Us new study highlights a critical, but often hidden, aspect of child health – the impact on mental health of living with two or more neurodevelopmental conditions.
We found children with multiple neurodevelopmental conditions – such as attention deficit hyperactivity disorder (ADHD), autism, learning disabilities, developmental delay, speech disorders, cerebral palsy, epilepsy, Tourette syndrome and behavioral problems – are much more likely to have depression and anxiety.
Our findings have important implications for health services and planning. They emphasize the importance of early and comprehensive care – where neurodevelopmental, educational and mental health services work together rather than separately.
We see more children with many conditions
More children are diagnosed with two or more neurodevelopmental conditions.
At the same time, mental health problems such as depression and anxiety occur more common to children and young people around the world. About 9% have a mental health disorder.
However, little was known about how often these emotional difficulties occur in children with multiple neurodevelopmental conditions and whether the risk increases as the number of such conditions increases.
Understanding these patterns can help health professionals, schools and policy makers identify children most at risk and provide early, comprehensive support.
What we did
We analyzed data from National Survey of Children’s Healtha large, nationally representative survey in the United States. This survey collects information from parents or carers about their children’s physical and mental health, development and family circumstances.
We combined data from 2016 to 2023, which included more than 267,000 children aged three to 17.
Parents were asked if their child had ever been diagnosed with any of ten neurodevelopmental conditions.
We classified children according to the number of neurodevelopmental conditions into five groups: no multiple neurodevelopmental conditions (none or one), two, three, four, and five or more neurodevelopmental conditions.
Parents also reported whether their child had ever been diagnosed with depression or anxiety and, if so, how severe these conditions were (mild, moderate, or severe).
Next, we examined how the number of neurodevelopmental conditions related to the likelihood of developing depression or anxiety.
Our findings were clear and consistent
The more neurodevelopmental conditions a child had, the greater the risk of depression and anxiety.
Compared to children without multiple neurodevelopmental conditions, children with two of these conditions were about 4.7 times more likely to have depression and 5.8 times more likely to have anxiety.
Children with five or more neurodevelopmental conditions were more than 5.3 times more likely to have depression and 12.9 times more likely to have anxiety.
The severity of mental health problems also increased sharply. Children with multiple neurodevelopmental conditions were much more likely to experience severe depression or anxiety than mild forms.
This pattern persisted after controlling for age, sex, race, country of birth, health service use, heart disease, diabetes, allergies, asthma, arthritis, body mass index, physical activity, adverse childhood experiences, family income, family structure, health insurance coverage, and parental education.
How does this apply globally?
Health systems around the world are facing increasing numbers children with multiple neurodevelopmental disorders. Therefore, it is vital to understand that these children are not a small minority – they represent a large and growing group that needs careful, coordinated care.
Although this study used US data, its findings have important lessons for countries around the world. This includes Australia, particularly as it struggles with its reform National Disability Insurance Scheme.
Neurodevelopmental conditions are common on a global level. However, most Australian studies have focused on children with a single neurodevelopmental status than those with multiples.
Very few Australian studies have looked at what happens when a child has two or more neurodevelopmental conditions at the same time. And when they have, these often had small sample sizes.
What are the implications?
By showing that the risk of depression and anxiety increases sharply as the number of neurodevelopmental conditions increases, our findings highlight an area that Australian research and policy could explore further.
With the increasing number of children diagnosed with neurodevelopmental conditions in Australia, understanding how these conditions interact and compound mental health risk is vital.
Our work also suggests that future Australian child health studies and programs need to look beyond individual conditions and consider the combined impact of multiple neurodevelopmental conditions on children’s emotional well-being, along with social and economic conditions and the ability to access services.
Doing so could lead to better monitoring, early intervention and better coordination of care for children and families in both health and education systems.
What now?
Based on our findings, several actions are required at different levels:
Health professionals they should routinely screen children with multiple neurodevelopmental conditions for anxiety and depression. Even if a child’s primary diagnosis is neurodevelopmental, mental health needs should not be overlooked. In general, parents also need support.
Schools and teachers they need training and resources to recognize emotional distress in students with neurodevelopmental challenges and to connect families with support services.
Parents and carers they should be encouraged to discuss emotional well-being with health care providers and seek help early if their child shows signs of worry, sadness, or withdrawal.
Researchers they should conduct long-term studies to investigate why these conditions often occur together and what early interventions work best to prevent later mental health problems.
Policy makers should fund and strengthen comprehensive child neurodevelopment and mental health programs. For example, this could be counseling at school. multidisciplinary care clinics that provide joint evaluations by pediatricians, psychologists, and speech or occupational therapists; and family support networks that offer parent education and peer support groups.
Without early recognition, intervention and support, these children may face ongoing difficulties in school, social isolation and long-term mental health problems in adulthood.
