ECHO Cohort Research Investigates Relationship Between Infant Gut Microbiome and Childhood Autism-related Traits

Authors: Vanja Klepac-Ceraj, Juliette C. Madan, 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 relationship between a person’s gut bacteria and the brain during early childhood, especially from birth to around age three years, helps the immune and nervous systems develop and function. The gut microbiome could be a promising area of research to understand the development of autism-related traits. Previous studies have found links between gut bacteria and social traits, but the results are not the same in different populations. To include a broader population of children in the U.S., researchers in this study sought to identify gut bacteria linked to social traits and brain development in two ECHO Cohort Study Sites.

What were the study results?

Researchers found that certain features of the gut microbiome of infants were associated with higher scores on the Social Responsiveness Scale-2 (SRS-2), a questionnaire that measures autism-related traits. Specifically, certain bacteria and their functional genes, particularly those related to the production of short-chain fatty acids, were linked to autism-related traits. These associations varied between sex and age groups.

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?

Understanding the potential likelihood of autism-related traits through the lens of the gut-brain axis opens new avenues for targeted interventions in early life.

Who was involved?

Researchers studied 481 samples from 304 healthy child participants from two ECHO Cohort study sites in New Hampshire and Rhode Island. The children were between 6 weeks old and 2 years old when they provided stool samples and between 3 and 19 years old when social traits were assessed.

What happened during the study?

The researchers compared groups of participants from two different study sites, focusing on their gut microbiomes when they were younger and social traits related to ASD at a later age. Both study sites contributing to this analysis had previously sequenced bacterial DNA from fecal samples collected from infants or toddlers. They calculated how common certain bacteria were in each sample and related that to the participant’s social behavior scores.

What happens next?

Future studies could explore interventions that could change the gut bacteria and potentially influence how the brain develops. Researchers also plan to investigate the influence of the developing gut microbiome on other neurobehaviorial outcomes, such as anxiety and depression.

Where can I learn more?

Access the full journal article, titled “Prospective Association of the Infant Gut Microbiome with Social Behaviors in the ECHO Consortium,” in Molecular Autism.

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

Published May 17, 2024

Read the associated article.

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ECHO Cohort Research Investigates Relationship Between Infant Gut Microbiome and Childhood Autism-related Traits

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.

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

Posted on April 10, 2024August 27, 2025 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.

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

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.

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

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

<< Back to Research Summaries

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

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

Posted on February 22, 2024August 27, 2025 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

Posted on February 2, 2024May 20, 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 well-being. 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

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.

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Shares articles on child mental health, including information on emotional development and child mental health disorders.

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Provides information on the development of school-age children, including physical development, behavior, language development, and parenting tips.

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How ECHO Advances Research on Children's 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

Since its launch, the ECHO Program has published more than 2,000 research articles on a wide range of child health topics. Within this body of work, many studies have examined neurodevelopmental outcomes.

Here are some research highlights:

Toddler Emotional and Behavioral Problems Decreased Slightly During Pandemic, ECHO Study Finds
September 2025
Children who grew up during the pandemic showed slightly fewer emotional and behavioral problems than those born before it.

Exposure to Common Flame-retardant Chemicals During Pregnancy May Be Associated with Behavioral Issues in Young Children, ECHO Study Finds
August 2025
Prenatal exposure to certain flame retardant chemicals, including BBOEP and BCPP, was linked to more emotional and behavioral problems in some young children.

Prenatal Exposure to Phthalates, But Not Phthalate Replacements, Linked to Children’s Behavior, ECHO Study Finds
August 2025
Higher prenatal levels of certain phthalates were linked to small increases in aggression and attention problems in young children, with effects varying by sex and neighborhood, while other phthalates and replacements showed no clear associations.

Executive Functioning May Be Connected to Child Health Behaviors, ECHO Cohort Study Suggests
January 2025
Across all age groups, children with higher working memory also had more health-promoting eating behaviors, such as less frequent intake of sugary drinks and saturated fats.

Children with Autism Are More Likely to Experience Emotional & Behavioral Challenges Like Anxiety, Depression, & ADHD, ECHO Study Suggests
January 2025
Children with autism spectrum disorder (ASD) generally had higher Child Behavior Checklist (CBCL) scores, indicating a possible link to greater emotional and behavioral challenges.

New ECHO Research Characterizes Children Born Preterm into Four Neurobehavioral Profiles Based on a Combination of Health Outcomes

Posted on November 10, 2023November 10, 2023 by Jodi Snare

Collaborative ECHO research led by Marie Camerota, PhD of the Warren Alpert Medical School of Brown University studies the health outcomes of children born preterm and characterizes them into four neurobehavioral profiles. This research, titled “Neurodevelopmental and behavioral outcomes of very preterm infants: latent profile analysis in the Environmental influences on Child Health Outcomes (ECHO) Program,” is published in Pediatric Research.

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.

This study included more than 2,000 babies who were born at less than 33 weeks gestational age from three ECHO Cohort Study Sites. When these children reached the age of two years, researchers conducted a neurodevelopmental assessment and a motor exam on the children while 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.

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 about 85% of children 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.

“This study helps us better understand outcomes for children following a very pre-term birth and shows that it is important to measure both neurodevelopmental and behavioral outcomes for children born preterm,” Dr. Camerota said. “The different groups of children we described might require different types of follow-up services or interventions. Therefore, the results of this study could potentially be used to develop personalized interventions for children following a very pre-term birth.”

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.

Read the research summary.