Association of cerebral palsy with autism spectrum disorder and attention-deficit/hyperactivity disorder in children: a large-scale nationwide population-based study.

OBJECTIVE: To examine the association of cerebral palsy with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), providing evidence for interdisciplinary medical service for children with cerebral palsy. DESIGN: A large-scale nationwide population-based study. SETTING: The National Health Interview Survey (NHIS). PATIENTS: 177 899 children aged 3-17 years among NHIS participants from 1997 to 2003 and 2008 to 2018. RESULTS: Among the 177 899 children included in this analysis, 602 (0.33%) had cerebral palsy, 1997 (1.16%) had ASD, and 13 697 (7.91%) had ADHD. Compared with children without cerebral palsy, children with cerebral palsy had a higher prevalence of ASD (6.09% vs 1.15%; p<0.001) and ADHD (15.91% vs 7.89%; p<0.001). After adjustment for age, sex, race/ethnicity, family highest education level, family income level and geographical region, the OR among children with cerebral palsy, compared with children without cerebral palsy, was 5.07 (95% CI 3.25 to 7.91) for ASD (p<0.001) and 1.95 (95% CI 1.43 to 2.66) for ADHD (p<0.001). Furthermore, the association of cerebral palsy with ASD and ADHD remained significant in all subgroups stratified by age, sex and race. CONCLUSION: In a large, nationally representative sample of US children, this study shows that children with cerebral palsy are at an increased risk of ASD and ADHD.

Intranasal Oxytocin Increases Head Motion During Functional MRI Scanning.

Oxytocin is a neuropeptide associated with prosocial behaviors, such as parent-child bonding, eye contact, and sexual activity. Intranasally-administered oxytocin has been widely used to study its effects on the brain using functional magnetic resonance imaging. Head motion is a significant confounding variable which was assessed as part of a double blind, placebo-controlled crossover study. Twenty-four mothers with drug addiction problems were initially recruited, along with 22 healthy control mothers, to test whether intranasal oxytocin enhances functional brain responses to images of their own versus unknown infant faces. Significant differences in head motion between oxytocin/placebo conditions and addiction/control groups were discovered. Administration of intranasal oxytocin was associated with more frequent counts of head motion exceeding 3 mm of framewise displacement, independent of group status (z=2.89, p=0.004). This effect was seen more strongly in the control group (z=2.30, p=0.02) than the addiction group (z=1.77, p=0.08). The addiction group was more likely to show increased head motion, independent of oxytocin or placebo condition (z=2.21, p=0.03). When examining the mean head motion across all time points, as opposed to the count of large movements, oxytocin's effect was limited to the addiction group (z=2.58, p=0.01), with a significant group by condition interaction effect observed. Intranasally-administered oxytocin may therefore have a confounding effect on functional MRI scanning results via its independent effect on head motion. These findings should be examined and replicated in other clinical populations.

Neural correlates of altered emotional responsivity to infant stimuli in mothers who use substances.

Mothers who use substances during pregnancy and postpartum may have altered maternal behavior towards their infants, which can have negative consequences on infant social-emotional development. Since maternal substance use has been associated with difficulties in recognizing and responding to infant emotional expressions, investigating mothers' subjective responses to emotional infant stimuli may provide insight into the neural and psychological processes underlying these differences in maternal behavior. In this study, 39 mothers who used substances during the perinatal period and 42 mothers who did not underwent functional magnetic resonance imaging while viewing infant faces and hearing infant cries. Afterwards, they rated the emotional intensity they thought each infant felt ('think'-rating), and how intensely they felt in response to each infant stimulus ('feel'-rating). Mothers who used substances had lower 'feel'-ratings of infant stimuli compared to mothers who did not. Brain regions implicated in affective processing (e.g., insula, inferior frontal gyrus) were less active in response to infant stimuli, and activity in these brain regions statistically predicted maternal substance-use status. Interestingly, 'think'-ratings and activation in brain regions related to cognitive processing (e.g., medial prefrontal cortex) were comparable between the two groups of mothers. Taken together, these results suggest specific neural and psychological processes related to emotional responsivity to infant stimuli may reflect differences in maternal affective processing and may contribute to differences in maternal behavior in mothers who use substances compared to mothers who do not. The findings suggest potential neural targets for increasing maternal emotional responsivity and improving child outcomes.

Self-Reported and Agency-Notified Child Abuse as Contributors to Suicidal Behaviour in a Population-Based Birth Cohort Study at 30-Year-Follow-Up.

This was a record-linkage analysis of a birth cohort to examine the association between self-reported self-harm in adulthood and childhood maltreatment (CM) as prospectively notified to authorities and self-reported on the Child Trauma Questionnaire. There were 2507 participants at 30-year follow-up with data on both CM and self-reported self-harm including an intent to die. Of the participants, 304 (12.1%) had self-harmed at some time in their lives while 150 (4.2%) had wanted to die. The prevalence of self- and agency-reported maltreatment was 513 (20.5%) and 143 (5.7%) respectively. On adjusted analyses, CM irrespective of reporting source showed significant associations with both suicidal outcomes. Physical and emotional abuse showed the strongest associations while findings for neglect were mixed. The only association for sexual abuse was for self-reported maltreatment and intent to die but numbers may have been under-powered.

The intersection of genome, epigenome and social experience in autism spectrum disorder: Exploring modifiable pathways for intervention.

The number of children diagnosed with autism spectrum disorder (ASD) has increased substantially over the past two decades. Current research suggests that both genetic and environmental risk factors are involved in the etiology of ASD. The goal of this paper is to examine how one specific environmental factor, early social experience, may be correlated with DNA methylation (DNAm) changes in genes associated with ASD. We present an innovative model which proposes that polygenic risk and changes in DNAm due to social experience may both contribute to the symptoms of ASD. Previous research on genetic and environmental factors implicated in the etiology of ASD will be reviewed, with an emphasis on the oxytocin receptor gene, which may be epigenetically altered by early social experience, and which plays a crucial role in social and cognitive development. Identifying an environmental risk factor for ASD (e.g., social experience) that could be modified via early intervention and which results in epigenetic (DNAm) changes, could transform our understanding of this condition, facilitate earlier identification of ASD, and guide early intervention efforts.

Adult attachment is related to maternal neural response to infant cues: an ERP study.

Maternal attachment security is an important predictor of caregiving . However, little is known regarding the neurobiological mechanisms by which attachment influences processing of infant cues, a critical component of caregiving. We examined whether attachment security, measured by the Adult Attachment Interview, might relate to neural responses to infant cues using event-related potentials. Secure (n=35) and insecure (n=24) mothers viewed photographs of infant faces and heard recordings of infant vocalizations while electroencephalography was recorded. We examined initial processing of infant faces (N170) and cries (N100), and attentional allocation to infant faces and cries (P300). Secure mothers were significantly faster than insecure mothers to orient to infant cries (N100), structurally encode their own infant's face (N170), and attend to infant faces (P300). These differences may elucidate mechanisms underlying how attachment may shape neural processing of infant cues and highlight the use ofsocial neuroscientific approaches in examining clinically relevant aspects of attachment.

Association between history of attention-deficit/hyperactivity disorder diagnosis and cardiovascular disease in U.S. adults.

OBJECTIVE: To examine the association between attention-deficit/hyperactivity disorder (ADHD) and cardiovascular disease (CVD) in a nationally representative population sample of adults in the United States. METHOD: We included adults aged 18 years or older who participated in the National Health Interview Survey 2007 and 2012, because information about ADHD diagnosis among adults was only available in these two cycles. Physician-diagnosed ADHD and CVD were defined based on an affirmative response in the questionnaire during a household interview. Logistic regression with survey sampling weights was used to estimate the odds ratio (OR) and 95% confidence intervals (CIs) of CVD. RESULTS: This analysis included 57,728 adults (weighted mean age 46.20 years; 47.66% males). Among them, 1,790 reported physician-diagnosed ADHD, 7,906 had CVD, 4,061 had coronary heart disease (CHD), and 1,749 had stroke. The age-adjusted prevalence of CVD was 19.72% (95% CI [16.56%, 22.88%]) among individuals with ADHD, and 12.09% (95% CI [11.75%, 12.43%]) among those without ADHD. After adjustment for age, sex, race/ethnicity, education level, family income level, smoking, alcohol drinking, physical activity, and body mass index, the OR of CVD, CHD and stroke in association with ADHD was 2.06 (95% CI [1.58, 2.68]), 1.88 (95% CI [1.31, 2.69]), and 1.75 (95% CI [1.07, 2.86]), respectively. CONCLUSIONS: In a nationally representative sample of U.S. adults, we found a significant, positive association between a history of ADHD diagnosis and CVD. Further investigation is needed to replicate our findings and determine the underlying mechanisms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Association of Food Allergy, Respiratory Allergy, and Skin Allergy with Attention Deficit/Hyperactivity Disorder among Children.

BACKGROUND: Previous studies have predominately examined associations of respiratory allergy and skin allergy with ADHD, but little is known about the association between food allergy and ADHD. METHODS: We included 192,573 children aged 4-17 years from the National Health Interview Survey (NHIS), a leading health survey in a nationally representative sample of the US population. Allergy conditions and ADHD were defined based on an affirmative response in the NHIS questionnaire. We used weighted logistic regression to estimate the odds ratio (OR) of ADHD. RESULTS: Among the 192,573 children, 15,376 reported ADHD diagnosis. The prevalence of ADHD was higher among children with allergic conditions: 12.66% vs. 7.99% among children with and without food allergy; 12.16% vs. 7.63% among children with and without respiratory allergy; and 11.46% vs. 7.83% among children with and without skin allergy. After adjusting for covariates, the OR of ADHD was 1.72 (95% CI, 1.55-1.91) comparing children with and without food allergy, 1.50 (95% CI, 1.41-1.59) comparing children with and without respiratory allergy, and 1.65 (95% CI, 1.55-1.75) comparing children with and without skin allergy. The observed associations remained significant after mutual adjustment for other allergic conditions. CONCLUSIONS: In a nationally representative sample of US children, we found a significant association of common allergic conditions (food allergy, respiratory allergy, and skin allergy) with ADHD.

Self-reported and Agency-Notified Child Abuse as a Contributor to Health Anxiety in a Population-Based Birth Cohort Study at 30-Year Follow-up.

BACKGROUND: Health anxiety is a subtype of the older term hypochondriasis, in which there is worry rather than conviction of having an illness. Information on the association between childhood maltreatment and health anxiety in adulthood often comes from retrospective questionnaires that may be subject to recall bias. There are no prospective data studies using reports to statutory agencies. OBJECTIVE: We therefore assessed the effect on these outcomes at 30-year follow-up using both prospective agency notifications of child abuse and retrospective self-reports in the same birth cohort. METHODS: At follow-up, there were 2458 adults with data on health anxiety as measured by the Whiteley Index. We also collected details on self-reported abuse with the Child Trauma Questionnaire and linked this to child maltreatment notifications to statutory agencies. RESULTS: The prevalence of self- and agency-reported maltreatment was 600 (24.4%) and 143 (5.8%), respectively. Of the participants, 235 were in the top 10% of Whiteley Index scores. On adjusted analyses, self-reported maltreatment of all types showed significant associations with increased health anxiety, while this was limited to sexual abuse in the case of agency-reported childhood maltreatment (adjusted odds ratio = 2.17; 95% confidence interval = 1.06-4.46; P = 0.034). Effects were strongest in women. CONCLUSIONS: Both self- and agency-reported childhood maltreatment showed a significant association with somatic symptoms in adulthood although patterns were different and of varying degrees.

Parenting a Child with a Neurodevelopmental Disorder during the Early Stage of the COVID-19 Pandemic: Quantitative and Qualitative Cross-Cultural Findings.

Research during the COVID-19 pandemic has shown a strong relationship between child symptoms, parental stress, and mental health challenges. The pandemic has changed family routines, worsening child symptomatology and parental burden. The aim of this study was to investigate how the magnitude of the perceived changes in child externalizing behavior, parental stress, and discontinuity of therapy-from before to during the COVID-19 pandemic-affected parental mental health during the pandemic. Moreover, we sought to compare these aspects cross-culturally between European countries and the USA. To these purposes, we asked Italian, Spanish, and U.S. parents of children with neurodevelopmental disabilities (NDD) to complete an online survey. Quantitative results showed that increased parental stress may have contributed to a worsening in parental psychological distress, regardless of culture. Moreover, they suggested an indirect effect of child externalizing behaviors on parents' psychological distress via parental stress. Qualitative analyses highlighted that the lack, or discontinuity, of therapeutic activities may have been one of the key contributors to parenting burden during the COVID-19 pandemic. Finally, qualitative results highlighted resilience factors that could have decreased the risk of psychological problems during the pandemic, such as a strong sense of parental efficacy and the ability to adapt to changing family dynamics.

A Comparison of Oral Health Outcomes of Self-Reported and Agency-Notified Child Maltreatment in a Population-Based Birth Cohort at 30-Year-Old Follow-Up.

OBJECTIVE: Information on the oral health outcomes of childhood maltreatment in adulthood is limited and reliant on retrospective questionnaires that are subject to recall bias. There are no data from prospective studies using maltreatment reports to statutory agencies. We therefore assessed the effect on dental outcomes and oral health care at 30-year follow-up using both prospective agency notifications and retrospective self-reports of child maltreatment in the same birth cohort. METHODS: There were 2456 adults with data on dental outcomes and oral health care at follow-up. Information on self-reported abuse was collected using the Child Trauma Questionnaire and linked to child maltreatment notifications to statutory agencies. RESULTS: The prevalence of self- and agency-reported maltreatment was 599 (24.4%) and 142 (5.8%), respectively. At follow-up, 850 participants (34.6%) had undergone a dental extraction for infection or decay, and 810 had experienced significant dental pain over their lifetime. One-third had not visited a dental clinic in the previous 2 years, and 40% failed to brush their teeth at least twice daily. On adjusted analyses, both self- and agency-reported maltreatment showed significant associations with dental extraction (odds ratio = 1.47 [95% confidence interval = 1.21-1.80] and odds ratio = 1.44 [95% confidence interval = 1.01-2.06], respectively). There were similar results for brushing frequency, whereas self-reported maltreatment was associated with dental pain. However, associations were weaker for dental clinic visits and some child maltreatment subtypes. CONCLUSIONS: Child maltreatment is associated with adverse oral health consequences in adulthood and is thus a dental and wider public health issue.

Association between serum selenium concentrations and learning disability in a nationally representative sample of U.S. children.

BACKGROUND: Oxidative stress has been implicated in the pathogenesis of neurodevelopmental disorders. As an anti-oxidative agent, selenium plays an important role in human health. However, the relationship between selenium status and learning disability (LD), a common neurodevelopmental disorder, is unknown. OBJECTIVE: To examine the association between serum selenium concentrations and learning disability. DESIGN: Nationwide, population-based, cross-sectional study. PARTICIPANTS/SETTING: Children aged 4-11 years who have available data on serum selenium concentrations and LD (N = 1,076) from the U.S. National Health and Nutrition Examination Survey 1999-2000. EXPOSURE: Serum selenium levels were measured using atomic absorption spectrometry. MAIN OUTCOME MEASURES: Diagnosis of LD was reported by the children's parents. STATISTICAL ANALYSES PERFORMED: Logistic regression models with survey weights were conducted adjusting for age, race/ethnicity, family income, total energy intake, body mass index, and serum cotinine levels. RESULTS: In this study, 8.2% (95% confidence interval [CI] 5.2%-11.2%) of children had a diagnosis of LD. Serum selenium concentration was lower among children with LD than those without LD (geometric mean ± standard error, 107.7 ± 2.7 ng/mL vs. 112.8 ± 1.0 ng/mL, P for difference = 0.08). The adjusted odds ratio (OR) of LD comparing the highest with lowest tertile of serum selenium concentrations was 0.39 (95% CI 0.19-0.82). Each 10 ng/mL increment in serum selenium concentrations was associated with 31% (OR 0.69, 95% CI 0.51-0.93) lower odds of LD. CONCLUSIONS: Higher serum selenium concentration was associated with a lower risk of LD in U.S. children. The causal relationship between selenium and LD and the underlying mechanisms warrant further investigation.

A comparison of psychosis-like symptoms following self-reported and agency-notified child abuse in a population-based birth cohort at 30-year-follow-up.

There is a strong association between self-reported child abuse and subsequent psychosis in retrospective data. Prospective studies of reports to statutory agencies are less common with limited information on people in their 30s. There have also been no comparisons of the influence of self- and agency-reported abuse on psychosis in adulthood. We therefore compared the prevalence of delusions and hallucinations in 30-year-olds who had experienced either self- or agency-reported childhood maltreatment with that in the remainder of a birth cohort. There were 2427 participants with data on psychosis and child abuse at 30-year follow-up. Information on self-reported abuse came from the Child Trauma Questionnaire (CTQ) and was linked to notifications of child maltreatment reported to statutory agencies. We measured psychotic-like experiences using the Peter's Delusions Inventory (PDI) and screening questions from the Composite International Diagnostic Interview. The prevalence of self- and agency-reported maltreatment was 599 (24.7%) and 141 (5.8%) respectively. At 30-year follow-up, 556 participants had PDI scores in the top two deciles, while 232 had experienced visual hallucinations and 134 auditory phenomena. On adjusted analyses, self-reported maltreatment, apart from sexual abuse, showed a strong association with all three outcomes. Associations were less strong for agency-notified child maltreatment and largely restricted to physical and emotional abuse. These findings suggest that people presenting with psychosis should be screened for child maltreatment, particularly physical and emotional abuse, as well as the possibility of psychosis considered in survivors of child maltreatment.

Adverse Childhood Experiences Predict Common Neurodevelopmental and Behavioral Health Conditions among U.S. Children.

OBJECTIVE: Adverse childhood experiences (ACEs) can have a significant but variable effect on childhood neurodevelopment. The purpose of this study was to quantify and compare the associations between "household challenge" ACEs and common childhood neurodevelopmental and behavioral health conditions, using nationally representative U.S. METHOD: This study used data from the 2016-2019 National Survey of Children's Health, a nationwide, population-based, cross-sectional survey. Seven household challenge ACEs (not including child maltreatment) were reported by parents/guardians: parental death, incarceration, divorce/separation, family violence, mental illness, substance abuse, and poverty. Logistic regression with sample weights was used to estimate the odds ratio (OR) for 15 parent-reported neurodevelopmental and behavioral health conditions, by the number of reported ACEs. A dose-response relationship was examined by applying tests of orthogonal polynomial contrasts to fitted logistic regression models. RESULTS: Down syndrome, Tourette syndrome and cerebral palsy were not associated with household challenge ACEs, whereas behavior/conduct problems, depression, and substance abuse were strongly associated, with adjusted ORs ranging from 6.36 (95% confidence interval (CI) 5.53, 7.32) to 9.19 (95% CI 7.79, 10.84). Other neurodevelopmental conditions not traditionally associated with childhood adversity showed moderate yet robust associations with ACEs, including autism (adjusted OR 2.15, 95% CI 1.64, 2.81), learning disability (adjusted OR 3.26, 95% CI 2.80, 3.80), and attention deficit hyperactivity disorder (adjusted OR 3.95, 95% CI 3.44, 4.53). The ORs increased with the number of ACEs, showing significant positive linear trends. CONCLUSION: We found significant dose-dependent or cumulative associations between ACEs and multiple neurodevelopmental and behavioral conditions.

Association between perinatal depression and risk of attention deficit hyperactivity disorder among children: a retrospective cohort study.

PURPOSE: Perinatal depression has previously been identified as a risk factor for attention deficit hyperactivity disorder (ADHD) in the offspring. Population-based studies utilizing diagnosis data are needed to better understand the relationship between these two variables. The objective of this study was to examine the association between perinatal depression and the risk of ADHD among children born during a 5 or-more-year follow-up period. METHODS: The sample was drawn from a population-based cohort of privately insured mother-child pairs within the state of Iowa. Hazard ratios for risk of ADHD by exposure to perinatal depression were estimated using adjusted Cox proportional-hazard models. RESULTS: Among the 5,635 mother-child pairs, 484 mothers were diagnosed with depression during the perinatal period, and 269 children were diagnosed with ADHD. After adjustment for confounders, children born to mothers with perinatal depression were over three times more likely to be diagnosed with ADHD (HR 3.16 (95% CI 2.35, 4.23)). CONCLUSIONS: Children born to mothers with perinatal depression were found to be at increased risk of ADHD. This finding suggests that ADHD and its adverse sequelae could be mitigated by increasing maternal depression intervention efforts as well as ADHD screening and treatment efforts targeted to this vulnerable population.

Risk Factors for Maltreatment in Siblings of Abused Children.

OBJECTIVES: To examine the association between child maltreatment (abuse and neglect) in one sibling and that in another as well as associated risk factors. METHODS: The participants were 520 sibling pairs enrolled in a population-based birth cohort study in Brisbane, Australia (N = 1040). Exposure to suspected child maltreatment was measured by linkage with state child protection agency data. Self-reports of childhood sexual abuse were also collected at the 21-year follow-up. RESULTS: There were notifications in both children for 8.5% of the sibling pairs (n = 44). A notification in the first sibling was associated with a 60-fold increase in the likelihood of a notification in the second sibling (95% confidence interval: 29.3-125.1), resulting in nearly three-quarters being the subject of a report. In terms of the subtypes, neglect revealed the strongest association, followed by sexual abuse. At the 21-year follow-up, 58% of second siblings reported sexual abuse when the first sibling disclosed similar experiences. On adjusted analyses, maternal age of <20 years was the strongest and most consistent predictor of abuse, with indigenous status, maternal depression, parental relationship, and familial poverty playing a lesser role. CONCLUSIONS: Our results highlight the close association between child abuse in one sibling and maltreatment in a second sibling as well as possible risk factors. Greater awareness of these factors may inform interventions, particularly primary and secondary prevention.

Association of Attention-Deficit/Hyperactivity Disorder With E-Cigarette Use.

INTRODUCTION: E-cigarette use in young people has emerged as a public health concern in the U.S. Previous studies have shown that individuals with attention-deficit/hyperactivity disorder are more likely to use conventional cigarettes. However, little is known about their use of E-cigarettes. This study examines the association of attention-deficit/hyperactivity disorder with E-cigarette and other tobacco product use among undergraduate and graduate students in the U.S. METHODS: This study included data from 195,443 U.S. undergraduate and graduate students aged 18-39 years who participated in the National College Health Assessment surveys from spring 2017 to fall 2018. History of attention-deficit/hyperactivity disorder diagnosis and current use of conventional cigarettes, E-cigarettes, and other tobacco products were ascertained by questionnaires. Logistic regression models estimated the ORs and 99% CIs of use of conventional cigarettes, E-cigarettes, and other tobacco products according to attention-deficit/hyperactivity disorder history. RESULTS: Among the 195,443 students, 16,800 (8.35%) were current conventional cigarette users and 15,863 (7.89%) were current E-cigarette users; 16,283 (8.10%) had a history of attention-deficit/hyperactivity disorder diagnosis. After adjustment for demographics, socioeconomics, lifestyle factors, BMI, anxiety, and depression, the OR of E-cigarette use among participants with attention-deficit/hyperactivity disorder, compared with those without attention-deficit/hyperactivity disorder, was 1.72 (99% CI=1.60, 1.85), which was comparable to the magnitude of associations for other tobacco products. CONCLUSIONS: Among U.S. undergraduate and graduate students, there is a significant association between attention-deficit/hyperactivity disorder diagnosis and current use of E-cigarettes. Health consequences of E-cigarette use among individuals with an attention-deficit/hyperactivity disorder diagnosis warrant further investigation.

Parenting and addictions: Current insights from human neuroscience.

Purpose: A growing body of human research has documented associations between the maternal brain and maternal substance use and addictions. This neuroscience-informed approach affords the opportunity to unpack potential neurobiological mechanisms that may underscore challenges in maternal caregiving behavior among mothers with addictions and provide new directions for parenting interventions. Findings: Consistent with theoretical models of parenting and addictions, five studies evidence both hypo- and hyper-reactivity to infant affective cues across neuroimaging methods and tasks that incorporate both infant face and cry stimuli. Three structural and resting-state brain studies as a function of maternal substance use are also reported. Conclusions: While human neuroimaging research converges in showing that maternal substance use is associated with differential reactivity to infant affective cues, further multi-level/multi-modal, longitudinal, and dimensional research is critically needed to advance this area of investigation.

Association of Anemia with Neurodevelopmental Disorders in a Nationally Representative Sample of US Children.

OBJECTIVE: To examine the associations of anemia with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and learning disability in US children. STUDY DESIGN: We included children and adolescents aged 3-17 years from the National Health Interview Survey (NHIS), 1997-2018. Information about physician-diagnosed history of anemia, ASD, ADHD, and learning disability was reported by a parent or guardian. Multiple logistic regression with sample weights was used to estimate the ORs and 95% CIs of neurodevelopmental disorders according to the presence of anemia. RESULTS: Of the total population of 213 893 children aged 3-17 years (mean age [SE], 10.01 [0.01] years), 2379 were reported to have a diagnosis of anemia, for a weighted prevalence of 1.06% (95% CI, 1.01-1.12). The prevalence of ASD was 1.94% (95% CI, 1.20-2.68) among children with anemia and 1.07% (95% CI, 1.01-1.14) among those without anemia. The corresponding prevalences were 12.24% (95% CI, 10.47-14.00) and 7.73% (95% CI, 7.58-7.88) for ADHD and 15.03% (95% CI, 13.08-16.99) and 7.75% (95% CI, 7.39-7.70) for learning disability, respectively. Compared with those without anemia, children with anemia were more likely to have neurodevelopmental disorders, with an aOR of 2.07 (95% CI, 1.39-3.08) for ASD, 1.84 (95% CI, 1.55-2.19) for ADHD, and 2.22 (95% CI, 1.90-2.60) for learning disability. CONCLUSIONS: In a nationally representative sample of US children, we found significant associations between anemia and neurodevelopmental disorders including ASD, ADHD, and learning disability. Further investigation is warranted to assess the causality and elucidate the underlying mechanisms.