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Risk of attention deficit hyperactivity and autism spectrum disorders among the children of parents with autoimmune diseases: a nationwide birth cohort study

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Abstract

Studies have suggested that maternal autoimmune diseases are associated with an increased risk of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). However, research on the association of paternal autoimmune diseases with ADHD and ASD risk has remained inconclusive. Using the Taiwan National Health Insurance Research Database, we selected 708,517 family triads (father–mother–child) between 2001 and 2008 and followed them until the end of 2011. Parental autoimmune diseases as well as ADHD and ASD in children were identified during the study period. Increased ADHD risk in children in terms of hazard ratios (HRs) and 95% confidence intervals (CIs) was associated with prenatal exposure to paternal autoimmune diseases, including Sjögren’s syndrome (HR: 8.41, 95% CI: 2.72–26.05), psoriasis (HR: 1.95, 95% CI: 1.05–3.63), and ankylosing spondylitis (HR: 2.02, 95% CI: 1.29–2.15), as well as maternal autoimmune diseases, such as systemic lupus erythematosus (HR: 1.53, 95% CI: 1.09–2.15), type 1 diabetes mellitus (HR: 1.55, 95% CI: 1.02–2.36), inflammatory bowel disease (HR: 2.37, 95% CI: 1.59–3.52), psoriasis (HR: 1.70, 95% CI: 1.00–2.87), and ankylosing spondylitis (HR: 2.07, 95% CI: 1.11–3.86). However, ASD was only associated with paternal inflammatory bowel disease (HR: 3.08, 95% CI: 1.15–8.28) and ankylosing spondylitis (HR: 2.65, 95% CI: 1.10–6.39). Both paternal and maternal autoimmune diseases were associated with increased likelihood of ADHD in children. However, only paternal autoimmune diseases were related to offspring ASD risk. The precise pathomechanism underlying the correlation between parental autoimmunity and child neurodevelopment requires further investigation.

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Acknowledgements

The authors would like to thank Mr I-Fan Hu, MA (Courtauld Institute of Art, University of London; National Taiwan University) for his friendship and support. Mr Hu declares that there is no conflict of interest.

Funding

The study was supported by grant from Taipei Veterans General Hospital (V106B-020, V107B-010, V107C-181, V108B-012, V110C-025, V110B-002), Yen Tjing Ling Medical Foundation (CI-109-21, CI-109-22, CI-110-30) and Ministry of Science and Technology, Taiwan (107-2314-B-075-063-MY3, 108-2314-B-075 -037, 110-2314-B-075-026, 110-2314- B-075-024-MY3). The funding source had no role in any process of our study.

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Author notes

  1. Hsuan Lee and Ju-Wei Hsu have equally contributed to this work.

Authors and Affiliations

  1. Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan

    Hsuan Lee, Ju-Wei Hsu, Shih-Jen Tsai, Kai-Lin Huang, Ya-Mei Bai, Tung-Ping Su & Mu-Hong Chen

  2. Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Ju-Wei Hsu, Shih-Jen Tsai, Kai-Lin Huang, Ya-Mei Bai, Tung-Ping Su & Mu-Hong Chen

  3. Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Tzeng-Ji Chen

  4. Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Tzeng-Ji Chen

  5. Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan

    Tung-Ping Su

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  1. Hsuan Lee
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Contributions

Drs MHC and JWH designed the study. Drs HL and MHC analyzed the data and drafted the first version of the manuscript. Drs YMB, SJT, KLH, TPS, and TJC performed literature search and reviewed the manuscript. All authors contributed substantially to the manuscript, and approved the final manuscript for submission. All authors are responsible for the integrity, accuracy, and presentation of the data.

Corresponding author

Correspondence to Mu-Hong Chen.

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Lee, H., Hsu, JW., Tsai, SJ. et al. Risk of attention deficit hyperactivity and autism spectrum disorders among the children of parents with autoimmune diseases: a nationwide birth cohort study. Eur Child Adolesc Psychiatry 32, 283–291 (2023). https://doi.org/10.1007/s00787-021-01860-0

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  • DOI: https://doi.org/10.1007/s00787-021-01860-0

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