Reproductive stoppage in autism spectrum disorder in a population of 2.5 million individuals.
Ralf Kuja-Halkola, Henrik Larsson, Sebastian Lundström and 5 others
PMID 31857873WHAT IT FOUND
When birth order and family factors were considered, having a child with ASD did not mean families stopped having more children.
If the first child had ASD, a second child was less likely; if a later child had ASD, families had more children.
Key findings
01Combining all birth orders and adjusting for covariates, families with a child with ASD did not show a lower chance of another child or a lower rate of subsequent children.
02For first to second births, families whose first-born had ASD were less likely to have another child after covariate adjustment.
03When the ASD diagnosis involved a later child, families had higher rates of subsequent childbearing.
STILL TO COME
How it was doneWhat they found
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What it does not show
ASD diagnoses came from the National Patient Register, so some true cases may not have been detected. The study assumed ASD was present from early age even when it was diagnosed later, which could bias results. It did not separate ASD subtypes, severity, or comorbidities, so family decisions may differ by those factors. The analytic dataset excluded children born after mothers emigrated and limited analyses to births before January 1, 2012 to allow at least 2 years of follow-up.
Declared interests
Funders were Forskningsrådet om Hälsa, Arbetsliv och Välfärd; Vetenskapsrådet; and Beatrice and Samuel A. Seaver Foundation. The funders had no role in design, collection, analysis, interpretation, writing, or submission decision.
The easy way to misread this
Do not conclude that having a child with ASD causes parents to stop having more children. The combined adjusted result did not support universal stoppage, and the birth order pattern is observational and may reflect family planning, diagnosis timing, or other factors.