Abstract
Many studies have shown low birth weight is associated with psychopathology later in life, particularly attention-deficit/hyperactivity disorder (ADHD). The association is well-replicated, independent from a variety of potential familial confounds, and follows a dose–response curve (decreasing birth weight linked with increasing odds of disorder). However, the specificity of the association to attention problems is called into question by the extent of comorbidity in ADHD, and recent findings that the association is stronger for autism than ADHD. We test the relative dose–response strength of birth weight on multiple aspects of behavior to explore specificity of the effect to attention problems. We also test recent suggestions that the association between birth weight and attention problems is driven by males. Our sample consisted of 9,076 children aged 9–10 from the United States (Adolescent Brain Cognitive Development study). Outcomes included 9 problem-scales and the total problems scale from the Child Behavior Checklist (CBCL). Attention problems were the most strongly associated with birth weight after controlling for gestational age, potential familial confounds, and multiple testing, supporting the outcome-specificity of this association. Contrary to recent registry-based findings, an association between birth weight and an autism scale was not observed. Sex moderated the effect of birth weight on total problems, attention problems and aggressive behavior such that these inverse associations were strongly driven by males. Our findings have strong implications for sex-specific prediction and etiological models of childhood psychopathology.
Highlights
Birth Weight and attention-deficit/ hyperactivity disorder (ADHD)Attention-deficit/hyperactivity disorder (ADHD) and its symptoms have been the most extensively studied psychological effects of low birth weight
Attention problems and somatic complaints were the only measured outcomes to remain significantly associated with birth weight after controlling for gestational age and all potential confounders
We found that the male-driven effect of birth weight on these problems was not explained by gestational age, suggesting that males are at greater risk to restricted foetal growth
Summary
Birth Weight and ADHDAttention-deficit/hyperactivity disorder (ADHD) and its symptoms have been the most extensively studied psychological effects of low birth weight. The association between lower birth weights and risk for ADHD appears to be robust, yet the transition from observation to prediction at the individual level has been hampered by the historic preference for case–control studies. Many studies have taken the binary approach to birth weight (e.g. under 2.5 kg or weight-for-gesational-age below the 1 0th percentile), showing an increased risk of psychopathology amongst these groups (meta-analyses: Aarnoudse-Moens et al, 2009; De Mola et al, 2014; Mathewson et al, 2017) it is clear from studies using continuous measures of birth weight (Abel et al, 2010; Pettersson et al, 2015, 2019; Wiles et al, 2006) that the risk is best described as continuous. We need to verify which outcomes are relevant (i.e. specificity) and moderating factors (e.g. sex) that may alter the slope or shape of the association.
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