Neonatal Medical Male Circumcision and Child Autism Diagnosis

Importance: Public concern and speculation have emerged around a possible link between neonatal male circumcision (NMC) and autism spectrum disorder (ASD). Evidence is limited and inconsistent. Objective: To examine associations between NMC and child ASD and autism-related traits and behaviors. Design, Setting, and Participants: This prospective cohort study was conducted among cohort sites participating in the Environmental Influences on Child Health Outcomes (ECHO) Cohort between February 2003 and September 2025. Statistical analyses were conducted from November 2025 to February 2026. The analysis included male, singleton children with data on NMC status and child ASD. Exposure: NMC status within 28 days of birth at a medical facility. Main outcomes and Measures: ASD diagnosis was based on parent report of diagnosis by a medical professional or documentation of criterion standard clinical assessments. Social Responsiveness Scale (SRS-2) T-scores assessed the presence and distribution of autism traits, and Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) Autism Spectrum Problems subscale T-scores from the Child Behavior Checklist (CBCL) 1.5/5 assessed the occurrence of child autism-related behaviors. Results: The sample included 2771 male children from 14 ECHO sites, of whom 1840 (66%) were circumcised before hospital discharge, and 192 (7%) had an autism diagnosis. Among 1840 circumcised males, 108 (6%) had autism, compared with 84 of 931 uncircumcised males (9%). Mean (SD) age at autism diagnosis was 3.8 (2.2) years. Among circumcised males, 31 (4%) were administered acetaminophen during the procedure, and 128 (7%) within the 30 days after birth. After adjusting for confounders, there was no association between NMC and ASD diagnosis (odds ratio [OR], 0.83; 95% CI, 0.59-1.17). After stratification by region, preterm birth, and neonatal intensive care unit admission, an inverse or no association was observed between NMC and ASD diagnosis. Adjusted analyses showed no associations between NMC and SRS-2 continuous (β = -0.62; 95% CI, -1.46 to 0.22) or binary (OR, 0.75; 95% CI, 0.48-1.15) T-scores. Similarly, no associations were observed between NMC and CBCL 1.5/5 continuous (β = 0.01; 95% CI, -0.54 to 0.56) or binary (OR, 1.30; 95% CI, 0.75-2.26) T-scores. Overall, inverse or no associations were observed across all strata for SRS-2 and CBCL 1.5/5 outcomes. Conclusions and Relevance: This cohort study yielded no evidence that NMC was associated with ASD risk, whether assessed by parent report of medical professional diagnosis or validated instruments measuring autism-related traits and behavior. These findings may provide reassurance for families who are considering or have elected NMC for their child.

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Journal
Archives of Pediatrics and Adolescent Medicine
Published
2026-08-03
DOI
https://doi.org/10.1001/jamapediatrics.2026.3239
Primary Topic
Genital Health and Disease
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article
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article

Neonatal Medical Male Circumcision and Child Autism Diagnosis

Amanda Goodrich, Casper G. Bendixsen, Annemarie Stroustrup, Daniel B. Horton et al.
Archives of Pediatrics and Adolescent Medicine
Genital Health and Disease
article

Neonatal Medical Male Circumcision and Child Autism Diagnosis

Amanda Goodrich, Casper G. Bendixsen, Annemarie Stroustrup, Daniel B. Horton, Diane R. Gold, Cristiane S. Duarte, Abdul‐Manaf Mutaru, James E. Gern, Aisha S. Dickerson, C A Camargo, Daniel J. Jackson, Suman Das, Gurjit K. Khurana Hershey, Tina V. Hartert, José F. Cordero, Lisa Croen, Anne P. Starling, Lisa P. Jacobson, Akram N. Alshawabkeh, Melinda Jarnecke, Hyeong‐Moo Shin, Monica McGrath, Susan V. Lynch, Traci A. Bekelman, Christine L.M. Joseph, Emily Ho, Courtney K. Blackwell, Meyer Kattan, Jane E. Freedman, George T. O’Connor, Meghan H. Shilts, Michelle Macy, Jonathan L. Slaughter, Priya Duggal, Patricia A. Brennan, Daphne Koinis Mitchell, Zhaozhong Zhu, Sean Deoni, Brian Lee, Ashley F. Sullivan, Catherine Monk, Dana Dabelea, Tenneill Murray, Robert F. Lemanske, John Meeker, Hans-Georg Mueller, Ruby H.N. Nguyen, Viren D'Sa, Carole Ober, Linda Adair, Deborah J. Rinehart, Claudia Lugo-Candelas, John Ainsworth, Christine Hockett, Leonard B. Bacharier, Monique M. Hedderson, Ravi V. Shah, Christine C. Johnson, Sheryl Magzamen, Emily Knapp, Sarah Keim, Greta Wilkening, Amii Kress, Brianna F. Moore, Maxwell A. Mansolf, Judy L. Aschner, Aaron A.R. Tobian, Jody Ganiban, Courtney D. Lynch, Glorisa Canino, Bennett Leventhal, Lauren C. Shuffrey, Wei Perng, Amy J. Elliott, David Cella, Xiuhong Li, M. Kate Grabowski, Assiamira Ferrara, Leonardo Trasande, Kohei Hasegawa, Diane Catellier, Karla Cardoso Garcia, Brennan Baker, L Kristin Newby, Simon A. Mallal, Anne L. Dunlop, Christian Douglas, Jonathan Posner, Mark Klebanoff, Rebecca J. Schmidt, Rachel L. Miller, Jin-Shei Lai, Richard Gershon, P Brian Smith, John A. McLean, Dennis Ownby
article en

Abstract

Importance: Public concern and speculation have emerged around a possible link between neonatal male circumcision (NMC) and autism spectrum disorder (ASD). Evidence is limited and inconsistent. Objective: To examine associations between NMC and child ASD and autism-related traits and behaviors. Design, Setting, and Participants: This prospective cohort study was conducted among cohort sites participating in the Environmental Influences on Child Health Outcomes (ECHO) Cohort between February 2003 and September 2025. Statistical analyses were conducted from November 2025 to February 2026. The analysis included male, singleton children with data on NMC status and child ASD. Exposure: NMC status within 28 days of birth at a medical facility. Main outcomes and Measures: ASD diagnosis was based on parent report of diagnosis by a medical professional or documentation of criterion standard clinical assessments. Social Responsiveness Scale (SRS-2) T-scores assessed the presence and distribution of autism traits, and Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) Autism Spectrum Problems subscale T-scores from the Child Behavior Checklist (CBCL) 1.5/5 assessed the occurrence of child autism-related behaviors. Results: The sample included 2771 male children from 14 ECHO sites, of whom 1840 (66%) were circumcised before hospital discharge, and 192 (7%) had an autism diagnosis. Among 1840 circumcised males, 108 (6%) had autism, compared with 84 of 931 uncircumcised males (9%). Mean (SD) age at autism diagnosis was 3.8 (2.2) years. Among circumcised males, 31 (4%) were administered acetaminophen during the procedure, and 128 (7%) within the 30 days after birth. After adjusting for confounders, there was no association between NMC and ASD diagnosis (odds ratio [OR], 0.83; 95% CI, 0.59-1.17). After stratification by region, preterm birth, and neonatal intensive care unit admission, an inverse or no association was observed between NMC and ASD diagnosis. Adjusted analyses showed no associations between NMC and SRS-2 continuous (β = -0.62; 95% CI, -1.46 to 0.22) or binary (OR, 0.75; 95% CI, 0.48-1.15) T-scores. Similarly, no associations were observed between NMC and CBCL 1.5/5 continuous (β = 0.01; 95% CI, -0.54 to 0.56) or binary (OR, 1.30; 95% CI, 0.75-2.26) T-scores. Overall, inverse or no associations were observed across all strata for SRS-2 and CBCL 1.5/5 outcomes. Conclusions and Relevance: This cohort study yielded no evidence that NMC was associated with ASD risk, whether assessed by parent report of medical professional diagnosis or validated instruments measuring autism-related traits and behavior. These findings may provide reassurance for families who are considering or have elected NMC for their child.

Archives of Pediatrics and Adolescent Medicine
Rutgers, The State University of New Jersey (US), Seattle Children's Hospital (US), University of Minnesota (US), Northwell Health (US), Nationwide Children's Hospital (US), Harvard University (US), Hofstra University (US), Johns Hopkins University (US), University of Miami (US), Medical University of South Carolina (US), Baylor University (US), George Washington University (US), University of Washington (US), Avera Health (US), Johnson University (US), University of Chicago (US), Massachusetts General Hospital (US), Cohen Children's Medical Center (US), Minnesota Department of Health (US), Center for Discovery (US), GW Medical Faculty Associates (US), Cohort (United Kingdom) (GB), The Ohio State University (US), New York University (US), Drexel University (US), University of California, Davis (US)
Good health and well-being
Openalex Percentile: Top 7%
Genital Health and Disease
DOISourceOpenAlex
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