Title : Health-related behaviors and autism spectrum disorder among U.S. children aged 3–5 years: National Survey of Children’s Health (NSCH) 2023–2024
Abstract:
Background: Health-related behaviors, including diet, outdoor activity, screen time, and sleep, are important determinants of child health and development, yet little is known about the associations between these behaviors and autism spectrum disorder (ASD) among young children.
Objective: To examine associations between health-related behaviors and ASD among U.S. children aged 3-5 years.
Methods: Data were obtained from the 2023-2024 National Survey of Children’s Health (NSCH). Health-related behaviors included fruit and vegetable consumption during the past week, daily outdoor time during weekdays and weekend, daily time using devices with screens on most weekdays, and daily age-appropriate sleep hours. Daily fruit/vegetable consumption was calculated by averaging fruit and vegetable consumption. Daily outdoor time was estimated as (daily weekday outdoor time*5+daily weekend outdoor time*2)/7. Survey-weighted logistic regressions, adjusting for covariates (age, sex, race/ethnicity, family structure, and household poverty level), were used to measure associations between each health-related behavior and ASD status. Full model additionally adjusted for other health-related behaviors. Tests for trend were conducted by modelling health-related behaviors as continuous variables and P-value for trend (P-trend) were reported.
Results: After excluding participants with missing variables, the final sample included 18,386 children aged 3-5 years (719 with ASD and 17,667 without ASD). The final sample included 33% 3- year old children and 33% 4-year old children, 50% boys, 66% non-Hispanic White (NHW), and 41% with income <300% of poverty level, and 76% with family structure of two married parents. Compared to children without ASD, children with ASD were more likely to be 4- or 5-year-old, male, non-white, from lower-income households, and from non–two-parent married households (all P<0.01).
From the full model, greater fruit/vegetable consumption was associated with significantly lower odds of ASD, with adjusted odds ratios (aORs) ranging from 0.21 (95% confidence interval (CI): 0.10-0.46) to 0.38 (95% CI: 0.19-0.74) across consumption categories compared with no fruit/vegetable intake (P-trend=0.011, Table 1). Increased outdoor time was also associated with lower odds of ASD, with children spending ≥2 hours outdoor daily having 29%–63% lower odds of ASD than those spending ≤1 hour outdoor daily (P-trend<0.001). Children sleeping 10–13 hours daily had 25% lower odds (95% CI: 0.55-1.03) of ASD than those sleeping <10 hours (P=0.076). Compared to children with <1-hour daily screen time, the aOR ranged from 1.44(95% CI: 0.90,2.29) for 1 hour to 3.17(95% CI: 1.74,5.78) for >4 hours screen time (P-trend=0.002).
Conclusions: Among U.S. children aged 3–5 years, greater fruit/vegetable consumption, increased outdoor time, lower screen time, and adequate sleep were strongly associated with lower odds of ASD. These findings highlight important behavioral differences between children with and without ASD, suggesting that young children with ASD may be more likely to engage in less healthy lifestyle behaviors. Interventions that promote healthy eating, outdoor activity, healthy sleep habits, and reduced screen time may help improve overall health and well-being among children with ASD.
