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Risk of Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder in Children With Hypoxic-Ischemic
Stephanie Chi Wing Chow1, Yuliang Wang1, Oscar Lok Kan Leung1
1Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
Journal of Autism and Developmental Disorders
|May 22, 2026
Summary
Children surviving hypoxic-ischemic encephalopathy (HIE) face an increased risk of attention-deficit/hyperactivity disorder (ADHD), particularly those born to younger mothers. The link between HIE and autism spectrum disorder (ASD) requires further investigation.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Public health
Background:
- Hypoxic-ischemic encephalopathy (HIE) is a common cause of neonatal brain injury.
- Birth complications like HIE can have long-term neurodevelopmental consequences.
- Understanding the risks of conditions like ADHD and ASD following HIE is crucial for early intervention.
Purpose of the Study:
- To investigate the association between surviving hypoxic-ischemic encephalopathy (HIE) and the subsequent risk of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in children.
- To explore potential modifying factors, such as maternal age, in this relationship.
Main Methods:
- A population-based cohort study utilizing electronic medical records of term infants born in Hong Kong.
- Inclusion criteria: term infants with HIE from January 2004 to December 2018, with follow-up until December 2024.
- Statistical analysis: Log-binomial regression models were employed to assess the association between HIE and neurodevelopmental outcomes, adjusting for age, sex, and socioeconomic status (SES).
Main Results:
- The study included 533,230 children, with 349 diagnosed with HIE.
- Children with HIE showed a significantly increased risk of ADHD (adjusted RR=1.84, p<0.001).
- A significant interaction was found between HIE and maternal age, with a substantially higher risk of ADHD in children of mothers under 24 years (RR=4.25). The association between HIE and ASD was not statistically significant (adjusted RR=1.58, p=0.08).
Conclusions:
- Children with a history of HIE are at an elevated risk for developing ADHD.
- The risk of ADHD in HIE survivors is particularly pronounced when born to younger mothers.
- The association between HIE and ASD requires further research to establish a conclusive link.
Related Concept Videos
01:30Attention-Deficit/Hyperactivity Disorder
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent inattention, hyperactivity, and impulsivity. It affects approximately 5-8% of children globally, with around 60-70% of cases persisting into adulthood. ADHD has significant implications for educational attainment, social interactions, and occupational success.
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings.
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings.
01:19Autism Spectrum Disorder
Autism spectrum disorder (ASD) is a neurodevelopmental condition marked by persistent deficits in social communication and interaction alongside restrictive and repetitive behaviors or interests. ASD is sometimes accompanied by intellectual impairment.
These core symptoms manifest differently among individuals, ranging from mild to severe. The disorder's complexity extends beyond its clinical presentation, encompassing a diverse range of biological, cognitive, and sociocultural influences.
These core symptoms manifest differently among individuals, ranging from mild to severe. The disorder's complexity extends beyond its clinical presentation, encompassing a diverse range of biological, cognitive, and sociocultural influences.
01:23Hypoxia
Hypoxia is a medical condition characterized by an inadequate oxygen supply to body tissues. It typically manifests as a bluish discoloration of the skin and mucosae, especially in fair-skinned individuals, when hemoglobin (Hb) saturation drops below 75%.
Types of Hypoxia
There are four primary types of hypoxia, each resulting from a different cause:
1. Anemic hypoxia: This type occurs due to insufficient oxygen delivery caused by a lack of red blood cells (RBCs) or RBCs with abnormal or...
Types of Hypoxia
There are four primary types of hypoxia, each resulting from a different cause:
1. Anemic hypoxia: This type occurs due to insufficient oxygen delivery caused by a lack of red blood cells (RBCs) or RBCs with abnormal or...