Toddler Emotional and Behavioral Problems Decreased Slightly During Pandemic, ECHO Study Finds

Authors: Lauren Shuffrey, Anahid Akbaryan, 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 disrupted family patterns and children’s environments, both of which play a role in early brain development. Early childhood is a period of rapid brain growth and increased sensitivity to environmental influences, making the early social environment important for children's health and well-being. Previous research raised concerns about the development of infants born during the pandemic, but there is limited evidence on how the pandemic affected the behavioral and emotional well-being of toddlers. In this study, researchers wanted to look at the association between growing up during the pandemic and behavioral outcomes in toddler-aged children.

What were the study results?

The study found that children who experienced the pandemic had fewer emotional and behavioral problems compared to children born and assessed before the onset of the pandemic, based on results from the Preschool Child Behavior Checklist (CBCL). Specifically, their scores for internalizing problems, such as anxiety or sadness, were about 1.5 to 2 points lower, and their scores for externalizing problems, such as aggression or hyperactivity, were about 1.7 to 3.2 points lower than those born and assessed before the pandemic.

Although these differences were small, researchers report that they were consistent. The study also found that these links between growing up during the pandemic and lower emotional and behavioral problems were significantly stronger for children whose mothers did not have a bachelor’s degree.

What was the study's impact?

The study suggests that toddler-age children may have shown resilience despite the disruptions of the pandemic. These findings could help identify potential protective factors that could have buffered the impact of the pandemic on child behavior and inform future interventions to support children's well-being during and after global crises.

Who was involved?

The study included 3,438 toddlers (average age of 2 years) across the U.S. and Puerto Rico. Researchers grouped children based on when they were born and when they were assessed: before the pandemic, born before but assessed after March 2020, or both born and assessed during the pandemic.

What happened during the study?

During the study, researchers compared young children’s behavior and emotions before and during the pandemic using data from the ECHO Cohort collected between September 2009 and July 2023. Parents filled out the Preschool CBCL, a commonly used tool to assess the child’s emotions and behaviors, like anxiety, sadness, or hyperactivity. Researchers then analyzed these results to see how the pandemic may have affected children’s emotional and behavioral well-being.

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?

Further research could help researchers identify potential protective factors that may have promoted resilience among children whose daily life was disrupted by the COVID-19 pandemic.

Where can I learn more?

Access the full journal article, titled “COVID-19 pandemic exposure and toddler behavioral health in the ECHO Program,” in JAMA Network Open.

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

Published September 3, 2025

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Toddler Emotional and Behavioral Problems Decreased Slightly During Pandemic, ECHO Study Finds

Toddlers Showed Slightly Fewer Behavioral Problems During COVID-19 Pandemic, NIH Study Finds

Posted on September 3, 2025September 3, 2025 by Jodi Snare

Toddlers assessed during the COVID-19 pandemic had slightly fewer emotional and behavioral problems compared to children assessed before the pandemic, suggesting some toddlers may have shown resilience during this time. This finding comes from a study of over 3,000 children across the United States using data from the Environmental influences on Child Health Outcomes (ECHO) Cohort Consortium collected between September 2009 and July 2023.

The COVID-19 pandemic disrupted family patterns and children’s environments, both critical for early brain development and well-being. While earlier research raised concerns about infants born during the pandemic, there is limited information about how toddlers’ emotional and behavioral health might have been affected.

To explore this, the study examined data from 3,438 toddlers (average age of 2 years) across the U.S. and Puerto Rico. Researchers used the Preschool Child Behavior Checklist (CBCL), a parent-reported measure of child behavior and emotions, to compare children assessed before and during the pandemic.

Children were grouped based on when they were born and when their behavior was assessed: before the pandemic, born before but assessed after March 2020, or both born and assessed during the pandemic. Parents completed the CBCL, which asks about behaviors such as anxiety, sadness, and aggression. These reports helped researchers understand how growing up during the pandemic might have influenced toddler emotional and behavioral health.

Key findings include:

Children who experienced the pandemic had significantly lower scores for internalizing problems (such as anxiety and sadness) and externalizing problems (such as aggression or hyperactivity) compared to children assessed before the pandemic.

Internalizing problem scores were about 1.5 to 2 points lower, and externalizing problem scores were about 1.7 to 3.2 points lower than those born and assessed before the onset of the pandemic.

Although the differences were small, they were consistent. The associations were stronger among children whose mothers did not have a bachelor’s degree.

“Our findings suggest that even during periods of widespread pandemic-related disruption, toddler-aged children may have experienced opportunities for resilience,” said study author Anahid Akbaryan, a Research Associate at NYU Grossman School of Medicine. “Future research should explore within-home factors that may have supported child mental health outcomes during this time, such as consistent caregiving routines, household stability, and positive parental coping strategies to identify potential protective influences during times of instability.”

Study author Lauren Shuffrey, PhD, of NYU Grossman School of Medicine, added, “These findings suggest that some families may have adapted in ways that buffered young children from behavioral challenges during the pandemic, highlighting the importance of identifying and strengthening those protective supports.”

The researchers emphasized that further studies are needed to identify these protective factors and develop strategies to help families support child well-being during and after times of global disruptions.

This collaborative research is published in JAMA Network Open.

About ECHO
The ECHO Cohort Consortium is a research program supported by the National Institutes of Health (NIH) with the mission to enhance the health of children for generations to come. ECHO Cohort investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

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Exposure to Certain Flame-retardant Chemicals During Pregnancy May Be Associated with Behavioral Issues in Young Children

Posted on August 26, 2025August 26, 2025 by Jodi Snare

Exposure to certain organophosphate esters (OPEs)—chemicals commonly used as flame retardants and plastic softeners in a variety of household and industrial products—during pregnancy was associated with more behavioral issues in young children, according to a new ECHO Cohort study led by Jiwon Oh, PhD and Deborah Bennett, PhD of the University of California, Davis.

Previous research has linked exposure to OPEs during pregnancy with potential adverse effects on child brain development, but more evidence is needed. In this study, researchers investigated the association between prenatal exposure to OPEs and child behaviors. The study included 2,948 mother-child pairs from 12 ECHO Cohort study sites across the U.S., and the investigators used the Child Behavior Checklist for ages 1½–5 to assess each child’s behavior during early childhood.

Among the nine OPEs measured, diphenyl phosphate (DPHP) was detected in almost all pregnant women (99.5%) and had the highest median concentration. Other frequently detected OPEs included dibutyl phosphate/di-isobutyl phosphate (DBUP/DIBP), bis (1,3-dichloro-2-propyl) phosphate (BDCPP), bis(2-chloroethyl) phosphate (BCETP), bis(2-butoxyethyl) phosphate (BBOEP), and bis(1-chloro-2-propyl) phosphate (BCPP).

“This research builds on a growing body of evidence of potential harm caused by exposures to OPEs,” said Dr. Bennett.

Key Takeaways include:

Prenatal exposure to BBOEP (at moderate concentrations rather than high concentrations) was associated with more internalizing behaviors (e.g., anxiety, depression), externalizing behaviors (e.g., aggression, hyperactivity), and total behavior issues in young children.
Exposure to BCPP was associated with more externalizing behaviors and total behavior issues.
Detectable dipropyl phosphate (DPRP) was associated with fewer externalizing behaviors.
Boys showed more behavior issues associated with prenatal BDCPP and BCPP exposure.
Children from highly vulnerable neighborhoods—defined by community-level demographics, socioeconomic status, housing, access to transportation, and other factors—exhibited more behavior issues associated with prenatal BCPP exposure.

“While further research is needed, our findings suggest that reducing exposure to this chemical class during pregnancy may help mitigate emotional and behavioral problems in young children,” said Dr. Oh.

This collaborative research, titled “Prenatal Exposure to Organophosphate Ester Flame Retardants and Behavioral Outcomes in Early Childhood in the Environmental influences on Child Health Outcomes (ECHO) Cohort,” is published in Environment International.

Read the research summary.

Exposure to Common Flame-retardant Chemicals During Pregnancy May Be Associated with Behavioral Issues in Young Children, ECHO Study Finds

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Exposure to Common Flame-retardant Chemicals During Pregnancy May Be Associated with Behavioral Issues in Young Children, ECHO Study Finds

Author(s): Jiwon Oh, 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?

Organophosphate esters (OPEs) are chemicals commonly used as flame retardants and plastic softeners in a variety of household and industrial products, including furniture, electronics, infant products, and fabrics. Previous research has linked exposure to OPEs during pregnancy with potential adverse effects on child brain development, but more evidence is needed. In this study, researchers investigated the association between prenatal exposure to OPEs and child behaviors.

What were the study results?

Among the nine OPEs measured, diphenyl phosphate (DPHP) was detected in almost all pregnant women (99.5%) and had the highest median concentration. Other frequently detected OPEs included dibutyl phosphate/di-isobutyl phosphate (DBUP/DIBP), bis (1,3-dichloro-2-propyl) phosphate (BDCPP), bis(2-chloroethyl) phosphate (BCETP), bis(2-butoxyethyl) phosphate (BBOEP), and bis(1-chloro-2-propyl) phosphate (BCPP).

Prenatal exposure to BBOEP (at moderate concentrations rather than high concentrations) was associated with more internalizing behaviors (e.g., anxiety, depression, emotional reactivity), externalizing behaviors (e.g., aggression, inattention), and total behavior issues in young children. Exposure to BCPP was associated with more externalizing behaviors and total behavior issues. In contrast, detectable dipropyl phosphate (DPRP) was associated with slightly fewer externalizing behaviors. Boys showed more behavior issues associated with prenatal BDCPP and BCPP exposure. Children from highly vulnerable neighborhoods—defined by community-level demographics, socioeconomic status, housing, access to transportation, and other factors—exhibited more behavior issues associated with prenatal BCPP exposure.

What was the study's impact?

Use of OPEs is increasing, with widespread exposure observed in pregnant women. While further research is needed, this study suggests that reducing exposure to certain chemicals during pregnancy may help mitigate emotional and behavioral problems in young children.

Who was involved?

The study included 2,948 mother–child pairs from 12 ECHO Cohort study sites across the United States. Non-Hispanic White (40.2%), non-Hispanic Black (28.6%), and Hispanic (21.3%) mothers were included in the study. Most participating mothers (85.2%) did not experience major pregnancy complications and most of their children (93.2%) were born after at least 37 weeks of pregnancy.

What happened during the study?

During the study, researchers collected urine samples from pregnant participants and analyzed them for nine chemical markers of OPE exposure. Later, researchers assessed the child’s behaviors using the Child Behavior Checklist for Ages 1½–5. The researchers then used statistical methods to examine associations between each OPE exposure during pregnancy and behavioral issues in children. The study also evaluated how other factors, like the child’s sex and their social vulnerability, may have influenced the effect of prenatal OPE exposure on their behavior.

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 better understand the effects of prenatal OPE exposure on child brain development and determine whether reducing these exposures could be beneficial to children’s health and development.

Where can I learn more?

Access the full journal article, titled “Prenatal Exposure to Organophosphate Ester Flame Retardants and Behavioral Outcomes in Early Childhood in the Environmental influences on Child Health Outcomes (ECHO) Cohort,” in Environment International.

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

Published August, 2025

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Exposure to Common Flame-retardant Chemicals During Pregnancy May Be Associated with Behavioral Issues in Young Children, ECHO Study Finds

NIH Study Suggests Behavioral and Emotional Challenges More Common in Children with Autism Spectrum Disorder (ASD)

Posted on February 28, 2025 by Jodi Snare

Children with autism spectrum disorder (ASD) showed higher levels of emotional and behavioral problems, including depression, anxiety, and ADHD, compared to their peers without ASD, according to a new study funded by the National Institutes of Health (NIH) Environmental influences on Child Health Outcomes (ECHO) Program.

Key Takeaways:

Children with ASD had higher scores on the Child Behavior Checklist (CBCL)—a questionnaire that helps identify emotional and behavioral challenges in children and adolescents—showing they may experience more emotional and behavioral challenges overall.
Higher CBCL scores were linked to the likelihood of receiving an ASD diagnosis, particularly for children scoring in the top 30%.
Among children with ASD, girls experienced significantly higher levels of anxiety and depression compared to boys, with age-related differences in symptom severity.
Autism-related traits measured by the Social Responsiveness Scale (SRS) were associated with higher CBCL scores, suggesting that children with more autism traits may face additional emotional and behavioral challenges.

These findings highlight the importance of monitoring and addressing emotional and behavioral health in children with ASD to better inform early interventions. To learn more, access the study online.

Read the research summary.

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

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

Authors: Heather E. Volk, et al.

Who sponsored this study?

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

Why was this study needed?

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

What were the study results?

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

What was the study's impact?

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

Who was involved?

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

What happened during the study?

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

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

What happens next?

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

Where can I learn more?

Access the full journal article, titled “Co-occurring Psychopathology in Children with and without Autism Spectrum Disorder (ASD): Differences by Sex in the ECHO Cohorts,” in Journal of Autism and Developmental Disorders.

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

Published January 6, 2025

Read the related research alert.

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

New ECHO Research Finds Children with Autism at Higher Risk for a Range of Health Outcomes

Posted on October 2, 2024April 1, 2025 by Jodi Snare

Collaborative ECHO research led by Elizabeth Kaplan-Kahn, PhD, Kristen Lyall, ScD of the A.J. Drexel Autism Institute at Drexel University and Heather Volk, PhD, MPH of the Bloomberg School of Public Health at Johns Hopkins University investigates the factors that influence the overall health and well-being of people on the autism spectrum. This research, titled “Describing Multidomain Health Outcomes in Autistic Children in the ECHO Program,” is published in the Journal of the American Academy of Child and Adolescent Psychiatry.

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 addressed that priority by investigating the physical, emotional, and overall health outcomes of children on the autism spectrum.

The study included over 4,500 children and adolescents at 29 ECHO research sites across the United States, including 286 participants with autism, with participants varying in age from 5 to 20 years old. The research team conducted an initial analysis on the 4,511 participants by comparing data on their health outcomes and demographic characteristics. 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 profiles were categorized based on data from the research team’s primary outcome measures—multiple Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health scores, the Child Behavior Checklist (CBCL) Dysregulation score, the Social Responsiveness Scale, Second Edition (SRS-2), and standardized Body Mass Index (BMI). These measures 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.

The study results indicate 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.

“The results of this study offer a glimpse into the range of emotional, physical, and overall health outcomes for children on the autism spectrum,” Dr. Kaplan-Kahn said. “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.”

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.

Read the research summary.

New ECHO Research Suggests Harsh Parenting and High Socioeconomic Stress May Be Associated With Higher Internalizing Problems in Children

Posted on May 16, 2024May 29, 2024 by Jodi Snare

Collaborative ECHO research led by Lue Williams, MA, MS, Veronica Oro, PhD and Leslie Leve, PhD of the Prevention Science Institute at the University of Oregon investigates the relationship between two early childhood stress factors, harsh parenting and socioeconomic stress, and children’s development from childhood through adolescence. This research, titled “Influence of Early Childhood Parental Hostility and Socioeconomic Stress on Children’s Internalizing Symptom Trajectories from Childhood to Adolescence,” is published in Frontiers in Psychiatry.

Internalizing problems in childhood may be early indicators of problems associated with disorders such as depression and anxiety. Internalizing by children can be influenced by biological and environmental factors, including parent-child relationships and socioeconomic status. This study looked at how harsh parenting and socioeconomic stress were associated with internalizing problems in children. The researchers characterized harsh parenting, or “parental hostility,” as non-supportive and controlling parenting practices, displays of anger and disappointment in children, and discipline through punishment. Socioeconomic stress reflects disadvantages associated with factors like household income.

The study included two samples—a nationwide sample of 481 children who were adopted at birth and a sample of 1,053 children from six predominantly low-wealth, rural communities in eastern North Carolina and central Pennsylvania. Adopted children from the Early Growth and Development Study (EGDS) have lived in their adoptive homes since birth and were recruited into the study between 2003 and 2009. Children from the Family Life Project (FLP) were raised by their biological parents and were recruited into the study at birth, from September 2003 through 2004.

The researchers analyzed data collected from the EGDS and FLP, and observed that, within the study sample, children fell into three main groups based on the severity of their internalizing behaviors and how those behaviors progressed with age: low, moderate-increasing, and higher-increasing. Some of the internalizing behaviors reported include feeling anxious or depressed, being withdrawn, and complaining of aches and sickness. Parents who reported more negative interactions with children in early childhood had children who were more likely to be in the group with the highest internalizing behaviors.

Children with more socioeconomic stress in their households were also most likely to be in the highest internalizing behaviors group, as compared with both the low- and moderate-internalizing symptoms groups. Researchers also observed that household socioeconomic stress directly predicted children’s mental health, but did not find any significant relationship between child sex assigned at birth and how likely they would be to show internalizing behaviors.

“Not many studies have examined early childhood predictors of internalizing behavior developments, so our research fills an important gap by examining the role of diverse risk factors in early life on patterns of internalizing symptoms later in childhood,” Williams said. “Our findings suggest that in addition to focusing on children’s symptoms when treating internalizing problems, health service providers may also wish to consider the broader context of caregiver behavior and access to resources for care.”

Future studies are needed to further support programming and research efforts by exploring how socioeconomic stress and parenting styles can influence children’s internalizing behaviors identified in the current study.

Read the research summary.

Harsh Parenting and High Socioeconomic Stress May Be Associated with Higher Internalizing Problems Like Anxiety in Children, ECHO Study Finds

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Harsh Parenting and High Socioeconomic Stress May Be Associated with Higher Internalizing Problems Like Anxiety in Children, ECHO Study Finds

Authors: Lue Williams, Veronica Oro, Leslie Leve, 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?

Internalizing problems in childhood such as chronic internal distress may be early indicators of problems associated with disorders such as depression and anxiety. Internalizing by children can be influenced by biological and environmental factors, including parent-child relationships and socioeconomic status.

This study examined the relationship between two early childhood stress factors, harsh parenting and socioeconomic stress, and children’s development from childhood through adolescence. For this study, the researchers characterized harsh parenting, or “parental hostility” as non-supportive and controlling parenting practices, displays of anger and disappointment in children, and discipline through punishment. Socioeconomic stress reflects disadvantages associated with factors like household income. Few studies have examined early childhood predictors of internalizing behavior development, so this research fills an important gap by examining the role of diverse risk factors in early life, between the ages of 18 months and 5 years, on patterns of internalizing symptoms later in childhood. The study design, which used data collected from participants over a long period, also allowed the research team to explore the long-range impact of early life influences across critical stages of children’s physical, social, and psychological development.

What were the study results?

Researchers observed that, within the study sample, children fell into three main groups based on the severity of their internalizing behaviors and how those behaviors progressed with age: low, moderate-increasing, and higher-increasing. Some of the internalizing behaviors reported include feeling anxious or depressed, being withdrawn, and complaining of aches and sickness. Parents who reported more negative interactions with children in early childhood had children who were more likely to be in the group with the highest internalizing behaviors. Children with more socioeconomic stress in their households were also most likely to be in the highest internalizing behaviors group, as compared with both the low- and moderate-internalizing symptoms groups.

Researchers also observed that household socioeconomic stress directly predicted children’s mental health. Study investigators did not find any significant relationship between child sex assigned at birth and how likely they would be to show internalizing behaviors.

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 this study's impact?

The findings from this study suggest that in addition to focusing on children’s symptoms when treating internalizing problems, health service providers may also wish to consider the broader context of caregiver behavior and access to resources for care.

Who was involved?

The study included two samples—a nationwide sample of 481 children who were adopted at birth and a sample of 1,053 children from six predominantly low-wealth, rural communities in eastern North Carolina and central Pennsylvania. Adopted children from the Early Growth and Development Study (EGDS) have lived in their adoptive homes since birth and were recruited into the study between 2003 and 2009. Children from the Family Life Project (FLP) were raised by their biological parents and were recruited into the study at birth, between September 2003 and 2004. Results may not be representative of the general population.

What happened during the study?

The researchers analyzed data collected from children and families that participated in the EGDS and FLP. EGDS children and families completed assessments approximately every nine months when adoptees were under the age of 3, and every one to two years after that. FLP participant families completed an initial home visit assessment when children were 2 months old and participated in annual assessments thereafter.

What happens next?

Future studies are needed to further support programming and research efforts by exploring mechanisms that underlie the relationship between socioeconomic stress, parenting styles, and children’s internalizing behaviors identified in the current study.

Where can I learn more?

Access the full journal article, titled “Influence of Early Childhood Parental Hostility and Socioeconomic Stress on Children’s Internalizing Symptom Trajectories from Childhood to Adolescence,” in Frontiers in Psychiatry.

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

Published April 16, 2024

Read the associated article.

Download this summary

Harsh Parenting and High Socioeconomic Stress May Be Associated with Higher Internalizing Problems Like Anxiety in Children, ECHO Study Finds

Factors Linked to Pregnancy Inflammation May Be Associated With Dysregulation in Children

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Factors Linked to Pregnancy Inflammation May Be Associated With Dysregulation in Children

Authors: Jean Frazier, Michael O’Shea, 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?

Inflammation is a normal part of the body’s defense to injury or infection. The investigators in this study wanted to find out whether factors known to be linked with inflammation during pregnancy (such as socioeconomic conditions, environmental exposures, and maternal infections) might be associated with emotional, cognitive, and behavioral dysregulation in children after birth. “Dysregulation” in this context refers to children’s attention, anxiety and depression, and aggression being measurably different from what is typically expected for children of their age.

What were the study results?

In this study, several maternal risk factors correlated with inflammation (lower education attainment, pre-pregnancy obesity, prenatal infections, and prenatal tobacco use) were strongly associated with dysregulation in offspring.

Researchers used a tool called the Child Behavior Checklist (CBCL) to measure aggressive behavior, anxiety/depression, and attention problems in children. Approximately 13.4 % of children and adolescents in the study met the criteria for the CBCL Dysregulation Profile. More youth with dysregulation (35%) were born to mothers with prenatal infections compared with 28% of youth without dysregulation.

Some additional maternal factors, including being overweight before pregnancy, lower education attainment, and smoking during pregnancy, were associated with higher likelihoods of childhood dysregulation. Children and adolescents who had a parent or sibling with a mental health disorder were more likely to experience dysregulation. Having a mother with gestational diabetes had no significant association with child dysregulation.

What was the study's impact?

By providing information about how maternal inflammation and relevant risk factors may be associated with dysregulation in a mother’s offspring, this study can help inform interventions to improve child health outcomes.

Who was involved?

This study included 4,595 children and adolescents (ages 6-18 years) from 18 ECHO research sites across the United States.

What happened during the study?

This study assessed perinatal factors known to be related to maternal and neonatal inflammation.

ECHO researchers collected data on maternal factors before and during pregnancy, including information about infections during pregnancy. They used the CBCL to collect parent-reported information about each child’s behavior. CBCL assessments were collected between 2009 and August 31, 2021, and researchers used these assessments to determine whether a child met criteria for the CBCL Dysregulation Profile based on their scores for aggression, anxiety/depression, and attention.

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 focus on identifying the mechanisms that link maternal factors with childhood dysregulation. These studies could also look at whether certain interventions are able to reverse or partially reverse the mechanisms that contribute to the development of dysregulation.

Where can I learn more?

Access the full journal article, titled “Perinatal Factors and Emotional, Cognitive, and Behavioral Dysregulation in Childhood and Adolescence,” in the Journal of the American Academy of Child and Adolescent Psychiatry.

Published May 17, 2023

Access the associated article.

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Factors Linked to Pregnancy Inflammation May Be Associated With Dysregulation in Children