Aug 2026· Early Human Development· Vol 223, pp.
106642
· 0 citations
Medicine
TL;DR
It is suggested that family structure may represent an important early-life context for neurodevelopment and may help inform developmental surveillance in societies experiencing declining fertility rates and delayed childbearing.
Abstract
Objective
Autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), cerebral palsy (CP), and developmental delay are major childhood neurodevelopmental disorders. Sibling status and birth order may influence neurodevelopmental outcomes, yet population-based evidence remains limited. This study examined their associations with childhood neurodevelopmental disorder risks in a nationwide birth cohort.
Methods
We analyzed 2,045,178 live births from Taiwan's Birth Registration Database (2004-2014), linked to National Health Insurance and Death Registry records through 2020. CP, developmental delay, ASD, and ADHD were identified using ICD codes. Children were classified by sibling status and birth order using maternal identifiers. Kaplan-Meier and Cox models estimated adjusted hazard ratios (aHRs), controlling for maternal age, birth period, perinatal factors, socioeconomic status, and urbanization.
Results
Compared with single children, those with siblings generally showed lower risks of CP and ASD, whereas associations with ADHD and developmental delay varied according to birth order. Later birth order was associated with lower recorded risks of ASD and ADHD. Similar patterns were observed after excluding multiple births and in analyses restricted to diagnoses before 6 years of age.
Conclusions
Family structure, including single-child status and birth order, was associated with childhood neurodevelopmental disorder risks. Compared with children who had siblings, single children generally had higher risks across multiple neurodevelopmental outcomes. These findings suggest that family structure may represent an important early-life context for neurodevelopment and may help inform developmental surveillance in societies experiencing declining fertility rates and delayed childbearing.
Background/Objectives: Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) substantially affect quality of life. Previous studies have not evaluated whether the associations between early-life antibiotic exposure and the risks of ASD and ADHD differ according to the antibiotic agents administered during infancy. Methods: This nationwide case–control study used Taiwan’s National Health Insurance Research Database, Birth Reporting Database, and Maternal and Child Health Database. The cohort included 1,693,718 term neonates born between 2004 and 2015 and followed through to 2022. For ASD (n = 7265) and ADHD (n = 39,056) cases, antibiotic-exposed children were matched 1:1 with unexposed children based on sex, gestational age, birth weight, and birth year. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox proportional hazards models. Results: Oral antibiotic exposure was associated with lower ASD but higher ADHD risk, while parenteral exposure was associated with increased risks of both outcomes. Amoxicillin and erythromycin exposure during the first year of life were associated with lower ASD risk, whereas ampicillin exposure at 4–12 months was associated with higher ASD risk (all p £ 0.033). For ADHD, exposure to amoxicillin/clavulanic acid, cefixime, ampicillin, and ampicillin/sulbactam was associated with increased risk, whereas erythromycin, cephalexin, and sulfamethoxazole-trimethoprim were associated with reduced risk (all p < 0.047). Conclusions: Associations between early-life antibiotic exposure and the risks of ASD and ADHD varied according to antibiotic agents, route of administration, and timing of exposure. These findings may help explain inconsistencies among previous studies and inform antibiotic prescribing during infancy.
ACEs were associated with adult ASD and ADHD traits and related symptom subdomains in adulthood and linked to specific ASD symptoms and ADHD symptoms in adulthood.
Hiroki Yamada, Toshinori Nakamura, Tomonari Yoshizawa et al.· Psychiatry and Clinical Neur...· 0 citations
Abstract Background Women with intellectual and developmental disability (IDD) are a population whose maternal health outcomes remain poorly documented. We estimated associations between maternal IDD diagnosis in California birth records and adverse maternal outcomes, and assessed whether prenatal clinical characteristics mediate these relationships. Methods This retrospective population‐based cohort study included all deliveries ≥22 weeks’ gestation in California between 2007 and 2021, using birth and fetal death certificates linked to inpatient and emergency department records. Outcomes included severe maternal morbidity (SMM), cesarean delivery, preeclampsia, and maternal hospital admission in the year following delivery. We calculated adjusted risk ratios (aRRs) matched on maternal age and year of delivery. We examined IDD as a single category and by subtype: autism spectrum disorder (ASD), cerebral palsy (CP), intellectual disability (ID), chromosomal differences, and other IDDs. Mediators included tobacco use, pre‐existing hypertension, pre‐existing diabetes, preeclampsia, prepregnancy body mass index, epilepsy, depression/anxiety, bipolar disorder or schizophrenia, and adequate prenatal care. Results Among 6,435,742 singleton births, 4492 mothers (0.07%) had an IDD diagnosis. Women with IDD faced elevated risks across all adverse outcomes compared to those without: SMM—aRR: 2.77, 95% CI: 2.40, 3.19; cesarean delivery—aRR: 1.44, 95% CI: 1.39, 1.50; preeclampsia—aRR: 2.52, 95% CI: 2.30, 2.77; and hospital admission within 1 year of delivery—aRR: 4.64, 95% CI: 4.26, 5.05. While risk was elevated for all subtypes across all outcomes, ID tended to confer the highest risk. In the mediation analysis, hypertensive disorders and mental health conditions were the strongest individual mediators. In a joint mediation analysis, select perinatal characteristics explained half of the excess risk of cesarean delivery (autism), preeclampsia (autism), hospital admission (ID), and SMM (ID). Conclusions Women with IDD documented in California birth records face substantially elevated risks of adverse maternal outcomes, with the largest disparities in hospital admission in the year following delivery. Hypertensive disorders, depression, and anxiety were the strongest potential mediators of those analyzed, and should be further evaluated as intervention targets. Given our reliance on inpatient diagnostic codes, findings may generalize most reliably to women with IDD with the highest support needs.
Catherine Psaras, Rita H. Ryu, R. Baer et al.· Pregnancy· 0 citations
A familial background of autism, male gender, premature birth, and admission to a neonatal intensive care unit were notably more prevalent in children with autism, underscoring populations who may require enhanced developmental monitoring.
M. Bashtawi, Ayah A. Al-zgool, Dima A. Al Sharman et al.· Maternal and Child Health Jo...· 0 citations
Importance
Diagnoses of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) have increased substantially in recent decades, but it is unclear whether associations of prediagnostic characteristics with these diagnoses have changed over time.
Objective
To examine temporal trends in associations between well-defined risk factors and subsequent diagnoses of ADHD and ASD.
Design, Setting, and Participants
This population-based matched case-control study was conducted using nationwide Danish registry data for individuals born between January 1, 1994, and December 31, 2022, followed up to age 18 years. Individuals diagnosed with ADHD or ASD before age 18 years between 2012 and 2022 were included as cases. Each case was matched to 10 controls without these diagnoses by sex, birth year, municipality of residence, and country of birth. Data were analyzed from April 2025 through June 2026.
Exposure
A list of 19 prediagnostic characteristics, including parental and family factors, birth and perinatal factors, and health care use.
Main Outcomes and Measures
Associations between prediagnostic characteristics and ADHD or ASD diagnoses by year of diagnosis, estimated as odds ratios (ORs) with 95% CIs using conditional logistic regression.
Results
Of 2 194 951 children and adolescents in the registry, 100 323 individuals (4.6%) were diagnosed with ADHD or ASD before age 18 years, among whom 71 317 children and adolescents were diagnosed between 2012 and 2022 and included as cases (26 452 female [37.1%]; median [IQR] age at diagnosis, 11.4 [8.1 to 14.9] years), matched with 713 170 controls. Individuals diagnosed with ADHD or ASD differed from controls across all characteristics, but differences diminished over time, with ORs attenuating toward the null, particularly for socioeconomic and perinatal factors. For example, the OR for low birth weight decreased from 1.54 (95% CI, 1.41 to 1.68) in 2012 to 2013 to 1.17 (95% CI, 1.10 to 1.24) in 2020 to 2022. Attenuation was greater for ADHD than ASD (eg, household income: mean yearly change in OR, 6.5% [95% CI, 5.7% to 7.3%] for ADHD; mean yearly change in OR, 0.7% [95% C, -0.1% to 1.5%] for ASD) and more pronounced among individuals diagnosed at ages 10 to 17 years than at younger ages. Patterns were similar across sexes and in analyses restricted to cases with higher diagnostic certainty.
Conclusions and relevance
This study found that from 2012 to 2022, children and adolescents diagnosed with ADHD or ASD became increasingly similar to peers without these diagnoses. These findings suggest that increasing diagnostic rates may reflect changes in diagnostic practices or health care capacity rather than changes in underlying risk alone and should not be interpreted as evidence that ADHD or ASD have become less impairing at the individual level.
Magnus Elias Tarp, M. L. Lousdal, C. U. Rask et al.· JAMA psychiatry· 1 citation
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