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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
PubMed

Insights

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.
Abstract

Keywords:
Attention-deficit/hyperactivity disorderAutism spectrum disorderBrain injuryDevelopmentHypoxic-Ischemic encephalopathy

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