Environment-Wide Association Study (En WAS) of Prenatal and Perinatal Factors Associated With Autistic Traits: A Population-Based Study.
Masoud Amiri, Sander Lamballais, Eloy Geenjaar and 4 others
PMID 32830427WHAT IT FOUND
Prenatal parental mental health symptoms, not specific environmental exposures, were the strongest predictors of later autistic traits.
No single factor stood out, suggesting a complex interplay. Clinicians should note that maternal reporting bias and genetic confounding may drive these associations rather than modifiable environmental causes.
Key findings
01Parental psychopathology variables, such as maternal anxiety and obsessive-compulsive symptoms, were the most significant predictors of higher autistic traits in children at age 6.
02No single environmental variable accounted for a large proportion of autistic symptoms, indicating that risk is likely distributed across many small-effect factors.
03Associations between maternal Dutch language ability and child autistic traits disappeared when the analysis was restricted to children with ethnically Dutch parents, suggesting measurement bias rather than a causal link.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study relied on parent-reported autistic traits (SRS) without multiple informants, meaning maternal psychopathology could bias the rating of the child's behavior (shared method variance). The sample size for children with a clinical ASD diagnosis was too small to analyze separately, so findings apply to continuous autistic traits in the general population rather than diagnosed ASD. Genetic confounding cannot be ruled out; associations between parental mental health and child traits may reflect shared genetics rather than environmental exposure. Ethnic and language differences in how parents completed the questionnaires influenced some results, suggesting that some 'risk factors' were actually artifacts of reporting style or cultural interpretation. The study was observational and cannot prove causation; reverse causality or unmeasured confounders remain possible.
Declared interests
The authors declared no conflicts of interest. The study was funded by the Simons Foundation Autism Research Initiative and The Netherlands Organization for Health Research and Development.
The easy way to misread this
Do not interpret the association between prenatal parental mental health symptoms and child autistic traits as evidence that treating maternal anxiety will prevent autism. The study cannot distinguish between environmental effects and genetic susceptibility, and the reliance on parent-reported outcomes means that a parent's own distress may color how they rate their child's social behavior.