Perceived Stress During Pregnancy Associated with Autism-related Traits in Children

Higher perceived stress during pregnancy may be associated with greater severity of autism-related traits in children, according to a recent ECHO Cohort study led by Luke Grosvenor, PhD, of Kaiser Permanente Northern California.

Many mothers experience higher levels of stress and other mental health challenges during pregnancy. Previous studies have found that pregnancy stress may be associated with increased risk of autism spectrum disorder (ASD) in children, but these studies have mostly focused on the occurrence of isolated adverse or stressful events that occur in the mother’s life during pregnancy. Fewer studies have measured general perceived stress among mothers during pregnancy. To better understand whether this prenatal exposure may be associated with severity of autism-related traits in children, researchers collected information from over 4,000 mothers and their children enrolled in 20 ECHO Cohort Study Sites across the United States.

Key Takeaways include:

  • Higher perceived stress during pregnancy was associated with slightly more severe autism‑related traits in children.
  • At higher prenatal perceived stress levels, children showed slightly higher scores on tests measuring social and behavioral traits related to autism. Children whose mothers had either moderate or high categorical stress scored higher than those whose mothers reported low or no stress.
  • The link between pregnancy stress and autism‑related traits did not differ between boys and girls.
  • The relationship between prenatal stress and autism‑related traits remained consistent even when the researchers accounted for mothers’ co-occurring prenatal depressive symptoms.
  • Stress during pregnancy is normal and common to experience. While the results of this study indicate that there may be a small association between pregnancy stress and autism-related traits, they do not imply that stress during pregnancy causes autism spectrum disorder or autism-related traits to occur in children.

“This study provides evidence for small yet significant associations between higher prenatal perceived stress and greater severity of autism-related traits,” said Dr. Grosvenor. “These results could have implications for prenatal mental health screening and behavioral interventions aimed at improving child outcomes.”

Future studies could help researchers better understand the specific periods during pregnancy during which stress may have the greatest association with child health and development and how other related social and emotional factors may influence this effect.

This collaborative research, titled “Associations between Prenatal Perceived Stress and Child Autism-Related Traits in the ECHO Cohort,” is published in The Journal of Pediatrics.

Read the research summary.

 

Perceived Stress During Pregnancy Associated with Autism-related Traits in Children, ECHO Study Finds

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Perceived Stress During Pregnancy Associated with Autism-related Traits in Children, ECHO Study Finds

Authors: Luke Grosvenor, 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?

Many mothers experience higher levels of stress and other mental health challenges during pregnancy. Previous studies have found that pregnancy stress may be associated with increased risk of autism spectrum disorder (ASD) in children, but these studies have mostly focused on the occurrence of isolated adverse or stressful events that occur in the mother’s life during pregnancy. Fewer studies have measured general perceived stress among mothers during pregnancy. This study examined the potential association between perceived stress during pregnancy and autism-related traits in children and evaluated how that association may differ according to the child’s sex or the mother’s experience of depression during pregnancy.

 

What were the study results?

Higher perceived stress during pregnancy was associated with slightly more severe autism‑related traits in children. At higher prenatal perceived stress levels, children showed slightly higher scores on tests measuring social and behavioral traits related to autism. Children whose mothers had either moderate or high categorical stress scored higher than those whose mothers reported low or no stress. The link between pregnancy stress and autism‑related traits did not differ between boys and girls. The relationship between prenatal stress and autism‑related traits remained consistent even when the researchers accounted for mothers’ co-occurring prenatal depressive symptoms.

 

What was the study's impact?

Stress during pregnancy is normal and common to experience. While the results of this study indicate that there may be a small association between pregnancy stress and autism-related traits, they do not imply that stress during pregnancy causes autism spectrum disorder or autism-related traits to occur in children.

 

Who was involved?

The study included 4,115 mother–child pairs from 20 ECHO Cohort Study Sites across the United States. Children ranged in age from about 2.5 to 18 years old.

 

What happened during the study?

Mothers reported their stress levels during pregnancy using a standard questionnaire. Later, parents reported on their children’s autism-related traits using a validated survey. Researchers analyzed the data using statistical models that accounted for factors such as child age, sex, and study site.

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 specific periods in pregnancy when stress may have the greatest association with child health and development and how other related social and emotional factors may influence this effect.

 

Where can I learn more?

Access the full journal article, titled “Associations between Prenatal Perceived Stress and Child Autism-Related Traits in the ECHO Cohort,” in The Journal of Pediatrics.

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

Published March 2, 2026

Access the associated article.

Exposure to Air Pollution During Pregnancy Associated with Higher Risk for Autism-related Outcomes

Exposure to certain air pollutants during pregnancy was associated with autism-related traits and increased odds of autism spectrum disorder (ASD) diagnosis in children, according to a recent ECHO Cohort study led by Akhgar Ghassabian, MD, PhD of NYU Grossman School of Medicine and Heather Volk, PhD of Johns Hopkins Bloomberg School of Public Health.

Air pollution is a significant environmental health concern and contributes to many illnesses and early deaths worldwide. Ambient air pollution can have detectable effects on the brain. Recent studies show that being exposed to air pollution during pregnancy and early life can affect how a child’s brain develops. This can happen through several pathways, such as causing inflammation in the brain, disrupting hormones, or changing how genes work. Previous research has suggested potential links between air pollution and neurodevelopmental disorders, but the relationship between exposure to air pollution, even at low levels, during pregnancy and ASD has been unclear.

This study included 8,035 mother-child pairs from 44 ECHO Cohort study sites, including over 1,000 children who were potentially at higher risk for ASD based on being born preterm or having siblings with autism.

Key takeaways include:

  • Prenatal exposure to ozone was associated with autism-related traits and increased risk of ASD diagnosis.
  • Exposure to fine particulate matter (PM5) and nitrogen dioxide was also associated with a higher risk of autism, but associations varied by geographical regions.
  • There was little evidence for differences between boys and girls in the association between prenatal air pollution exposure and autism outcomes.

These findings suggest that even low levels of air pollution exposure during pregnancy can be associated with autism-related outcomes. This highlights the importance of understanding the risks associated with air pollution exposure during pregnancy and its effects on neurodevelopment.

This collaborative research, titled “Prenatal Air Pollution Exposure and Autism Spectrum Disorder in the ECHO Consortium,” is published in Environmental Health Perspectives.

Prenatal Exposure to Air Pollution Associated with Higher Risk for Autism-related Outcomes, ECHO Study Finds

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Prenatal Exposure to Air Pollution Associated with Higher Risk for Autism-related Outcomes, ECHO Study Finds

Author(s): Heather Volk, Akhgar Ghassabian, 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?

Air pollution is a significant environmental health concern and contributes to many illnesses and early deaths worldwide. Ambient air pollution can have detectable effects on the brain. Recent studies show that being exposed to air pollution during pregnancy and early life can affect how a child’s brain develops. This can happen through several pathways, such as causing inflammation in the brain, disrupting hormones, or changing how genes work.  Previous research has suggested potential links between air pollution and neurodevelopmental disorders, but the relationship between exposure to air pollution, even at low levels, during pregnancy and ASD has been unclear. This study examined the associations between prenatal air pollution exposure and autism spectrum disorder (ASD) in children.

 

What were the study results?

The study team observed that higher prenatal exposure to ozone was associated with autism-related traits and increased risk of ASD diagnosis. Exposure to fine particulate matter (PM2.5) and nitrogen dioxide was also associated with a higher risk of autism, but associations varied by geographical regions. There was little evidence for differences between boys and girls in the association between prenatal air pollution exposure and autism outcomes.

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 study's findings suggest that even low levels of air pollution exposure during pregnancy might be associated with autism-related outcomes. This highlights the importance of understanding the risks associated with air pollution exposure during pregnancy and its effects on child neurodevelopment.

 

Who was involved?

The study involved 8,035 mother-child pairs from 44 ECHO study sites across the United States. This sample included over 1,000 child participants who were potentially at higher risk for ASD due to being born preterm or having siblings with autism. The remaining participants were recruited from samples representative of the general population.

 

What happened during the study?

This study looked at scores from the Social Responsiveness Scale (SRS), a parent-report tool that measures autism-related traits in children, with higher scores indicating higher autism-related traits. During the study, researchers estimated daily exposure to particulate matter, nitrogen dioxide, and ozone at the residential addresses of pregnant women. They then analyzed the associations between these air pollutants and autism-related traits using the Social Responsiveness Scale (SRS) and physician-diagnosed ASD.

What happens next?

The study results suggest that even small changes in prenatal air pollution exposure could have a significant impact on child neurodevelopment. Future studies are needed to understand why these connections exist and to look at the impact of specific air pollution components.

 

Where can I learn more?

Access the full journal article, titled “Prenatal Air Pollution Exposure and Autism Spectrum Disorder in the ECHO Consortium,” in Environmental Health Perspectives.

 

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

Published June 11, 2025

Read the related research alert.

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

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.

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

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.

ECHO Cohort Study Finds No Significant Evidence that Prenatal Cannabis Exposure Increases Likelihood of Child Autism Spectrum Disorder

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ECHO Cohort Study Finds No Significant Evidence that Prenatal Cannabis Exposure Increases Likelihood of Child Autism Spectrum Disorder

Authors: Chaela Nutor, Patricia A. Brennan, et al.

 

Who sponsored this study?

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

 

Why was this study needed?

With the legalization of cannabis in some areas of the U.S., there has been a decrease in the perception of risk and an increase in cannabis use among pregnant women. While fetal exposure to cannabis has been linked to poorer neonatal and cognitive outcomes, relatively few studies have examined the association between prenatal cannabis exposure and neurodevelopmental outcomes, including autism spectrum disorder (ASD).

 

What were the study results?

The investigators found no evidence that prenatal cannabis exposure increased the likelihood for ASD in the group of children included in the study. There was also no evidence that child sex or gestational age at birth affected how prenatal cannabis exposure related to likelihood of ASD. No other aspects of brain or child development were evaluated in the study.

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

 

What was this study's impact?

Although no significant associations were found with ASD outcomes in this study, other studies have found that prenatal cannabis exposure may still be associated with ASD traits or other facets of child development and behavior that were outside of the scope of this study.

 

Who was involved?

This study included 11,570 school-age children from 34 ECHO Cohort research sites across the U.S., including three sites that enrolled children with a higher likelihood of ASD and three sites that enrolled children from neonatal intensive care units (NICU).

 

What happened during the study?

ECHO Cohort researchers gathered data on cannabis use during pregnancy directly from mothers and indirectly from their medical records. They also collected information on ASD diagnosis, as well as caregiver-reported data on the children’s autism-related traits from the ages of 1 to 18 years. The researchers used this information to test whether prenatal cannabis use might be associated with ASD.

 

What happens next?

The researchers are planning another large national study to further examine the relationship between prenatal cannabis exposure and autism traits. Other work could examine whether exposure to cannabis in utero alters brain functioning.

 

Where can I learn more?

Access the full journal article, titled “Examining the Association Between Prenatal Cannabis Exposure and Child Autism Behaviors: A Multi-cohort Investigation in the Environmental influences on Child Health Outcomes (ECHO) 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 2024

Read the associated article.

New ECHO Cohort Research Suggests No Significant Association Between Prenatal Cannabis Exposure and Child Autism-Related Outcomes

Collaborative ECHO research led by Chaela Nutor, MA and Patricia A. Brennan, PhD of Emory University investigates the association between prenatal cannabis exposure and autism spectrum disorder (ASD). The study looked at data from 11,570 school-aged children from across the United States and found no evidence that prenatal cannabis exposure increases the likelihood of ASD, regardless of the child’s sex or gestational age at birth. This research, titled “Examining the Association Between Prenatal Cannabis Exposure and Child Autism Traits: A Multi-cohort Investigation in the Environmental influences on Child Health Outcomes (ECHO) Program,” is published in Autism Research.

This study included children and their mothers from 34 ECHO cohorts across the United States. ECHO researchers gathered data on cannabis use during pregnancy directly from mothers and from their medical records. They also collected information on ASD diagnosis, as well as caregiver-reported data on the children’s autism traits when the children were 1 to 18 years. The researchers used these data and reports to test whether prenatal cannabis use might be associated with ASD.

“With the legalization of cannabis in some areas of the United States, there has been a decrease in the perception of risk and an increase in cannabis use among pregnant women,” said Chaela Nutor. “While fetal exposure to cannabis has been linked to poorer neonatal and cognitive outcomes, relatively few studies have tested the association between prenatal cannabis exposure and autism spectrum disorder.”

The results of this study supported the findings from previous studies showing that initial unadjusted associations between prenatal cannabis exposure and ASD behaviors in school-aged children are no longer significant when controlling for other factors, such as maternal use of other substances during pregnancy.

The researchers are planning another large national study to further investigate the relationship between prenatal cannabis exposure and autism-related behaviors. Future work could examine the role of continued exposure to cannabis after mothers are aware of pregnancy, and other studies could investigate combined exposure to tobacco and cannabis and associated risk for ASD.

Read the research summary.

ECHO Researchers Investigate Association of Early Childhood Phthalate Exposures with ADHD Behaviors in Childhood and Adolescence

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ECHO Researchers Investigate Association of Early Childhood Phthalate Exposures with ADHD Behaviors in Childhood and Adolescence

Authors: Jiwon Oh, Julie B. Schweitzer, Deborah H. Bennett, 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?

Phthalates are widely used chemicals found in many everyday items such as food packaging, flooring, building materials, medicine coatings, medical supplies, cosmetics, and personal care products. When phthalates enter the body, they are metabolized and converted into various smaller molecules, known as metabolites.

Animal studies suggest that exposure to phthalates during early life may negatively affect the nervous system, but there has been limited investigation into potential associations between early childhood phthalate exposure and attention-deficit/hyperactivity disorder (ADHD) behaviors in later childhood and adolescence.

For this study, ECHO researchers wanted to investigate whether exposure to phthalates in children at ages 2-5 years was associated with ADHD symptoms when these children were ages 8-18 years.

Learn how to say phthalate.

 

What were the study results?

ECHO Cohort researchers evaluated the levels of several metabolites that result from phthalate exposure. They saw that in children ages 2-5 years, most of these molecules were not associated with ADHD behaviors in these children at ages 8-18 years.

However, among children who had been diagnosed with autism spectrum disorder (ASD), one of these metabolites—mono-2-heptyl phthalate (MHPP)—was associated with more ADHD behaviors. Among typically developing children, a different small molecule—mono-carboxy isooctyl phthalate (MCiOP)—was associated with more hyperactive/impulsive behaviors.

 

What was this study's impact?

This study suggests that early childhood exposure to certain phthalates may be associated with having both ASD and ADHD traits. Since ADHD behaviors are more commonly found in children with ASD, deepening the understanding of how exposure to environmental chemicals, such as phthalates, could contribute to this comorbidity may be important for managing and treating these conditions effectively.

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

 

Who was involved?

This study included 243 children living in Northern California and taking part in the ReCHARGE (Revisiting Childhood Autism Risks from Genetics and Environment) study. This study included both neurotypical and neurodiverse children, with about 60% of them having ever had neurodevelopmental concerns. Therefore, the children included in the study tended to have more ADHD behaviors compared with children in the general population.

 

What happened during the study?

Phthalate metabolites can be measured in biological samples, such as urine, to assess exposure to phthalates. In this study, the researchers measured 15 phthalate metabolites in urine samples of young children ages 2-5 years. Parents answered questions about each child’s ADHD symptoms at ages 8-18 years.

 

What happens next?

While the metabolite MHPP and the phthalate it’s derived from, di-n-heptyl phthalate (DHPP), are commonly found in children’s urine, their influence on neurodevelopment has not been studied as much as other phthalates. Since exposure to DHPP has been linked to problems with development and behavior in animals, further studies need to look more closely at this compound to understand its effects on how the brain develops in children.

 

Where can I learn more?

Read the full research article, titled “Early childhood exposures to phthalates in association with attention-deficit/hyperactivity disorder behaviors in middle childhood and adolescence in the ReCHARGE study,” in the journal International Journal of Hygiene and Environmental Health.

Learn more about ECHO’s other chemical exposure research.

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

Published June 2024