{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:40:08Z","timestamp":1787164808533,"version":"build-2736575974"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"DOI":"10.1007\/s00431-025-06739-9","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T16:41:29Z","timestamp":1768581689000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Medical comorbidities in autistic children: prevalence, sex-specific clustering, and network patterns at diagnosis in a Chilean cohort"],"prefix":"10.1007","volume":"185","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4278-9188","authenticated-orcid":false,"given":"Mauricio","family":"Lopez-Espejo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Nu\u00f1ez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"6739_CR1","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1002\/aur.1492","volume":"8","author":"KA Aldinger","year":"2015","unstructured":"Aldinger KA, Lane CJ, Veenstra-VanderWeele J, Levitt P (2015) Patterns of risk for multiple co-occurring medical conditions replicate across distinct cohorts of children with autism spectrum disorder. Autism Res 8:771\u2013781. https:\/\/doi.org\/10.1002\/aur.1492","journal-title":"Autism Res"},{"key":"6739_CR2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0033224","volume":"7","author":"IS Kohane","year":"2012","unstructured":"Kohane IS, McMurry A, Weber G et al (2012) The co-morbidity burden of children and young adults with autism spectrum disorders. PLoS ONE 7:e33224. https:\/\/doi.org\/10.1371\/journal.pone.0033224","journal-title":"PLoS ONE"},{"key":"6739_CR3","doi-asserted-by":"publisher","DOI":"10.3390\/children10081414","volume":"10","author":"J Burns","year":"2023","unstructured":"Burns J, Phung R, McNeill S et al (2023) Comorbidities affecting children with autism spectrum disorder: a retrospective chart review. Children (Basel) 10:1414. https:\/\/doi.org\/10.3390\/children10081414","journal-title":"Children (Basel)"},{"key":"6739_CR4","doi-asserted-by":"publisher","first-page":"2260","DOI":"10.1017\/S0033291721000192","volume":"51","author":"A Havdahl","year":"2021","unstructured":"Havdahl A, Niarchou M, Starnawska A et al (2021) Genetic contributions to autism spectrum disorder. Psychol Med 51:2260\u20132273. https:\/\/doi.org\/10.1017\/S0033291721000192","journal-title":"Psychol Med"},{"key":"6739_CR5","doi-asserted-by":"publisher","first-page":"2540","DOI":"10.1007\/s10803-021-05380-3","volume":"53","author":"EE Eyoh","year":"2023","unstructured":"Eyoh EE, Failla MD, Williams ZJ et al (2023) Brief report: the characterization of medical comorbidity prior to autism diagnosis in children before age two. J Autism Dev Disord 53:2540\u20132547. https:\/\/doi.org\/10.1007\/s10803-021-05380-3","journal-title":"J Autism Dev Disord"},{"key":"6739_CR6","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1016\/j.rasd.2012.08.008","volume":"7","author":"M-H Chen","year":"2013","unstructured":"Chen M-H, Su T-P, Chen Y-S et al (2013) Comorbidity of allergic and autoimmune diseases in patients with autism spectrum disorder: a nationwide population-based study. Res Autism Spectr Disord 7:205\u2013212. https:\/\/doi.org\/10.1016\/j.rasd.2012.08.008","journal-title":"Res Autism Spectr Disord"},{"key":"6739_CR7","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1146\/annurev-clinpsy-050212-185608","volume":"9","author":"D Borsboom","year":"2013","unstructured":"Borsboom D, Cramer AOJ (2013) Network analysis: an integrative approach to the structure of psychopathology. Annu Rev Clin Psychol 9:91\u2013121. https:\/\/doi.org\/10.1146\/annurev-clinpsy-050212-185608","journal-title":"Annu Rev Clin Psychol"},{"key":"6739_CR8","doi-asserted-by":"publisher","first-page":"4311","DOI":"10.1007\/s10803-021-05289-x","volume":"52","author":"A Shoaib","year":"2022","unstructured":"Shoaib A, Cepeda MS, Murray G, Ochs-Ross R (2022) Autism: comorbidities and treatment patterns in the real world, a retrospective cohort study among children, adolescents and adults newly diagnosed with autism. J Autism Dev Disord 52:4311\u20134320. https:\/\/doi.org\/10.1007\/s10803-021-05289-x","journal-title":"J Autism Dev Disord"},{"key":"6739_CR9","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci10050274","author":"F Chiarotti","year":"2020","unstructured":"Chiarotti F, Venerosi A (2020) Epidemiology of autism spectrum disorders: a review of worldwide prevalence estimates since 2014. Brain Sci. https:\/\/doi.org\/10.3390\/brainsci10050274","journal-title":"Brain Sci"},{"key":"6739_CR10","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2019-3447","volume":"145","author":"SL Hyman","year":"2020","unstructured":"Hyman SL, Levy SE, Myers SM (2020) Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics 145:e20193447. https:\/\/doi.org\/10.1542\/peds.2019-3447","journal-title":"Pediatrics"},{"key":"6739_CR11","doi-asserted-by":"publisher","first-page":"2797","DOI":"10.1007\/s10803-024-06376-5","volume":"55","author":"MA Lopez-Espejo","year":"2025","unstructured":"Lopez-Espejo MA, Nu\u00f1ez AC, Saez V et al (2025) The influence of social and developmental factors on the timing of autism spectrum disorder diagnosis of preschool-aged children: evidence from a specialized chilean center. J Autism Dev Disord 55:2797\u20132806. https:\/\/doi.org\/10.1007\/s10803-024-06376-5","journal-title":"J Autism Dev Disord"},{"key":"6739_CR12","unstructured":"OECD (2024) Adult education level (indicator). https:\/\/www.oecd-ilibrary.org\/content\/data\/36bce3fe-en. Accessed 12 Mar 2023"},{"key":"6739_CR13","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1038\/s41582-024-01052-9","volume":"21","author":"O Bruni","year":"2025","unstructured":"Bruni O, Breda M, Mammarella V et al (2025) Sleep and circadian disturbances in children with neurodevelopmental disorders. Nat Rev Neurol 21:103\u2013120. https:\/\/doi.org\/10.1038\/s41582-024-01052-9","journal-title":"Nat Rev Neurol"},{"key":"6739_CR14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5223\/pghn.2017.20.1.1","volume":"20","author":"J Zeevenhooven","year":"2017","unstructured":"Zeevenhooven J, Koppen IJN, Benninga MA (2017) The new Rome IV criteria for functional gastrointestinal disorders in infants and toddlers. Pediatr Gastroenterol Hepatol Nutr 20:1\u201313. https:\/\/doi.org\/10.5223\/pghn.2017.20.1.1","journal-title":"Pediatr Gastroenterol Hepatol Nutr"},{"key":"6739_CR15","doi-asserted-by":"publisher","unstructured":"(2006) WHO child growth standards based on length\/height, weight and age. Acta Paediatr Suppl 450:76\u201385. https:\/\/doi.org\/10.1111\/j.1651-2227.2006.tb02378.x","DOI":"10.1111\/j.1651-2227.2006.tb02378.x"},{"key":"6739_CR16","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1111\/epi.12550","volume":"55","author":"RS Fisher","year":"2014","unstructured":"Fisher RS, Acevedo C, Arzimanoglou A et al (2014) Ilae official report: a practical clinical definition of epilepsy. Epilepsia 55:475\u2013482. https:\/\/doi.org\/10.1111\/epi.12550","journal-title":"Epilepsia"},{"key":"6739_CR17","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1097\/MPG.0000000000002497","volume":"70","author":"S Husby","year":"2020","unstructured":"Husby S, Koletzko S, Korponay-Szab\u00f3 I et al (2020) European society paediatric gastroenterology, hepatology and nutrition guidelines for diagnosing coeliac disease 2020. J Pediatr Gastroenterol Nutr 70:141\u2013156. https:\/\/doi.org\/10.1097\/MPG.0000000000002497","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"6739_CR18","doi-asserted-by":"publisher","DOI":"10.1038\/ncomms5212","volume":"5","author":"X Zhou","year":"2014","unstructured":"Zhou X, Menche J, Barab\u00e1si A-L, Sharma A (2014) Human symptoms-disease network. Nat Commun 5:4212. https:\/\/doi.org\/10.1038\/ncomms5212","journal-title":"Nat Commun"},{"key":"6739_CR19","doi-asserted-by":"publisher","first-page":"2525","DOI":"10.1007\/s10803-014-2123-9","volume":"44","author":"SE Goldman","year":"2014","unstructured":"Goldman SE, Adkins KW, Calcutt MW et al (2014) Melatonin in children with autism spectrum disorders: endogenous and pharmacokinetic profiles in relation to sleep. J Autism Dev Disord 44:2525\u20132535. https:\/\/doi.org\/10.1007\/s10803-014-2123-9","journal-title":"J Autism Dev Disord"},{"key":"6739_CR20","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1177\/1362361315616345","volume":"20","author":"J Granich","year":"2016","unstructured":"Granich J, Lin A, Hunt A et al (2016) Obesity and associated factors in youth with an autism spectrum disorder. Autism 20:916\u2013926. https:\/\/doi.org\/10.1177\/1362361315616345","journal-title":"Autism"},{"key":"6739_CR21","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1097\/YCO.0000000000000896","volume":"36","author":"A Keski-Rahkonen","year":"2023","unstructured":"Keski-Rahkonen A, Ruusunen A (2023) Avoidant-restrictive food intake disorder and autism: epidemiology, etiology, complications, treatment, and outcome. Curr Opin Psychiatry 36:438\u2013442. https:\/\/doi.org\/10.1097\/YCO.0000000000000896","journal-title":"Curr Opin Psychiatry"},{"key":"6739_CR22","doi-asserted-by":"publisher","DOI":"10.1016\/j.brainres.2024.148877","volume":"1833","author":"KQ Leow","year":"2024","unstructured":"Leow KQ, Tonta MA, Lu J et al (2024) Towards understanding sex differences in autism spectrum disorders. Brain Res 1833:148877. https:\/\/doi.org\/10.1016\/j.brainres.2024.148877","journal-title":"Brain Res"},{"key":"6739_CR23","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-018-0874-2","volume":"20","author":"SL Ferri","year":"2018","unstructured":"Ferri SL, Abel T, Brodkin ES (2018) Sex differences in autism spectrum disorder: a review. Curr Psychiatry Rep 20:9. https:\/\/doi.org\/10.1007\/s11920-018-0874-2","journal-title":"Curr Psychiatry Rep"},{"key":"6739_CR24","doi-asserted-by":"publisher","first-page":"764","DOI":"10.3390\/clockssleep6040049","volume":"6","author":"V-A Bricout","year":"2024","unstructured":"Bricout V-A, Covain S, Paterno J, Guinot M (2024) Sex differences in sleep and physical activity patterns in autism spectrum disorder. Clocks Sleep 6:764\u2013776. https:\/\/doi.org\/10.3390\/clockssleep6040049","journal-title":"Clocks Sleep"},{"key":"6739_CR25","doi-asserted-by":"publisher","DOI":"10.3390\/ijms25105377","author":"M Caldarelli","year":"2024","unstructured":"Caldarelli M, Rio P, Marrone A et al (2024) Gut-brain axis: focus on sex differences in neuroinflammation. Int J Mol Sci. https:\/\/doi.org\/10.3390\/ijms25105377","journal-title":"Int J Mol Sci"},{"issue":"25","key":"6739_CR26","doi-asserted-by":"publisher","first-page":"02117","DOI":"10.1016\/j.jaac.2025.10.010","volume":"S0890\u20138567","author":"EH Suominen","year":"2025","unstructured":"Suominen EH, Chen CA, Dunlop A et al (2025) Sex\/gender differences in internalizing problems of autistic children and young people: a systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry S0890\u20138567(25):02117\u201302123. https:\/\/doi.org\/10.1016\/j.jaac.2025.10.010","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"6739_CR27","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1001\/jama.2009.1549","volume":"302","author":"CU Correll","year":"2009","unstructured":"Correll CU, Manu P, Olshanskiy V et al (2009) Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. JAMA 302:1765\u20131773. https:\/\/doi.org\/10.1001\/jama.2009.1549","journal-title":"JAMA"},{"key":"6739_CR28","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-060640","volume":"151","author":"SE Hampl","year":"2023","unstructured":"Hampl SE, Hassink SG, Skinner AC et al (2023) Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics 151:e2022060640. https:\/\/doi.org\/10.1542\/peds.2022-060640","journal-title":"Pediatrics"},{"key":"6739_CR29","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1093\/sleep\/29.9.1203","volume":"29","author":"TI Morgenthaler","year":"2006","unstructured":"Morgenthaler TI, Owens J, Alessi C et al (2006) Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep 29:1277\u20131281","journal-title":"Sleep"},{"key":"6739_CR30","doi-asserted-by":"publisher","first-page":"424","DOI":"10.7861\/clinmedicine.17-5-424","volume":"17","author":"ES Bruce","year":"2017","unstructured":"Bruce ES, Lunt L, McDonagh JE (2017) Sleep in adolescents and young adults. Clin Med 17:424\u2013428. https:\/\/doi.org\/10.7861\/clinmedicine.17-5-424","journal-title":"Clin Med"},{"key":"6739_CR31","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1542\/peds.2009-1878C","volume":"125","author":"T Buie","year":"2010","unstructured":"Buie T, Campbell DB, Fuchs GJ et al (2010) Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: a consensus report. Pediatrics 125:S1\u2013S18. https:\/\/doi.org\/10.1542\/peds.2009-1878C","journal-title":"Pediatrics"},{"key":"6739_CR32","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1542\/peds.2013-3995","volume":"133","author":"BO McElhanon","year":"2014","unstructured":"McElhanon BO, McCracken C, Karpen S, Sharp WG (2014) Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis. Pediatrics 133:872\u2013883. https:\/\/doi.org\/10.1542\/peds.2013-3995","journal-title":"Pediatrics"},{"key":"6739_CR33","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1002\/aur.2454","volume":"14","author":"L Wang","year":"2021","unstructured":"Wang L, Shen W, Yao H et al (2021) Association between autism spectrum disorder and food allergy: a systematic review and meta-analysis. Autism Res 14:220\u2013230. https:\/\/doi.org\/10.1002\/aur.2454","journal-title":"Autism Res"},{"key":"6739_CR34","doi-asserted-by":"publisher","first-page":"1505","DOI":"10.1177\/1362361321995631","volume":"25","author":"J Baraskewich","year":"2021","unstructured":"Baraskewich J, Von Ranson KM, McCrimmon A, McMorris CA (2021) Feeding and eating problems in children and adolescents with autism: a scoping review. Autism 25:1505\u20131519. https:\/\/doi.org\/10.1177\/1362361321995631","journal-title":"Autism"},{"key":"6739_CR35","doi-asserted-by":"publisher","DOI":"10.1038\/tp.2016.77","volume":"6","author":"TC Theoharides","year":"2016","unstructured":"Theoharides TC, Tsilioni I, Patel AB, Doyle R (2016) Atopic diseases and inflammation of the brain in the pathogenesis of autism spectrum disorders. Transl Psychiatry 6:e844. https:\/\/doi.org\/10.1038\/tp.2016.77","journal-title":"Transl Psychiatry"},{"key":"6739_CR36","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1016\/j.jadohealth.2022.12.010","volume":"73","author":"MM Hughes","year":"2023","unstructured":"Hughes MM, Shaw KA, Patrick ME et al (2023) Adolescents with autism spectrum disorder: diagnostic patterns, co-occurring conditions, and transition planning. J Adolesc Health 73:271\u2013278. https:\/\/doi.org\/10.1016\/j.jadohealth.2022.12.010","journal-title":"J Adolesc Health"},{"key":"6739_CR37","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1111\/dmcn.13598","volume":"60","author":"L Strasser","year":"2018","unstructured":"Strasser L, Downes M, Kung J et al (2018) Prevalence and risk factors for autism spectrum disorder in epilepsy: a systematic review and meta-analysis. Dev Med Child Neurol 60:19\u201329. https:\/\/doi.org\/10.1111\/dmcn.13598","journal-title":"Dev Med Child Neurol"},{"key":"6739_CR38","doi-asserted-by":"publisher","DOI":"10.3390\/children8111024","author":"L Reche-Olmedo","year":"2021","unstructured":"Reche-Olmedo L, Torres-Collado L, Compa\u00f1-Gabucio LM, Garcia-de-la-Hera M (2021) The role of occupational therapy in managing food selectivity of children with autism spectrum disorder: a scoping review. Children (Basel). https:\/\/doi.org\/10.3390\/children8111024","journal-title":"Children (Basel)"},{"key":"6739_CR39","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1007\/s10803-009-0825-1","volume":"40","author":"SL Odom","year":"2010","unstructured":"Odom SL, Boyd BA, Hall LJ, Hume K (2010) Evaluation of comprehensive treatment models for individuals with autism spectrum disorders. J Autism Dev Disord 40:425\u2013436. https:\/\/doi.org\/10.1007\/s10803-009-0825-1","journal-title":"J Autism Dev Disord"},{"key":"6739_CR40","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1177\/1362361313480277","volume":"18","author":"AM Daniels","year":"2014","unstructured":"Daniels AM, Mandell DS (2014) Explaining differences in age at autism spectrum disorder diagnosis: a critical review. Autism 18:583\u2013597. https:\/\/doi.org\/10.1177\/1362361313480277","journal-title":"Autism"},{"key":"6739_CR41","doi-asserted-by":"publisher","first-page":"566","DOI":"10.5152\/TurkArchPediatr.2023.23194","volume":"58","author":"A Posar","year":"2023","unstructured":"Posar A, Visconti P (2023) Autism spectrum disorder in 2023: a challenge still open. Turk Arch Pediatr 58:566\u2013571. https:\/\/doi.org\/10.5152\/TurkArchPediatr.2023.23194","journal-title":"Turk Arch Pediatr"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-025-06739-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-025-06739-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-025-06739-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T15:22:21Z","timestamp":1772551341000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-025-06739-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,16]]},"references-count":41,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["6739"],"URL":"https:\/\/doi.org\/10.1007\/s00431-025-06739-9","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-7350018\/v1","asserted-by":"object"}]},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,16]]},"assertion":[{"value":"11 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 November 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 December 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 January 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Faculty of Medicine (CEC-Salud) of the Pontifical Catholic University of Chile (ID: 200601006).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"N\/A.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"N\/A.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"85"}}