dr. Hamra at the JHU DAC built all of the models. Dr. Hamra also looked at all of the information.

What happens next?

Researchers can make more models to explore other forms of bias that could make combining information across studies difficult.

Where can I learn more?

Researchers can get the modeling code to look into this issue if they choose to in the journal article, titled “Combining Effect Estimates Across Cohorts and Sufficient Adjustment Sets for Collaborative Research: A Simulation Study” in Epidemiology.

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

Published: May 1, 2021

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ECHO Study Outlines How Researchers Can Combine Datasets With Different Confounders*

ECHO Study Identifies Genetic Underpinnings of Wheezing Patterns Linked to Asthma

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ECHO Study Identifies Genetic Underpinnings of Wheezing Patterns Linked to Asthma

Author(s): Brian Hallmark, 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 under Award Number 5UH3 OD023282.

What were the study results?

Four wheezing patterns were seen among the children: (1) infrequent—few wheezing episodes in the first three years then none after that; (2) transient—some wheezing in first few years then fewer and gone by around age six; (3) late onset—little wheezing in the first few years then slowly happens more often; (4) persistent—many wheezing episodes over the first 11 years.

About half of children experience wheezing before three years old, and 62% wheezed in the first 10 years of life. The wheezing may start because of a viral infection (like the common cold). Many children only wheeze as preschoolers. AA children were more likely than European American (EA) children to have persistent wheezing.

Several small gene changes were connected to transient, late onset, and persistent wheezing in EA children, but for both AA and EA children, only two specific small gene changes were connected with a greater likelihood of the child wheezing after the first three years.

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?

For the first time, it is reported that genetic changes associated with childhood asthma are also associated with all wheezing patterns in young children. These wheezing patterns were found consistently in children located in different cities and born in different decades.

Wheezing in young children is often a result of common respiratory viruses that affect breathing. These findings, together with what we know about the genes associated with asthma, suggest that some of these small gene changes may be connected to a higher risk of colds and other viral airway infections that trigger wheezing in small children.

This study also highlights the importance of including multiple race/ancestry groups in genetic studies to understand how small changes in genes are connected to different health outcomes in diverse groups.

Why was this study needed?

Previous studies have shown that many children wheeze during the first few years of life—some later stop, while others can develop ongoing asthma. Other children do not wheeze during early life but still develop asthma later during childhood. Understanding where these patterns come from may shed light on how asthma begins and help doctors identify children who might need help earlier. Other studies identified small changes in specific genes that could be responsible for some cases of childhood asthma. This study tried to find possible connections between those small gene changes and different wheezing patterns in children. This is also the first study that looks at how small genetic changes may relate to specific patterns of wheezing in African American (AA) children.

Who was involved?

Data came from children enrolled at birth in seven different studies across the US. Nearly 3,700 children who experienced at least three wheezing events were included, and researchers analyzed the genes of 1,928 of these children. About 32% of these children were AA. Each study site used questionnaires and interviews to collect information from children and their parents over many years.

What happened during the study?

The team collected patient characteristics and data on wheezing and asthma and pulled those data together to group each child based on when and how often they wheezed from birth to age 11. Each site also collected DNA samples from the children and sent them to be analyzed for small changes in genes associated with asthma. The researchers used statistics to identify four different wheezing patterns and connect them with specific genetic changes.

What happens next?

The team is looking at possible associations between children’s insulin levels, genetic variations, and the development of asthma in childhood.

Where can I learn more?

Access the full journal article, titled “Chromosome 17q12-21 Variants Are Associated with Multiple Wheezing Phenotypes in Childhood,” in the American Journal of Respiratory and Critical Care Medicine.

Additional Details

This project would not have been possible without ECHO CREW support, as the data came from seven separate birth cohorts brought together by that program. In particular, combining those datasets was essential to getting a large enough sample size to include AA children.

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

Read the corresponding article.

Published: April 1, 2021

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ECHO Study Identifies Genetic Underpinnings of Wheezing Patterns Linked to Asthma

ECHO Study Finds Children Are Less Likely to Get the Common Cold as They Get Older

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ECHO Study Finds Children Are Less Likely to Get the Common Cold as They Get Older

Author(s): Timothy Choi, James E. Gern and Yury A. Bochkov

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. Additional support came from contributing studies by the NIH, the Sigrid Juselius Foundation (Helsinki, Finland) and the National Health Medical Research Council (Australia).

What were the study results?

As children age, they are less likely to be infected with the rhinovirus C species. This may be because the immune system gets stronger against infection with rhinovirus C species compared to other species. Other personal factors related to more frequent infections are wheezing respiratory illnesses and a genetic difference in a protein used by the viruses to enter cells.

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 care without first consulting your healthcare professional.

What was the study's impact?

Infections with rhinoviruses, generally known as common colds, are the most common cause of wheezing illnesses in preschoolers and children with asthma. Unfortunately, there are no treatments for these respiratory viruses. The results of the study identify children most likely to develop more severe illnesses with rhinovirus C based on young age and genetics. This new information on at-risk populations and the viruses most likely to cause illnesses can help scientists create a vaccine specifically for the rhinovirus C species.

Why was this study needed?

Rhinovirus is a leading cause of the common cold and wheezing illnesses in young children and in children with asthma. There are three species of rhinoviruses (A, B, and C), and C viruses are often more likely to cause wheezing illnesses, especially in young children. The main objectives of this study were to identify age and other personal risk factors for rhinovirus illnesses, and to determine whether certain rhinoviruses are more frequent and more likely to cause wheezing illnesses.

Who was involved?

More than 4,000 children were enrolled in 14 independent studies across the United States, Finland, and Australia from 2000 to 2019. Study participants had illnesses of varying severity and varied in age from zero to 19 years.

What happened during the study?

Each of the 14 sites collected nasal samples and studied them for rhinovirus species and type. The investigators then tested whether characteristics such as age, gender, and race influenced which viruses were seen. Investigators also identified which viruses are most common and which are most likely to cause illnesses.

What happens next?

Future research will focus on studying the strength and length of time people can be immune to rhinovirus C. This will help determine why these viruses are able to produce such a strong immune response, and why rhinovirus C infections decrease with age. This information may help researchers design a practical vaccine against rhinovirus C that could be used to protect high-risk children.

Where can I learn more?

View the full journal article, titled "Enhanced Neutralizing Antibody Responses to Rhinovirus C and Age-Dependent Patterns of Infection," in American Journal of Respiratory and Critical Care Medicine.

Additional details

The authors thank the many investigators, children and families who conducted and participated in this multinational collaborative study.

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

Published: April 1, 2021

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ECHO Study Finds Children Are Less Likely to Get the Common Cold as They Get Older

ECHO Discovery

Co-author James Gern presented An Integrated Approach to Identifying Early Life Causes of Childhood Asthma at a past ECHO Discovery webinar. You can view his presentation here.

ECHO Study Suggests PCBs in Soil, Water, Building Materials Increase Time Couples Need to Get Pregnant

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ECHO Study Suggests PCBs in Soil, Water, Building Materials Increase Time Couples Need to Get Pregnant

Author(s): Linda Kahn, Alison Hipwell, Kim Harley, Pam Factor-Litvak, Michele Klein-Fedyshin, Christine Porucznik, Eva Siegel, Yeyi Zhu

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. Individual authors were additionally supported by the National Institutes of Environmental Health Sciences, Diabetes and Digestive and Kidney Diseases, and Alcohol Abuse and Alcoholism.

What were the study results?

The strongest evidence points to a connection between human-made chemicals called polychlorinated biphenyls and a longer time to get pregnant. These chemicals used to be used in electrical and hydraulic equipment. Even though production of these chemicals stopped in the late 1970s, we are still exposed to them through soil, water, and building materials. Another group of chemicals called organochlorine pesticides do not seem to affect the time it takes to get pregnant. We still need more research on brominated flame retardants, found in furniture, clothing, and other household products, and per- and polyfluoroalkyl substances, found in non-stick cookware and stain-resistant fabrics. Many of the newer chemicals in these categories have not yet been studied.

What was the study's impact?

This review shows that some long-lasting chemicals may increase the time it takes for couples to get pregnant. This can be stressful and lead couples to seek expensive fertility treatment. Although many of the chemicals covered in our review are no longer made or used in the US, they can last for years—even decades—in the environment and in our bodies. Therefore, they can still affect our health. We need more research on newer chemicals that have been invented to replace dangerous ones. We also need to figure out exactly how these chemicals interfere with healthy reproduction. For example, there may be times in life, such as puberty, when being exposed to them may be especially damaging. The ECHO Program is an important resource for answering these questions.

Why was this study needed?

Some human-made chemicals can cause problems with the reproductive system. Many studies have looked at whether these chemicals affect how long it takes to get pregnant. How long it takes to become pregnant is a sign of a couple’s reproductive health and can be a sign that they need to seek fertility treatment. Our review compares the results of past studies to see if there are consistent patterns for particular types of chemicals. It also identifies chemicals that need further research.

Who was involved?

This review includes all papers published in English on this topic from January 1, 2007 to August 6, 2019. Our search looked at 28 articles. These articles used data from 19 different studies. The studies took place in North America, Europe, and East Asia.

What happened during the study?

We searched five science libraries and found more than 4500 articles that could possibly fit our topic and narrowed them down to the 28 articles discussed in our paper. We read each article carefully, gave it a score based on its quality, and pulled out the most important information. This included whether the chemicals the paper looked at affected how long it took to get pregnant, and if so, by how much. We then put that information into tables. Finally, we looked at whether or not results were consistent, especially among high-quality studies. We then drew our conclusions.

What happens next?

This is the second review that this team of authors has written on chemicals and time to pregnancy. Our next paper will look at whether different types of air pollution affect how long it takes to get pregnant.

Where can I learn more?

Access the full journal article titled "Persistent organic pollutants and couple fecundability: a systematic review" published in Human Reproduction Update.

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

Published: February 19, 2021

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ECHO Study Suggests PCBs in Soil, Water, Building Materials Increase Time Couples Need to Get Pregnant

ECHO Study Identifies Disparities in Preterm Birth Risk Based on Race, Ethnicity, Neighborhood Conditions, Education Level

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ECHO Study Identifies Disparities in Preterm Birth Risk Based on Race, Ethnicity, Neighborhood Conditions, Education Level

Author(s): Anne L. Dunlop, Alicynne Glazier-Essalmi, 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?

There were differences in how early the baby was born based on the mother’s race and ethnicity. Compared to non-Hispanic white women, women of all other races had a higher chance of PTB. For women overall, a bachelor’s degree or above was linked to less chances of PTB, and a high school education or less led to higher chances of PTB. This link between education level and PTB was mostly seen in non-Hispanic white women and those who lived in the South and Midwest regions of the US. This study also collected data on neighborhood factors; non-Hispanic white women living in a rural area had a higher chance of PTB delivery compared to women living in an urban area.

What was the study's impact?

This study explored an important gap in the field of children’s health. It gathered information on how factors such as the mother’s race/ethnicity, location, education level, and SES affect if a baby is born early. The results show that higher education among women could help decrease the chances of PTB in the US, especially in the South and Midwest regions.

Why was this study needed?

There are high rates of preterm birth (PTB) in the US. Previous studies show that the rates of PTB are different based on race and location, but there is not much information available on what causes these differences. This study also explored the link between the mother’s SES, race, and location and how they affect the baby’s age at birth. Socioeconomic status (SES) is a combination of factors such as education, income, and occupation.

Who was involved?

Women enrolled in the ECHO Program who delivered a baby were included in this study. They provided all of the required information about themselves and their infant. More than 20,000 mother-infant pairs participated.

What happened during the study?

Researchers studied a variety of information including the mother’s age at delivery, education, physical address or region, alcohol use, prenatal care, and the child’s birth sex and how many weeks they were at birth. They took this information and looked for patterns and connections between factors that affect PTB.

What happens next?

Non-Hispanic Black women, Native American, and Alaskan Native women have the highest rates of PTB. Future studies in these populations will help explore the causes for these differences and figure out ways to prevent PTB.

Where can I learn more?

View the full journal article, titled “Racial and geographic variation in effects of maternal education and neighborhood-level measures of socioeconomic status on gestational age at birth: Findings from the ECHO cohorts” in PLOS One.

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

Published: January 8, 2021

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ECHO Study Identifies Disparities in Preterm Birth Risk Based on Race, Ethnicity, Neighborhood Conditions, Education Level

Pregnant Women Exposed to Various Chemicals, Including Chemicals in Personal Care Products and Consumer Goods

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Pregnant Women Exposed to Various Chemicals, Including Chemicals in Personal Care Products and Consumer Goods

Author(s): Brett Doherty and Megan Romano

Who sponsored this study?

Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, and grant funding.*

What were the study results?

Researchers found 199 unique chemicals in the wristbands worn by women in the study. There were 16 chemicals, including chemicals in personal care products and consumer goods, which were found most often. Most women had comparatively low amounts of exposures to these chemicals but others had more unique combinations of chemical exposures. Education and behaviors, such as nail polish use, helped predict the level of chemical exposures.

What was the study's impact?

This work helps identify opportunities and challenges for using tools like silicone wristbands to understand chemical exposures during pregnancy. The research team also identified common exposures and exposure patterns within the study population, which may be studied in future research.

Why was this study needed?

Pregnant women are exposed to chemicals that may be bad for their health or their babies’ health. At the same time, the types of chemicals and their co-occurrence are not well understood. The researchers used silicone wristbands that capture chemicals in the environment to learn more about these exposures in a group of pregnant women in northern New England.

Who was involved?

This study included 255 women enrolled in the New Hampshire Birth Cohort Study (NHBCS) between 2017 and 2019. The NHBCS began in 2009 and includes more than 2,000 mother and child pairs.

What happened during the study?

During early pregnancy, the women wore the wristbands and went about their normal activities while chemicals in their environment became trapped in their wristbands. The women then returned the wristbands after one week and researchers measured the captured chemicals. This provided information about the chemicals in the women’s environments.

What happens next?

The team will connect the chemical exposure information collected from the silicone wristbands to maternal and infant health outcomes. This connection may show how chemicals influence human health and provide clues to prevent health problems. The team will also compare these wristband measurements to traditional measurements of chemical exposures. This will help scientists better understand the strengths and weaknesses of this new technology.

Where can I learn more?

Access the full journal article , titled “Assessment of Multipollutant Exposures During Pregnancy Using Silicone Wristbands” published in Frontiers in Public Health.

Additional details

This work included collaboration with Dr. John Pearce, who, like Dr. Romano, is an OIF Cycle 1 Awardee. Dr. Pearce provided expertise related to the statistical methods used in this research, which he developed through his project entitled “Developing exposure characterization tools to address complex exposures within ECHO” (EC0155).

*Award Numbers include U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), and UH3 OD023275, and the National Institute of Environmental Health Sciences under Award Number P42ES007373. Brett T. Doherty was supported by National Cancer Institute grant R25CA134286.

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

Published: September 29, 2020

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Pregnant Women Exposed to Various Chemicals, Including Chemicals in Personal Care Products and Consumer Goods

Better Sleep Quality Is Linked to Lower Levels of Stress and Better General Health in Children

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Better Sleep Quality Is Linked to Lower Levels of Stress and Better General Health in Children

Author: Courtney K. Blackwell

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?

Results suggested better sleep quality was connected with lower levels of stress and better general health. This, in turn, predicted higher levels of life satisfaction. Findings remained stable for a subsample of children with the poorest sleep quality.

*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?

Children who sleep well have happier lives than those who do not sleep as well. Given the varying nature of children’s sleep quality, this study offers findings to inform future studies that want to test specific ways to improve children’s well-being. Ways to improve sleep may include education programs for parents that teach parents how to prevent things that keep children from sleeping well (e.g., ways to lower screen time in the hour before bed). Other ideas may include looking at how elementary school start times affect children’s sleep quality.

Why was this study needed?

Sleep quality is important to children’s health and well-being. Until now, research has focused on how poor sleep may cause health problems. The current study explored if and how better sleep quality may lead to positive health in children.

Who was involved?

More than 1000 caregivers of 5- to 9-year-old children from 3 ECHO Program cohorts participated in this study. Participants were from different places in the United States, had different financial backgrounds and 10% were of Hispanic origin.

What happened during the study?

Between March and December 2017, caregivers completed surveys about their children’s sleep quality, general health, stress, and life satisfaction.

What happens next?

This study provides early evidence on the ways better sleep can improve the lives of children. Future research with more diverse samples can make these findings apply to more people. Additionally, measures to try with younger children are available so that we can see how this affects children younger than 5.

Where can I learn more?

Access the full journal article, titled “Better sleep, better life? How sleep quality influences children's life satisfaction.”

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

Published: September 29, 2020

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Better Sleep Quality Is Linked to Lower Levels of Stress and Better General Health in Children

ECHO Researchers Test a Short Questionnaire for Measuring Autism-Related Behaviors in Children

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ECHO Researchers Test a Short Questionnaire for Measuring Autism-Related Behaviors in Children

Author(s): Kristen Lyall and Craig Newschaffer

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 the short questionnaire did a good job predicting autism diagnosis and measuring social communication behaviors. However, more research is needed to see how the short questionnaire compares in other ways to the long questionnaire.

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 the shorter version of the questionnaire is quicker, easier for participants to complete, and produces the same quality of work as the longer version. This work is also important because it may be helpful for people who do not meet the definition of ASD, but still face challenges in social communication and could benefit from help.

Why was this study needed?

Autism spectrum disorder (ASD) is a condition defined by challenges in social communication. Social communication refers to how we use language or words in social interactions with others, including how we may change words we use in different situations and with different people. This study wanted to see if a shorter version of a social communication questionnaire could predict ASD and other challenges related to social communication as correctly as a longer version. Having a shorter survey would mean that it would take participants less time to complete it. This study could also help identify questionnaires that could be used to find different social communication challenges in people with and without ASD.

Who was involved?

More than 3,000 people completed questionnaires for this study, including almost 200 parents who had a child with ASD between the age of 2-18. Participants were from research studies from across the United States.

What happened during the study?

Researchers used questionnaires from 10 different research projects in the United States to compare how well information from the shorter version predicted ASD diagnosis and measured broader behaviors in people without ASD diagnosis.

What happens next?

We now know that the shorter version of the questionnaire is comparable to the longer version, in terms of measuring these behaviors and predicting ASD diagnosis. However, more work is needed to confirm that the short questionnaire performs in all the same ways that the longer one does, since the study addressed only a few of these questions.

Note: This study is part of a project examining how different versions of this questionnaire measure ASD and broader, related social communication traits.

Where can I learn more?

More information on the questionnaire used in this study can be found through the publisher website and additional information on the shortened questionnaire can be found on PubMed .

Access the full journal article , titled “Distributional Properties and Criterion Validity of a Shortened Version of the Social Responsiveness Scale: Results from the ECHO Program and Implications for Social Communication Research.”

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

Published: September 17, 2020

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ECHO Researchers Test a Short Questionnaire for Measuring Autism-Related Behaviors in Children

ECHO Study Suggests Chronically Ill Children Can Still Have High Life Satisfaction

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ECHO Study Suggests Chronically Ill Children Can Still Have High Life Satisfaction

Author(s): Courtney K. Blackwell, Amy J. Elliott, Jody Ganiban, 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?

Results suggested that children with at least one chronic illness had worse general health, but similar levels of life satisfaction as other children their age who do not have a chronic illness. Children (those with and without illness) who were less stressed and came from higher income families had higher life satisfaction. Overall, this study shows that chronic illnesses do not necessarily keep children from leading happy, satisfying lives.*

*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 is the first ECHO project to collect and combine new data from multiple cohorts to examine the topic of positive health. Findings highlight opportunities for healthcare professionals to broaden views of health from meaning the “absence of disease” to one where all children, regardless of illness, have well-being. This idea aligns with the Institute of Medicine’s definition of child health, and this study provides innovative measures to understand such outcomes. Results from this study may lead to future research on the relationship between certain chronic illnesses and child well-being. It may be particularly interesting for large research programs, such as ECHO, that have access to larger groups of children with different illnesses. Study findings also give researchers a way to address recent national initiatives, such as the Health Resources and Services Administration’s focus on creating programs that address children’s life satisfaction.

Why was this study needed?

The relationship between chronic illness and negative health outcomes is well-known. However, less is known about the relationship between chronic illness and positive health outcomes, such as life satisfaction, especially in children.

Who was involved?

Participants came from three ECHO Program cohorts. Participants were 1,113 caregivers who reported information for 1,253 children 5-9 years old.

Of these children:

About half were male (53%)
The majority were white (79%)
A tenth were Hispanic (10%)
A fifth had at least one chronic illness (20%)

What happened during the study?

Three ECHO cohorts surveyed caregivers on their children’s general health, life satisfaction, and stress between March 2017 and December 2017. Cohorts shared results from these surveys and data related to children’s medical conditions and family demographic information with the ECHO research team.

What happens next?

This study provides a start for more research on the relationship between certain chronic illnesses and children’s well-being as well as how chronic illness relates to the change in well-being over time.

Where can I learn more?

Access the full journal article, titled “General Health and Life Satisfaction in Children With Chronic Illness.”

For an overview of the research and findings, see the American Academy of Pediatrics press release.

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

Published: June 2019

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ECHO Study Suggests Chronically Ill Children Can Still Have High Life Satisfaction