Associations between multiple neurodevelopmental disorders and mental health in children

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This study investigated the association between multiple NDDs and the prevalence and severity of current depression and anxiety among children aged 3–17 years. We analyzed caregiver-reported data from 2016 to 2023 US National Survey of Children's Health. Children aged 3–17 years were included. We considered a broader spectrum of NDDs by including behavioral problems and grouped children based on the number of NDDs (out of ten): no multiple NDDs (none or one NDD), two NDDs, three NDDs, four NDDs, and five or more NDDs. Four mental health outcomes were measured: depression (yes/no), anxiety (yes/no), depression severity (mild/moderate/severe), and anxiety severity (mild/moderate/severe). Multinomial logistic regression models were used. Among 267,044 children (mean age = 10.2 years; male = 51.8 %), 10.6 % had multiple NDDs. The increasing number of co-occurring NDDs was associated with higher odds of prevalence and severity of depression and anxiety. Children with multiple NDDs were 4.7–5.3 times more likely to have depression and 5.8–12.9 times more likely to have anxiety compared with those without multiple NDDs. These positive associations remained consistent for mild or moderate depression (adjusted odds ratios [ORs]: 5.0–5.6) and for mild or moderate anxiety (adjusted ORs: 5.6–8.9). The associations were more pronounced for severe mental health conditions, with children being 7.8–16.9 times more likely to experience severe depression and 8.1–34.9 times more likely to experience severe anxiety. The cumulative mental health burden associated with multiple NDDs emphasizes the need for integrated screening and tailored interventions to support this population. • Increasing NDD count is associated with higher prevalence of depression and anxiety among children. • Associations are stronger for anxiety than depression. • Associations are stronger for severe than mild or moderate mental health conditions. • Children with five or more NDDs are 7.8–34.9 times more likely to have severe symptoms. • Findings highlight the need for early screening and integrated interventions.