Caregiver-Reported Measures of Childhood Behavior May be Biased by the Demographic Traits of Caregivers and Children

Authors: Shuting Zheng, Maxwell Mansolf, Somer Bishop, 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?

Behavior problems observed in a young child can provide information on that child’s risk for certain developmental conditions and later mental health issues. A valid and unbiased measure of childhood behavior is critical for helping researchers and clinicians answer questions about the development of behavior problems in children from different backgrounds.

What were the study results?

Scores from the Child Behavior Checklist (CBCL) 1.5–5—a commonly used, caregiver-reported measure of internalizing (e.g., anxious) and externalizing (e.g., aggressive) behavior problems in children ages 1.5 to 5 years—may be biased by demographic factors such as the child’s age or the caregiver’s sex, education level, and primary language. Researchers found that caregiver responses for a number of questions on the CBCL were affected by caregiver or child demographic factors. The language (English vs. Spanish) the caregiver used to complete the survey contributed most to measurement bias, followed by their education level and sex. The child’s age and race also influenced CBCL scores.

By determining the factors contributing to measurement bias, ECHO researchers identified a subset of questions on the CBCL that were less impacted by bias but still reliably captured childhood behavior problems.

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

What was the study's impact?

The results of this study highlight the need to carefully consider possible sources of bias when using caregiver-reported measures. This study was the first to use a large, diverse sample of families to examine how demographic factors influence the answers given for individual survey questions in the widely used CBCL. Developing surveys with less bias can help researchers and clinicians better measure and compare behavior problems across groups of children who differ in age and family background.

Who was involved?

The study included caregivers of 9,087 young children (ages 18 to 71 months) from 26 ECHO research sites across the United States.

What happened during the study?

The researchers used data from 26 ECHO research sites to evaluate how caregiver responses to the CBCL varied based on the characteristics (age, sex, race, bilingual status, and neurodevelopmental disorders) of the child and the characteristics (sex, education level, household income level, and depression diagnosis) of the caregiver. Researchers then selected the CBCL questions that showed the least amount of bias and compared how well this subset of questions worked for evaluating childhood behavior problems when compared to the full CBCL survey. Additionally, the researchers mapped the scores from the less biased question sets to the scores provided by the full item sets, allowing them to derive comparable scores to the original CBCL scale.

What happens next?

ECHO researchers plan to apply the newly identified subset of less biased CBCL survey questions, evaluating its reliability in identifying children with clinically significant behavior problems. The identification of question sets with little bias offers researchers and clinicians better alternatives for measuring and comparing behavior problems across groups of children who differ in age and family background.

Where can I learn more?

Access the full journal article, titled “Measurement Bias in Caregiver-Report of Early Childhood Behavior Problems across Demographic Factors in an ECHO-wide Diverse Sample,” in the Journal of Child Psychology & Psychiatry Advances.

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

Published September 29, 2023

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Caregiver-Reported Measures of Childhood Behavior May be Biased by the Demographic Traits of Caregivers and Children

ECHO Research Identifies Variety of Low-calorie, Nutrient-rich Foods for Optimal Prenatal Nutrition

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ECHO Research Identifies Variety of Low-calorie, Nutrient-rich Foods for Optimal Prenatal Nutrition

Authors: Katherine Sauder, Catherine Cohen, 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 the study needed?

Most pregnant women in the U.S. are at risk of not getting enough of nutrients like vitamin A, vitamin D, folate, calcium, iron, and omega-3 fatty acids from foods alone. Previous ECHO Cohort research found that only one prenatal supplement available in the U.S. may give pregnant women the optimal amounts of each of these six nutrients. However, that supplement costs $200 per month and requires the patient to take seven pills a day. Researchers in this study turned to diet to explore energy-efficient foods that could provide the right amounts of these nutrients for pregnant patients.

What were the study results?

Researchers in this study identified more than 2,300 low-calorie foods with enough of at least one of the six nutrients important in pregnancy, including many with reasonable serving amounts to avoid excessive intake. For instance, consuming an additional 0.2 cups of raw carrots could provide the optimal amount of vitamin A. An additional 2.6 cups of reduced-fat milk could provide the optimal amount of vitamin D. An additional 0.4 cups of edamame could provide the optimal amount of folic acid. An additional 1 cup of a nutritional drink or shake could provide the optimal amount of calcium. An additional 0.9 cups of multigrain cereal could provide the optimal amount of iron. An additional 0.1 cups of canned chicken could provide the optimal amount of omega-3 fatty acids.

However, no single food evaluated gave enough of all six nutrients. Seaweed (raw or cooked without fat) provided sufficient vitamin A, folate, calcium, iron, and omega-3s but would require consumption of more than 5 cups per day. Twenty-one other foods and beverages (mainly fish, vegetables, and beverages) provided target amounts of four of the six key nutrients. Few foods met targets for vitamin D or iron, suggesting that dietary supplements may be necessary to meet those nutrient needs. Other foods could be added in limited amounts to help meet intake targets without exceeding caloric recommendations or nutrient safety limits.

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

What was the study's impact?

Results highlight the difficulty in meeting nutritional requirements from diet alone and can inform pregnant women and their doctors about dietary changes and additional supplements that can improve nutrition during pregnancy. Pregnant women can focus on boosting prenatal intake of low-mercury fish, low-fat dairy, green and leafy vegetables, and fortified cereals to meet nutrient recommendations.

Who was involved?

This study included 2,450 pregnant participants from six ECHO Cohort Study Sites located across the U.S.

What happened during the study?

The researchers compared over 2,300 foods and beverages consumed in the U.S., focusing on the nutrients that are most important for maternal and infant health: vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids. ECHO researchers looked at foods and drinks that pregnant participants consumed during their pregnancies and then calculated how much of these six nutrients they were getting from their diet. The researchers compared the participants’ diets to nutrition recommendations for pregnancy to determine the amount of nutrients the participants would need from foods to make up for the gaps in their diet.

What happens next?

Future research may focus on studying exactly how much of these nutrients are needed for pregnant women.

Where can I learn more?

Access the full journal article, titled “Identifying Foods that Optimize Intake of Key Micronutrients During Pregnancy" in The Journal of Nutrition.

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

Published September 27, 2023

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ECHO Research Identifies Variety of Low-calorie, Nutrient-rich Foods for Optimal Prenatal Nutrition

ECHO Cohort Researchers Find Association Between Some Prenatal Chemical Exposures and Postpartum Depression

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ECHO Cohort Researchers Find Association Between Some Prenatal Chemical Exposures and Postpartum Depression

Authors: Melanie Jacobson, 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?

Postpartum depression affects up to 20% of new mothers, making it the most common pregnancy complication to occur after delivery. Postpartum depression can impact a mother’s daily functioning, quality of life, and long-term health. Furthermore, it is associated with poor mother-child attachment, which can impact child health and development.

Factors like genetics and stress can make some people more likely to experience postpartum depression, but researchers are still trying to understand how synthetic chemicals might also play a role. Chemicals such as phenols, phthalates, and parabens can be found in plastics and personal care products. While these chemicals are nonpersistent, meaning that they don’t linger in the environment, their presence is widespread due to frequent exposure through diet, absorption through skin, and inhalation. The investigators in this study wanted to examine the extent to which exposure to these chemicals might be associated with postpartum depression symptoms.

What were the study results?

Prenatal phthalate concentrations were associated with increased odds of slightly higher postpartum depression scores, and the condition was observed to be more likely in people who were Hispanic, had lower education levels, and had prenatal depression.

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?

Of the many synthetic chemicals investigated, only prenatal phthalate concentrations were associated with increased odds of postpartum depression. This suggests that finding ways to reduce prenatal exposure to phthalates might reduce the frequency of postpartum depression.

Who was involved?

Researchers used data from 2,174 pregnant individuals across five study sites. This information included data on urinary chemical concentrations from at least one point during the pregnancy and a self-reported postnatal depression assessment between two weeks and 12 months after delivery.

What happened during the study?

Researchers measured the concentrations of nonpersistent chemicals in urine samples. Researchers also collected, between two weeks and 12 months after delivery, data using self-reported postnatal depression assessments completed by the same individuals. Screening instruments indicated the presence or absence of postnatal depressive symptoms. Data was then harmonized to the Patient-Reported Measurement Information System (PROMIS) Depression scale.

What happens next?

While this is believed to be the largest study to-date examining the effects of environmental chemicals on postpartum depression, future studies are needed to replicate this research with larger sample sizes in diverse populations.

Where can I learn more?

Access the full journal article, titled “Prenatal exposure to nonpersistent environmental chemicals and postpartum depression,” in JAMA Psychiatry.

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

Published September 20, 2023

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ECHO Cohort Researchers Find Association Between Some Prenatal Chemical Exposures and Postpartum Depression.

ECHO Researchers Characterize Children Born Preterm into Four Neurobehavioral Profiles

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ECHO Researchers Characterize Children Born Preterm into Four Neurobehavioral Profiles

Authors: Marie Camerota, 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 the study needed?

Birth outcomes for infants born very preterm have steadily improved over the past several decades. More children born at earlier gestational ages are surviving into childhood, however, it is unclear how being born very preterm may influence neurodevelopmental or behavioral problems.

Outcomes of children born at a gestational age of less than 33 weeks (“very pre-term”) vary significantly, with some children showing few neurodevelopmental concerns and others showing significant impairment. Most prior research has looked at single outcomes—for example, whether a child born preterm had a lower neurodevelopmental score or higher levels of behavior problems. Understanding how these different outcomes may group together can help researchers and healthcare providers provide more comprehensive treatment plans for children born very preterm.

What were the study results?

Researchers found evidence for four different neurobehavioral profiles based on different combinations of cognitive, motor, and behavioral outcomes of children at the age of two. These profiles range from few or no developmental concerns to severe impairment in one or more domains. The study placed most children (about 85%) into one of two groups with no/mild developmental delay and a low prevalence of behavioral problems. The remaining 15% fell into one of two profiles with more serious neurodevelopmental problems with (5%) or without (10%) co-occurring behavior problems.

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

What was the study's impact?

This study helps researchers better understand outcomes for children following a very pre-term birth. The different groups of children this study described might require different types of follow-up services or interventions.

Who was involved?

This study included more than 2,000 babies who were born at less than 33 weeks gestational age and were evaluated at the age of two years. Pre-term children from three ECHO research sites in the U.S. were included in this analysis.

What happened during the study?

Researchers recruited children born less than 33 weeks gestational age into the ECHO Program shortly after they were born. When these children reached age two years, researchers conducted a neurodevelopmental assessment and a motor exam; parents completed questionnaires about their children’s behavior. ECHO researchers looked for patterns in these data to understand whether there were groups of children with similar strengths and weaknesses.

What happens next?

More research is needed to understand why some preterm children develop neurodevelopmental and/or behavioral problems and others do not. To do this, future studies may study risk factors in pregnancy, the perinatal period, and in early infancy.

Where can I learn more?

Access the full journal article, titled “Neurodevelopmental and behavioral outcomes of very preterm infants: latent profile analysis in the Environmental influences on Child Health Outcomes (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 September 12, 2023

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ECHO Researchers Characterize Children Born Preterm into Four Neurobehavioral Profiles

“Accelerated” Biological Age at Birth Not Linked to Behavioral and Emotional Health Outcomes in Early Childhood

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“Accelerated” Biological Age at Birth Not Linked to Behavioral and Emotional Health Outcomes in Early Childhood

Authors: Christine Ladd-Acosta, 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 the study needed?

Previous studies have shown that early identification and intervention in the development of emotional and behavioral health challenges in children seems connected to better long-term health outcomes. Recently, researchers have begun looking at how epigenetic factors affect children’s biological age and health outcomes.

A molecular process known as DNA methylation, or DNAm, adds a tag to DNA to control gene expression. Researchers measure DNAm to estimate a person’s biological age and compare it with their chronological age to better understand the factors that may influence their long-term health outcomes. In this study, ECHO researchers looked at the link between biological age at birth, the time between conception and birth (chronological gestational age), and emotional and behavioral health outcomes in children.

What were the study results?

Differences between biological age at birth and chronological gestational age did not appear linked to emotional and behavioral problems in childhood. This study did not find any difference between boys and girls in terms of the effect of “accelerated” biological age on behavioral and emotional outcomes.

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

What was the study's impact?

These results highlight that because biological age at birth does not seem to predict emotional or behavioral health challenges in early childhood, research should investigate how other biological factors at birth may influence neurodevelopmental health outcomes in early childhood.

Who was involved?

The study included four ECHO research sites in the United States and a total of 592 children.

What happened during the study?

Researchers calculated each child’s “biological age” by analyzing DNA samples collected at birth, and they compared this age to the child’s chronological gestational age. They then tested whether newborns who showed increased biological age relative to their chronological age (“accelerated aging”) were more likely to have emotional and behavioral problems in early childhood.

What happens next?

Future research in a larger sample might confirm these findings. The relatively small sample size of this study may have made it difficult to observe differences in behavioral or emotional outcomes based on child sex. Future research with larger samples could help investigate potential differences in the results between boys and girls.

Where can I learn more?

Access the full journal article, titled “Accelerated epigenetic age at birth and child emotional and behavioral development in early childhood: a meta-analysis of four prospective cohort studies in ECHO,” in Epigenetics.

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

Published September 10, 2023

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“Accelerated” Biological Age at Birth Not Linked to Behavioral and Emotional Health Outcomes in Early Childhood

Can Neighborhood Conditions Throughout Childhood Shape the Risk of Developing Asthma?

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ECHO Study Suggests Neighborhood Conditions Throughout Childhood May Shape Risk of Developing Asthma

Authors: Izzuddin Aris, 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?

Neighborhood conditions, such as access to housing, healthy food, transportation, and education centers, can contribute to the development of childhood asthma. Researchers often measure these conditions using the Child Opportunity Index and the Social Vulnerability Index, which link residential addresses at birth, infancy (age 0.5‒1.5 years), and early childhood (age 2.0‒4.8 years) to census-tract data about the opportunities and resources available in the surrounding neighborhood. Previous studies looking into this topic lacked geographic diversity or considered only specific socioeconomic aspects of neighborhood disadvantage, which may not fully capture the role of early-life experiences on health outcomes. This study examines the association of conditions and resources available in neighborhoods during different developmental stages with childhood asthma incidence.

What were the study results?

Living in a neighborhood with higher opportunity at birth, infancy, or early childhood was associated with lower asthma incidence when compared to living in a neighborhood with lower opportunity. Differences in sociodemographic characteristics, parental asthma history, or the number of births a mother had did not explain this effect.

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?

Neighborhood conditions could help researchers identify vulnerable children who are at high risk for developing asthma. Policymakers, researchers, and community groups can use this information to guide decisions and interventions to improve the health of children and promote equitable opportunities across neighborhoods.

Who was involved?

This study used data from 10,516 children at 46 research sites participating in ECHO. The participants have at least one residential address from birth and a parent or caregiver report of a physician’s diagnosis of asthma.

What happened during the study?

Researchers linked participants’ residential addresses to the Child Opportunity Index and Social Vulnerability Index. They estimated asthma incidence rates associated with Child Opportunity Index or Social Vulnerability Index data for a child’s neighborhood at each life stage, adjusting for sociodemographic characteristics, maternal and paternal history of asthma, and the number of births a mother had.

What happens next?

Future studies can explore the impact of investing in early life health and environmental, social, and economic resources on improving health outcomes for children in disadvantaged neighborhoods. Follow-up studies can also focus on how these neighborhood-level factors are affecting asthma rates and how moving may alter asthma development.

Where can I learn more?

Access the full journal article, titled “Associations of Neighborhood Opportunity and Vulnerability with Incident Asthma Among U.S. Children in the ECHO cohorts,” in JAMA Pediatrics.

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

Published August 28, 2023

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ECHO Study Suggests Neighborhood Conditions Throughout Childhood May Shape Risk of Developing Asthma

Different Viruses that Cause Wheezing Illnesses Provide Limited Protection Against Each Other

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Different Viruses that Cause Wheezing Illnesses Provide Limited Protection Against Each Other

Authors: Yury Bochkov, James Gern, 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?

Rhinovirus (RV) is the most common virus detected in both mild and acute respiratory illnesses, such as the common cold and wheezing. While three species of rhinoviruses (A, B, and C) can cause upper respiratory illnesses, RV-A and RV-C are more likely to cause wheezing illnesses in preschoolers and in children and adults who have asthma. No specific vaccines for these viruses exist yet, in part because the large range of rhinovirus strains makes vaccine development difficult.

After a natural infection, neutralizing antibody responses develop in infected persons that help reduce the risk of illness on a second exposure. The goal of this study was to test whether RV-C infections are more likely than RV-A infections to induce long-lasting antibodies that can protect against other RV-C strains.

What were the study results?

Both RV-A and RV-C infections induced neutralizing antibody responses of similarly long durations but did not provide strong protection against each other. The researcher’s data analysis suggests that RV-C types are less likely than RV-A types to create a strong immune response against different virus strains. Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was the study's impact?

The results showed that while protective antibody responses to RV-C last for several years, they have only modest cross-protection that is limited to genetically similar viruses. These findings suggest that vaccines against RV-C might need to include many of the most common RV-C types to offer broad protection.

Who was involved?

Over 4,000 children were enrolled in 14 independent studies across Australia, Finland, and the United States. Study participants varied in age from 0 to 19 years and had RV-induced illnesses of varying severity. Some studies included participants with asthma, in addition to healthy participants.

What happened during the study?

Researchers tested whether RV-C infections cause protection against multiple RV-C types. Researchers analyzed samples collected between 1998 and 2019. Each of the 14 sites collected nasal samples that were analyzed for RV species and type. Data from 11 studies and 3,199 children included serial sampling for analysis across more than one RV illness. Many children in this study contracted a series of illnesses caused by various RV-A and RV-C types. The investigators examined the sequence of illnesses that children had experienced to understand which kinds of rhinovirus might provide protection against which other kinds of rhinovirus. Researchers also analyzed blood specimens to see whether RV-C infections are more likely to create antibodies to fight other rhinoviruses or produce antibody responses of longer duration than RV-A infections do.

What happens next?

Researchers want to determine why RV-C infections occur so frequently in preschool children, and why they are more likely to cause wheezing illnesses. These studies aim to help researchers design a practical RV-C vaccine that could protect high-risk children.

Where can I learn more?

Access the full journal article, titled “Rhinoviruses A and C Elicit Long-lasting Antibody Responses with Limited Cross-neutralization,” in the Journal of Medical Virology.

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

Published August 28, 2023

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ECHO Researchers Find Different Rhinoviruses Can Provide Limited Protection Against Each Other

Educational Background and Child Age Influenced Experiences of Caregivers During COVID 19 Pandemic

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Educational Background and Child Age Influenced Experiences of Caregivers During COVID‑19 Pandemic

Authors: Kaja Z. LeWinn, Lisa Jacobson, et al.

Who sponsored this study?

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

Why was this study needed?

The COVID-19 pandemic and resulting public health measures presented unique challenges for families, frequently influenced by factors such as income and educational background. Yet while research has highlighted the sociodemographic factors that influenced adults’ experience, the COVID-19 pandemic generally interfered with population-based studies of children and families. However, in April 2020, the ECHO Program introduced a COVID‑19‑specific questionnaire that allowed researchers to gather information on how the pandemic and its effects on daily life were influencing the health of children. This study used ECHO data collected from April 2020 to March 2022 to examine sociodemographic differences in pandemic-related experiences.

What were the study results?

The study suggested that caregivers with less than a high school education were more likely to report challenges accessing COVID-19 testing for their children, were less likely to work remotely, and reported financial concerns and access to necessities such as food as top sources of stress. Caregivers with a master’s degree or higher, on the other hand, were more likely to name social distancing as the top source of their pandemic stress. The study also noted that caregivers with higher education had a significantly greater likelihood of having the option to work remotely. Caregivers with children between the ages of 1 and 5 reported the least support from school systems, the most difficulty finding childcare, and fewer remote learning options; were more likely to have healthcare appointments canceled due to COVID‑19 concerns, and were most concerned about how the pandemic would affect their ability to work.

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 underscores the importance of understanding how children and caregivers from various backgrounds experienced the COVID-19 pandemic. This understanding can help uncover social inequities that could worsen conditions for some populations during future public health crises. These findings suggest that families with young children may be in particular need of more support related to childcare and work flexibility during future public health crises that involve school disruption.

Who was involved?

The study analyzed data from 14,646 ECHO children and 13,644 ECHO caregivers between April 2020 and March 2022.

What happened during the study?

Researchers measured COVID‑19 pandemic‑related experiences using three characteristics—caregiver education, child life stage, and urban or rural residence. Caregivers completed ECHO COVID‑19 surveys about their experiences during the pandemic for their children and themselves. Among children, researchers examined items related to COVID‑19 infection, access to COVID‑19 testing, changes to healthcare, and disruptions to school, preschool, or daycare. For caregivers, researchers examined remote work, childcare challenges, and their subjective ranking of pandemic‑related stressors.

What happens next?

Future research could explore the complex connections between the outcomes examined as well as the long-term impacts of COVID‑19 infection and pandemic‑related adversities for children in the ECHO Cohort over time.

Where can I learn more?

Access the full journal article, titled “Sociodemographic Differences in COVID-19 Pandemic Experiences Among Families in the United States,” 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.

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Published August 23, 2023

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Educational Background and Child Age Influenced Experiences of Caregivers During COVID‑19 Pandemic

Prenatal Depression May Be Linked to Autism-Related Traits in Children

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Prenatal Depression May Be Linked to Autism-Related Traits in Children

Authors: Lyndsay A. Avalos, Lisa A. Croen, 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 suggests an association between prenatal depression or a history of depression prior to pregnancy and autism spectrum disorder (ASD) in children, but most studies have focused on a formal ASD diagnosis, rather than autism-related traits. Studying social communication and other autism-related traits can help researchers and clinicians understand how prenatal depression may be associated with these traits present in children at varying levels without a formal diagnosis. This is critical because autism‑related traits can impact children’s physical, social, and psychological development, regardless of whether they receive a clinical diagnosis.

What were the study results?

Children of mothers with prenatal depression had slightly more autism-related traits compared to those without. The association was similar among boys and girls. Prenatal depression also increased the likelihood of moderate to severe autism-related traits, indicating a higher likelihood of ASD diagnosis.

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 adds to the understanding of how prenatal depression may be associated with neurodevelopment in children, such as social communication and behavioral characteristics that may not reach a clinical threshold but can still impact a child’s social and behavioral functioning. These findings highlight the need for early ASD screening for children whose parents had prenatal depression to promote early intervention and support their healthy development. Mental health screening and prevention efforts for depression in pregnant individuals could also be beneficial.

Who was involved?

The study involved 33 prenatal and pediatric research sites with information on depression in birth parents and autism-related traits in children. The primary analysis included 3,994 parent-child pairs with prenatal depression diagnosis data; a secondary analysis included 1,730 parent-child pairs with depression severity data.

What happened during the study?

Researchers measured the incidence and severity of prenatal depression and assessed autism-related traits using the Social Responsiveness Scale (SRS) for children up to 12 years of age.

What happens next?

While this study didn’t explore the reason for the association between autism-related traits in children and prenatal depression in mothers, future research may analyze parent and child genetic data to clarify whether certain genes increase the likelihood of depression and autism-related traits, or what other factors affect the findings.

Where can I learn more?

Access the full journal article, titled “Prenatal Depression and Risk of Child Autism-Related Traits Among Participants in the Environmental influences On Child Health Outcomes Program,” in Autism Research.

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

Published August 1, 2023

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Prenatal Depression May Be Linked to Autism-Related Traits in Children

Shortened Social Responsiveness Scale (SRS) Observed to be Comparable to Full SRS in Autism Risk Factor Estimation

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Shortened Social Responsiveness Scale (SRS) Observed to be Comparable to Full SRS in Autism Risk Factor Estimation

Authors: Marisa Patti, 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?

The Social Responsiveness Scale (SRS) is a questionnaire used to measure social communication and autism spectrum disorder (ASD)-related traits. Researchers have developed a shortened version of the SRS, which included only 16 questions out of the original 65. This shortened version is intended to provide a very similar summary of behaviors and traits as the longer version but takes less time to complete.

As a new tool, the short SRS has been previously tested to ensure that it measures autism spectrum-related traits. However, it was not clear prior to this study if the short SRS can measure associations in epidemiologic analyses of autism spectrum risk factors in the same way as the full SRS so that research findings can be comparable across studies using both versions. In other words, do scores from both the short and long versions suggest the same associations? Or does shortening the SRS reduce our ability to detect risk factors due to differences in measurement? In this study, the authors tested associations with an established risk factor for autism diagnosis, preterm birth, or gestational age, to see if patterns were consistent across versions.

What were the study results?

Younger gestational age and preterm birth were associated with higher full SRS scores. The same associations were seen with short SRS scores. These associations are also consistent with associations seen for autism diagnosis, suggesting the ability of both the full and short SRS to detect risk factor associations.

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?

Gathering meaningful information for research studies can be a lengthy and time-consuming process for participants. This study shows that in some studies information collected using shorter assessments can be as useful as that captured using longer assessments, helping to reduce the time participants spend answering questionnaires.

Who was involved?

The study included 2,760 child-parent pairs from 11 different research sites within the ECHO Program. Participating children were between 2.5 and 18 years in age. The study sample included participants from research sites drawn from the general population, pre-term birth research sites, and familial-autism research sites, the last consisting of participants with a child diagnosed with autism.

What happened during the study?

Researchers collected caregiver-reported responses from both the full and shortened SRS. Information on gestational age and pre-term birth were collected from maternal reports on standardized questionnaires and from medical records.

What happens next?

Future studies are needed to investigate how comparable estimates are between the full and short SRS using other types of risk factors, such as genetic factors, and in other study populations. Researchers may also consider using the short SRS in future studies as an efficient measure of social behaviors.

Where can I learn more?

Access the full journal article, titled “A Comparative Analysis of the Full and Short Versions of the Social Responsiveness Scale in Estimating an Established Autism Risk Factor Association in ECHO: Do we Get the Same Estimates?” in the Journal of Autism and Developmental Disorders.

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

Published July 22, 2023

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Shortened Social Responsiveness Scale (SRS) Observed to be Comparable to Full SRS in Autism Risk Factor Estimation