ECHO Study Suggests Living Near Green Space Is Associated with Lower Anxiety and Depression in Preschool-Age Kids

Authors: Nissa Towe-Goodman

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?

While previous research has suggested that access to nature is important for mental health, there are a limited number of studies that have examined these effects on young children. ECHO investigators addressed this research gap by looking at whether exposure to green space was associated with internalizing symptoms (e.g., anxiety, depression) and externalizing symptoms (e.g., aggression, rule-breaking) among children.

What were the study results?

The ECHO researchers found that higher levels of green spaces, up to three-fourths of a mile from a child’s home, were linked with lower symptoms of anxiety and depression from ages 2 to 5. Although green space was also linked with symptoms of aggression and rule-breaking in early childhood, this association was reduced after accounting for factors such as poverty levels, unemployment, and housing costs. Researchers found no significant association between residential green space and internalizing or externalizing symptoms in middle childhood, ages 6 to 11.

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?

Most research evaluating the effect of green space on health so far has been limited in children and studied one or a few cities at a time. ECHO Program researchers were able to examine data from children in 199 counties across 41 U.S. states, exploring the connection between exposure to green spaces from birth and anxiety, depression, aggression, and other symptoms during early or middle childhood. These findings suggest that green initiatives such as parks, urban forest programs, or protected natural areas may influence early emerging anxiety and depression symptoms.

Who was involved?

The 2,103 children included in the study were born between 2007 and 2013 and ranged in age from 2 to 11, spanning early and middle childhood.

What happened during the study?

Researchers analyzed information from parents who completed the Child Behavior Checklist for their children from ages 2 to 11 and combined this data with the family’s residential address since the child was born and satellite-based imagery of vegetation density around their homes. Green space exposure was measured using the Normalized Difference Vegetation Index (NDVI), a widely used metric for quantifying vegetation density using sensor data. NDVI values range from -1 to 1. High NDVI values (approximately 0.6 to 0.9) represent dense vegetation, such as forests; values approaching 0 represent areas without live vegetation.

What happens next?

Future studies can explore the types of natural areas linked with early mental health and examine the role of green space around schools. Investigating how early exposure to nature influences mental health into adolescence and adulthood could also be an important area to study.

Where can I learn more?

Access the full journal article, titled “Green space and internalizing or externalizing symptoms among children,” 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 April 10, 2024

Read the associated article.

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ECHO Study Suggests Living Near Green Space Is Associated with Lower Anxiety and Depression in Preschool-Age Kids

Living Near Green Space Associated With Fewer Emotional Problems in Preschool-Age Kids, NIH Study Finds

Posted on April 10, 2024April 11, 2024 by Jodi Snare

FOR IMMEDIATE RELEASE

Children who live in areas with natural spaces (e.g., forests, parks, backyards) from birth may experience fewer emotional issues between the ages of 2 and 5, according to a study funded by the NIH Environmental Influences on Child Health Outcomes (ECHO) program.

While research has suggested that time in nature is important for mental health, studies examining the effects on young children are limited. ECHO investigators addressed this research gap by analyzing information from parents about the behavior of their children from ages 2 to 11. They combined this data with the family’s residential address when the child was born and satellite data on live vegetation density around their homes.

What researchers found in their analysis, published in JAMA Network Open, was that higher levels of green spaces up to three-fourths of a mile from a child’s home were linked with lower anxiety and depression symptoms from ages 2 to 5 years. The association persisted even after researchers factored in the child’s sex, parent education, age at birth, and neighborhood socioeconomic vulnerability. Researchers did not find a significant association between green space around the home and mental health symptoms in later childhood years from ages 6 to 11, when children spend more time at school.

“Our research supports existing evidence that being in nature is good for kids,” said Nissa Towe-Goodman, PhD, an ECHO researcher from the Frank Porter Graham Child Development Institute at the University of North Carolina, Chapel Hill. “It also suggests that the early childhood years are a crucial time for exposure to green spaces.”

Most research so far has been limited to studying one or a few cities at a time, and focused on adult health. Because the ECHO Program collects data nationwide, researchers were able to examine data from children in 199 counties across 41 U.S. states, exploring the connection between exposure to green spaces from birth and anxiety, depression, aggression, and other symptoms during early or middle childhood.

The study included children born between 2007 and 2013 and whose parents completed the Child Behavior Checklist, a common survey to rate a child’s emotional and behavioral symptoms. The 2,103 children included in the study ranged in age from 2 to 11, spanning early and middle childhood.

Green space exposure was measured using the Normalized Difference Vegetation Index (NDVI), a widely used metric for quantifying vegetation density using sensor data. NDVI values range from -1 to 1. High NDVI values (approximately 0.6 to 0.9) represent dense vegetation, such as forests; values close to zero represent areas without live vegetation.

“In the future, researchers could look into what kinds of experiences in nature are connected to kids' early mental health,” said Dr. Towe-Goodman. “Also, we should study how creating or preserving natural areas around homes and schools might make a difference in a child’s mental health.”

Dr. Towe-Goodman lead this collaborative research in JAMA Network Open.

###

About ECHO:

Launched in 2016, the Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

For information or to request an interview, contact Rebekah Yeager, rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact NIHKidsandEnvironment@od.nih.gov.

Connect With Us

Check out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth on X for the latest ECHO Program updates.

ECHO Researchers Study the Relationship Between Maternal Education and Children’s Neurocognitive Development Over Time

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ECHO Researchers Study the Relationship Between Maternal Education and Children’s Neurocognitive Development Over Time

Author: Santiago Morales

Who sponsored this study?

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

Why was this study needed?

Previous research has found a relationship between maternal education and children’s neurocognitive functions, but many of these studies have focused on early childhood. In addition, many previous studies have treated maternal education as something that doesn’t change over time. Few studies have explored whether a mother’s education level over the course of their child’s development might associate with neurocognitive function. ECHO researchers wanted to examine the relationship between changes in a mother’s education over time and their children’s later neurocognitive functioning, such as executive function and language skills.

What were the study results?

A mother’s education level during pregnancy and infancy was associated with children’s language and executive function. Increases in maternal education were related to improved language performance but were not associated with executive functioning performance.

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 suggests that early maternal education is strongly associated with later child neurocognitive outcomes. In the study, changes in maternal education were also associated with some of these outcomes. These results suggest that further examining these associations can provide important insights that can help inform policies and interventions designed to foster neurocognitive development.

Who was involved?

The study included 2,688 children, adolescents, and young adults from 3 to 20 years of age at ECHO research sites in 42 states across the U.S.

What happened during the study?

Mothers reported their own education levels during pregnancy and their child’s infancy, and again, years later when their children’s neurocognitive functions were also assessed. For both periods, the study categorized the mother’s education level into one of five groups—less than high school; high school or GED equivalent degree; some college, associate degree or trade school; bachelor’s degree; and graduate degree. The same categories were used to measure maternal education during childhood. Maternal education and income are two commonly used indicators of socioeconomic status. However, missing income data in this study prevented investigators from fully assessing the impact of socioeconomic status and income on neurocognitive skills.

Researchers also measured child participants' cognitive abilities during childhood, adolescence, or young adulthood using the NIH Toolbox Cognition Battery. These tests assess aspects of cognition including language, memory, and problem solving. Test results created scores that reflected language skills, executive function, and overall brain function. The analysis included child participants who contributed at least one score.

What happens next?

While this study suggests an association between maternal education and a child’s neurocognitive function, this research doesn’t necessarily explain the factors or mechanisms involved in that association. Future studies might further explore these factors to provide additional insights.

Where can I learn more?

Access the full journal article, “Maternal Education Prospectively Predicts Child Neurocognitive Function: An ECHO Study,” in Developmental Psychology.

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

Published February 26, 2024

Access the associated article.

Download this summary

ECHO Researchers Study the Relationship Between Maternal Education and Children’s Neurocognitive Development Over Time

New ECHO Research Study Relationship Between Maternal Education and Children’s Neurocognitive Development Over Time

Posted on February 27, 2024April 11, 2024 by Jodi Snare

Collaborative ECHO research led by Santiago Morales, PhD of the University of Southern California investigates the relationship between maternal education and children’s neurocognitive development over time. This research, titled “Maternal Education Prospectively Predicts Child Neurocognitive Function: An ECHO Study,” is published in Developmental Psychology.

ECHO researchers wanted to examine the relationship between changes in a mother’s education over time and their children’s later neurocognitive functioning, such as executive function and language skills. Studies to date have focused on early childhood outcomes and have treated a mother’s education as unchanging over time.

This study included 2,688 children, adolescents, and young adults from 3 to 20 years of age at ECHO research sites in 42 states across the U.S.

Mothers reported their own education levels during pregnancy and their child’s infancy, and again, years later when their children’s neurocognitive functions were also assessed. For both periods, the study categorized the mother’s education level into one of five groups—less than high school; high school or GED equivalent degree; some college, associate degree or trade school; bachelor’s degree; and graduate degree. The same categories were used to measure maternal education during childhood. Maternal education and income are two commonly used indicators of socioeconomic status. However, missing income data in this study prevented investigators from fully assessing the impact of socioeconomic status and income on neurocognitive skills.

Researchers also measured child participants’ cognitive abilities during childhood, adolescence, or young adulthood using the NIH Toolbox Cognition Battery. These tests assess aspects of cognition including language, memory, and problem solving. Test results created scores that reflected language skills, executive function, and overall brain function. The analysis included child participants who contributed at least one score.

This study found that a mother’s education level during pregnancy and infancy was associated with children’s language and executive function. Increases in maternal education were related to improved language performance but were not associated with executive functioning performance.

“These results suggest that further examining these associations can provide important insights that can help inform policies and interventions designed to foster neurocognitive development,” said Dr. Morales.

Future research can explore the factors involved in the suggested association between maternal education and a child’s neurocognitive development.

Read the research summary.

ECHO Research Suggests Airborne Lead Exposure Affects Children’s Cognitive Development, Impacting Males More Than Females

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ECHO Research Suggests Airborne Lead Exposure Affects Children’s Cognitive Development, Impacting Males More Than Females

Authors: Amii Kress, Lisa Gatzke-Kopp, 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?

Chemicals used in manufacturing, such as lead, are often released into the air and water. The government sets limits on the amount of pollution that is allowed based on what scientists believe are safe levels for humans. Studies suggest that there is no safe level of lead exposure for children. Despite a substantial decrease in children’s blood lead levels in recent decades, significant disparities in lead exposure still exist. Houses with old lead paint and areas with older and poorly kept housing or corroded pipes pose a higher risk of lead exposure. However, there is limited research on how airborne lead from industrial emissions affects children. This study tested whether lead pollution in the air, even at very low levels, is related to children’s intelligence and executive functioning.

What were the study results?

Children who lived in areas with relatively more lead pollution in the air in the early years of their lives exhibited less impulse control and had slightly lower IQ scores when they reached preschool and school age. Each increase in the level of airborne lead exposure was linked to an average decrease of 0.74 points in children’s IQ scores. The association between lead exposure and executive function was less straightforward in this study, with the influence changing noticeably only at higher levels. This was especially true for boys, who were more sensitive to the effects of airborne lead. Cognitive flexibility, or the ability to adapt to changing situations, and memory did not appear to be affected.

Note: 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 this study's impact?

These results suggest that the amount of lead in the air during early childhood may affect children’s brain development. These findings could contribute to a broader approach to children’s health by considering all of the ways that a child’s environment could pose invisible risks. This study suggests that, in addition to efforts to reduce environmental pollution in general, attention to factors like nutrition that may mitigate the impact of exposure on children’s development could reduce health disparities of lead exposure for vulnerable individuals.

Who was involved?

This study looked at over 3,000 children from across the United States who were part of a research study that contributed to the ECHO Cohort.

What happened during the study?

Researchers used children’s home addresses to create a timeline of all the places that they lived from the time they were born until they were 5 years old. They then matched those locations to a database provided by the Environmental Protection Agency (EPA) that estimates the relative amount of lead pollution in the air for every half-square mile yearly. Researchers determined the average amount of exposure over the course of five years for each individual child and then examined whether the level of exposure was related to how the children performed on cognitive and IQ tests when they were between 3 and 8 years old.

What happens next?

Future studies are needed to examine whether other factors in the child’s environment make the effects of lead pollution better or worse. For instance, children with a healthy diet may be less likely to suffer from the effects of air pollution. Furthermore, previous work has suggested that males are more vulnerable to the effects of adverse conditions during neurodevelopment generally. These findings, along with evidence that lead exposure may affect male and female children differently, warrant additional research.

Where can I learn more?

Learn more about the additional data supporting this study through the EPA’s Toxic Release Inventory program. The program offers a Toxics Tracker website that people can use to learn more about the sources of air pollution in their communities.

Access the full journal article titled “Airborne Lead Exposure and Childhood Cognition: The Environmental Influence on Child Health Outcomes (ECHO) Cohort (2003-2022)” in the American Journal of Public Health.

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

Published March, 2024

Access the associated article.

Download this summary

ECHO Research Suggests Airborne Lead Exposure Affects Children’s Cognitive Development, Impacting Males More Than Females

Early-Life Airborne Lead Exposure Associated With Lower IQ and Self-Control in NIH Study

Posted on February 22, 2024April 11, 2024 by Jodi Snare

FOR IMMEDIATE RELEASE

Children who lived in areas with higher levels of airborne lead in their first five years of life appeared to have slightly lower IQs and less self-control, with boys showing more sensitivity to lead exposure, according to a new study from the NIH Environmental influences on Child Health Outcomes (ECHO) Program.

Lead exposure, even at low levels, can affect cognitive and physical development in children. While children’s blood lead levels have decreased in recent decades, inequities persist in areas with older, poorly maintained housing or inadequate water system management. There is limited research on how airborne lead from industrial emissions affects children.

ECHO Cohort researchers wanted to learn if airborne lead exposure is associated with children’s IQ and executive functioning. Their analysis, published in the American Journal of Public Health, suggests there may be an association between lead released into the air and children’s brain development.

“To ensure that children have a fair chance at healthy development, reducing the environmental pollution in general and focusing on factors such as nutrition could lessen the impact of lead exposure on children’s development,” said study author Lisa Gatzke-Kopp, PhD of Penn State.

In the study, lower average IQ scores were associated with high levels of airborne lead exposure in children between the ages of 4 and 8. A similar association was observed with executive function between the ages of 3 and 8, but only for impulse control and not the ability to follow changes in instructions. The association with impulse control was more pronounced in boys.

To gain these insights, investigators used residential address data of more than 3,000 children from 14 ECHO Cohorts combined with an Environmental Protection Agency (EPA) database of historical and geographically specific estimates of airborne lead levels. After calculating the average lead exposures for each child over the course of their first five years, researchers analyzed their IQ and cognitive test scores from ages 3 to 8, while accounting for a number of additional factors, such as socioeconomic status.

These findings are consistent with a previous study, reinforcing the importance of examining air pollution and child development. However, researchers pointed out that other chemicals could also play a role, and factors like nutrition might help mitigate the effects of lead exposure.

Future studies can examine whether other factors in a child’s environment modify lead pollution and why boys appear to be more susceptible.

Dr. Gatzke-Kopp led this collaborative research in the American Journal of Public Health.

###

About ECHO:

Launched in 2016, the Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.

Media Contacts

For information or to request an interview, contact Rebekah Yeager, rebekah.yeager@nih.gov.

If you are not a member of the media, but have a general inquiry, please contact NIHKidsandEnvironment@od.nih.gov.

Connect With Us

Check out the recent issues of our bi-monthly newsletter, the ECHO Connector, for program news and the latest research findings.

To receive the ECHO Connector through email, subscribe here.

Follow @ECHOChildHealth for the latest ECHO Program updates on X (formerly known as Twitter).

New ECHO Research Highlights Gaps in Literature Studying Role of Fathers in Child Development

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New ECHO Research Highlights Gaps in Literature Studying Role of Fathers in Child Development

Authors: Elena Jansen, Kristine Marceau, et al.

Who sponsored this study?

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

Why was this study needed?

While few studies on parental health and child development include fathers in any substantial way, a growing body of literature emphasizes their vital role—even in the period before birth. This study reviewed existing literature on what is known about the father’s role in child development. It highlights how a father’s history and personal characteristics before the baby is born, during pregnancy, and after birth can influence their child directly via their parenting behaviors and indirectly by influencing the child’s mother. The study also discusses how the ECHO Program can address key gaps in the literature by designing studies that address unanswered questions.

What were the study results?

The researchers reviewed the existing literature to find out which characteristics or behaviors of fathers have been connected to children’s development, especially their physical and mental health. While many studies give some information about the role of fathers, often fathers do not provide this information themselves, or existing data do not allow researchers to compare the role of fathers to that of mothers. Compared to the pregnancy and pre-pregnancy stages, this study allows researchers to better understand a father’s role once a baby is born. The study team created a model to guide future inquiry and suggest methods researchers can use to help fill in some knowledge gaps in the future. One unique aspect of this work is describing how fathers can impact the child by first influencing the mother, for example, by helping her follow healthy behaviors, such as cooking or helping to cook healthy meals and eating healthy food himself.

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 this study's impact?

This review of other publications reveals gaps in the research community’s understanding of the father’s role in child development. First, very little is known about the father’s role in child development before birth. The study authors noted that more studies are needed to research mothers and fathers before they have children, focusing on including fathers in a substantial way. Some of the father data collected in the existing literature was reported by the mother. This highlights a gap in the literature and the need to incorporate maternal and paternal reported data on father characteristics. Second, this review demonstrates how studying the effect of fathers on child development has revealed additional insights into children’s health outcomes, including reasons for declines in physical or mental health.

This study also introduces a model designed to guide other researchers in focusing on pieces of the puzzle that are currently less understood. The model may help explain how each parent interacts with their child and which influence has a stronger impact or is more prevalent for which parent.

Who was involved?

This literature review involved an in-depth look into existing research on the role of fathers in child development and evaluated its quality. The study focuses on three specific child outcome areas of the ECHO program: obesity, neurodevelopment, and positive health.

What happened during the study?

This literature review begins by describing data collected by the ECHO Cohort and identifying critical gaps in the research related to the role of fathers in ECHO’s five key health outcome areas. After understanding the program’s data collection methods, the research team analyzed multiple research papers categorized into three broad stages of child development—preconception, prenatal, and postnatal. The review concludes with the presentation of a new proposed conceptual model to guide future studies considering paternal influences in ECHO and beyond.

What happens next?

With more data becoming available from the ECHO Program, information on fathers' characteristics can be connected to the rich data on family characteristics, mothers' influences, and child development. Additional data will be gathered to provide further insights and answer remaining questions.

Where can I learn more?

Access the full journal article, titled “The Role of Fathers in Child Development from Preconception to Postnatal Influences: Opportunities for the National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) Program” in Developmental Psychobiology.

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

Published December 27, 2023

Read the associated article.

Download this summary

New ECHO Research Highlights Gaps in Literature Studying Role of Fathers in Child Development

Posted on February 2, 2024April 11, 2024 by Jodi Snare

Collaborative ECHO research led by Elena Jansen, PhD of Johns Hopkins School of Medicine, and Kristine Marceau, PhD of the College of Health and Human Sciences at Purdue University reviewed existing literature on what is known about a father’s role in child development, highlighting how a father’s history and personal characteristics can influence their child’s health and wellbeing. This research, titled “The Role of Fathers in Child Development from Preconception to Postnatal Influences: Opportunities for the National Institutes of Health Environmental influences on Child Health Outcomes (ECHO) Program,” is published in Developmental Psychobiology.

While few studies on parental health and child development include fathers in any substantial way, a growing body of literature emphasizes their vital role—even before birth. This literature review studied existing research on the role of fathers in child development. It evaluated the quality of this research, focusing on three outcome areas of the ECHO Program: obesity, neurodevelopment, and positive health. The review also discussed how the ECHO Program can address gaps in the literature by designing studies that address unanswered questions.

The review first described data collected by the ECHO Cohort and identified critical gaps in the research related to the role of fathers in ECHO’s five key health outcome areas. After understanding the program’s data collection methods, the research team analyzed multiple research papers categorized into three broad stages of child development—preconception, prenatal, and postnatal.

This review focused on which previously studied characteristics or behaviors of fathers have been connected to children’s development. It demonstrated how studying the effect of fathers on child development has revealed additional insights into children’s health outcomes, including reasons for declines in physical or mental health. Compared to the pregnancy and pre-pregnancy stages, this study allowed researchers to better understand a father’s role once a baby is born.

“One unique aspect of this work is describing how fathers can impact the child by first influencing the mother, for example, by helping her follow healthy behaviors, such as cooking or helping to cook healthy meals and eating healthy food himself,” Dr. Jansen said.

This literature review also revealed gaps in the research community’s understanding of the father’s role in child development, highlighting the need to incorporate maternal and paternal reported data on fathers’ characteristics. While many studies offer insights into the role of fathers, often fathers do not provide this information themselves, or existing data do not allow researchers to compare the roles of fathers and mothers.

Additionally, the study team proposed a new conceptual model to guide future inquiry considering paternal influences, and suggest methods researchers can use to help fill in some knowledge gaps.

“Our model can help guide other researchers to focus on the pieces of the puzzle that we currently know very little about,” Dr. Jansen said. “It may help explain how each parent interacts with their child and which influence has a stronger impact or is more prevalent for which parent.”

With more data becoming available from the ECHO Program, information on fathers’ characteristics can be connected to the rich data on family characteristics, mothers’ influences, and child development. Additional data will be gathered to provide further insights and answer remaining questions.

Read the research summary.

Neurodevelopment

How ECHO Advances Research on Children's Brain Development

ECHO researchers use data from more than 64,000 diverse children and their families across the U.S. to examine how much factors such as chemical exposures, environmental hazards, social stressors, maternal health during pregnancy, and other considerations may influence neurodevelopment.

The prenatal period and childhood are critical times for brain development or neurodevelopment, but this important process continues during adolescence until early adulthood. Understanding the associations between environmental factors and neurodevelopmental outcomes can inform prevention efforts, interventions, and other strategies to enhance child health.

Healthy brain development is key for cognitive, physical, and social functioning. ECHO research can help explain the factors that impact neurodevelopment in children and how neurodevelopment might have additional effects on other health outcomes. This research can help inform programs, policies, and practices that address health differences from the beginning, promoting a lifetime of good health that continues for generations.

What We're Learning

The ECHO Program has published more than 1,500 articles about the results of its research, including many that looked at neurodevelopment outcomes.

Here are recent examples of that research:

Exposure to Certain Phthalates During Pregnancy May Affect Brain Development in Infant Girls
November 2022
Certain phthalates measured in the infant’s first stool seemed associated with lower scores in girls under age 5 years on a common test that measures motor, visual, and language skills.

ECHO Study Suggests Prenatal Exposure to Perfluorononanoic Acid (PFNA) May Be Linked to Autism-Related Traits in Children
January 2023
Prenatal exposure to one specific PFAS chemical, perfluorononanoic acid, seemed associated with an increase in autism-related traits in children.

No Association Between Antidepressant Use During Pregnancy, Child's Risk for Autism-Related Traits
November 2022
Prenatal use of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), did not increase a child’s risk for autism spectrum disorder or related traits.

Gestational Diabetes and Postpartum Depression May Be Linked With Early Childhood Behavior Problems
May 2023
Gestational diabetes, prenatal maternal depressive symptoms, and postnatal maternal depressive symptoms each seemed associated with increased child behavior problems.

ECHO Discovery Webinar Insights

Prenatal Air Pollution Exposure and Risk of Autism: New Insight from ECHO Cohorts

Perinatal Sleep Health and Offspring Neurodevelopment

Neurodevelopment Resources

CDC: Children's Mental Health
Shares articles on child mental health, including information on emotional development and child mental health disorders.

MedlinePlus: School-Age Children Development
Provides information on the development of school-age children, including physical development, behavior, language development, and parenting tips.

Questions

For more information, please email the NIH at NIHKidsandEnvironment@od.nih.gov.
For media inquiries or to request an interview, contact Rebekah Yeager at rebekah.yeager@nih.gov.

Read Additional ECHO Research Related to Neurodevelopment

ECHO Study Suggests Living Near Green Space Is Associated with Lower Anxiety and Depression in Preschool-Age Kids Read more

ECHO Researchers Study the Relationship Between Maternal Education and Children’s Neurocognitive Development Over Time Read more

ECHO Research Suggests Airborne Lead Exposure Affects Children’s Cognitive Development, Impacting Males More Than Females Read more

New ECHO Research Highlights Gaps in Literature Studying Role of Fathers in Child Development Read more

ECHO Researchers Characterize Children Born Preterm into Four Neurobehavioral Profiles Read more

ECHO Researchers Measure Pandemic-Related Traumatic Stress in Families Read more

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

New ECHO Cohort Research Finds Adolescents with Disabilities May Have Been More Vulnerable to Social Disruptions During COVID-19 Pandemic Read more

ECHO Study Suggests Maternal Sleep During Second Trimester of Pregnancy May be Associated with ADHD Symptoms and Sleep Quality in Early Childhood Read more

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

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