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Sibling influence on childhood neurodevelopmental disorders: A cohort study in Taiwan

Yi-Yu Su1, Chi-Jen Chen2, Mei-Huei Chen3

  • 1Institute of Environmental and Occupational Health Sciences, National Taiwan University, College of Public Health, Taipei, Taiwan; Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.

Early Human Development
|August 17, 2026
PubMed

Insights

Children without siblings generally face higher risks for neurodevelopmental disorders like autism spectrum disorder (ASD) and cerebral palsy (CP). Birth order also influences risks for ADHD and developmental delay.

Area of Science:

  • Neurodevelopmental disorders
  • Pediatric health
  • Public health

Background:

  • Childhood neurodevelopmental disorders, including autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), cerebral palsy (CP), and developmental delay, pose significant public health challenges.
  • Limited population-based evidence exists on the influence of sibling status and birth order on neurodevelopmental outcomes.

Purpose of the Study:

  • To investigate the association between sibling status, birth order, and the risk of major childhood neurodevelopmental disorders.
  • To provide population-based evidence on how family structure impacts neurodevelopmental outcomes.

Main Methods:

  • Analysis of a nationwide birth cohort of 2,045,178 live births in Taiwan (2004-2014).
  • Utilized linked birth registration, health insurance, and death registry records.
  • Identified neurodevelopmental disorders (CP, developmental delay, ASD, ADHD) using ICD codes and analyzed sibling status and birth order.
  • Employed Kaplan-Meier and Cox models, adjusting for covariates like maternal age, socioeconomic status, and urbanization.

Main Results:

  • Children with siblings generally exhibited lower risks for cerebral palsy (CP) and autism spectrum disorder (ASD) compared to single children.
  • Associations between ADHD and developmental delay varied by birth order.
  • Later birth order was linked to reduced recorded risks for ASD and ADHD.
  • Findings remained consistent after excluding multiple births and in analyses restricted to early-onset diagnoses.

Conclusions:

  • Family structure, specifically single-child status and birth order, is associated with varying risks of childhood neurodevelopmental disorders.
  • Single children generally face higher risks for multiple neurodevelopmental outcomes compared to those with siblings.
  • Family structure is a crucial early-life factor influencing neurodevelopment, informing surveillance strategies amidst declining fertility and delayed childbearing.
Abstract

Keywords:
Birth orderFamily structureNeurodevelopmental disordersSiblingsTaiwan

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