{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T06:06:54Z","timestamp":1789020414459,"version":"build-2803163510"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Iron deficiency (ID) and iron deficiency anemia (IDA) are common in children with autism spectrum disorder (ASD) and may contribute to behavioral problems. We examined their association with internalizing and externalizing behavioral problems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study (October 2023 to March 2025) was conducted at a tertiary hospital in India. Of 179 children aged 2 to 18 years with newly diagnosed ASD (DSM-5 criteria), 173 were analyzed after six exclusions for missing data. ID and IDA were defined using age-specific World Health Organization thresholds and modeled as a three-category variable with normal iron status as the reference. The Child Behavior Checklist was used to assess internalizing and externalizing problems (T-score &amp;gt; 63). Multivariable logistic regression was used to estimate adjusted odds ratios (aORs), controlling for age, sex, maternal education and family type; ferritin and hemoglobin were modeled using restricted cubic splines. Bonferroni correction was applied across the six adjusted comparisons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 173 children (median age 4.0 years [IQR 3.0\u20135.0]; 79.8% male), 19.7% had ID, 22.5% had IDA and 42.2% had either; internalizing and externalizing problems occurred in 39.9% and 35.8% of the children, respectively. Compared with normal iron status, both ID and IDA were associated with higher odds of internalizing problems (ID aOR 3.03, 95% confidence interval [CI] 1.34\u20136.86; IDA aOR 2.73, 95% CI 1.23\u20136.05) and externalizing problems (ID aOR 3.71, 95% CI 1.63\u20138.46; IDA aOR 3.24, 95% CI 1.45\u20137.24), corresponding to prevalence differences of 25 to 29 percentage points. An interquartile increase in ferritin (9.2 to 21.4 \u00b5g\/L) was associated with lower odds of both outcomes (internalizing aOR 0.23, 95% CI 0.11\u20130.46; externalizing aOR 0.30, 95% CI 0.15\u20130.60). Five of six associations survived Bonferroni correction; IDA with internalizing problems did not. Hemoglobin was not consistently associated with either outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ID and IDA are prevalent in Indian children with ASD and are associated with clinically significant behavioral problems, with higher serum ferritin inversely associated with both outcomes. Routine iron screening may be considered during initial ASD evaluation, particularly in high-burden settings, although randomized trials are needed to determine whether correcting deficiency improves behavioral outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1900958","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:31:15Z","timestamp":1789018275000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of iron deficiency and iron-deficiency anemia with behavioral problems in children with autism: a cross-sectional study"],"prefix":"10.3389","volume":"17","author":[{"given":"Jatan Uday","family":"Merwana","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Bharati Vidyapeeth (Deemed to be University) Medical College","place":["Pune, Maharashtra, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay Raghunath","family":"Kalrao","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Bharati Vidyapeeth (Deemed to be University) Medical College","place":["Pune, Maharashtra, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritika","family":"Chaudhry","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Bharati Vidyapeeth (Deemed to be University) Medical College","place":["Pune, Maharashtra, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leena","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Bharati Vidyapeeth (Deemed to be University) Medical College","place":["Pune, Maharashtra, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"B1","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","year":"2013"},{"key":"B2","unstructured":"Autism Spectrum Disorders\n          \n          2023"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0273819","article-title":"Iron deficiency and common neurodevelopmental disorders\u2014a scoping review","volume":"17","author":"McWilliams","year":"2022","journal-title":"PloS One"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002615","article-title":"Neurodevelopmental disorders in children aged 2\u20139 years: Population-based burden estimates across five regions of India","volume":"15","author":"Arora","year":"2018","journal-title":"PloS Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2788.2008.01065.x","article-title":"Prevalence and risk factors for maladaptive behaviorin young children with autistic disorder","volume":"52","author":"Hartley","year":"2008","journal-title":"J Intellect Disabil Res"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3390\/children12030297","article-title":"Prevalence, socio-demographic characteristics, and comorbidities of autism spectrum disorder in US children: Insights from the 2020\u20132021 National Survey of Children\u2019s Health","volume":"12","author":"Salehi","year":"2025","journal-title":"Children"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1097\/CHI.0b013e318179964f","article-title":"Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample","volume":"47","author":"Simonoff","year":"2008","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"B8","unstructured":"Anemia in Women and Children\n          \n          2023"},{"key":"B9","volume-title":"National Family Health Survey (Nfhs-5), 2019\u201321: India. Volume I","year":"2021"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.rasd.2009.12.008","article-title":"Iron deficiency in preschool children with autism spectrum disorder","volume":"4","author":"Bilgi\u00e7","year":"2010","journal-title":"Res Autism Spectr Disord"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jada.2009.10.032","article-title":"Food selectivity and sensory sensitivity in children with autism spectrum disorders","volume":"110","author":"Cermak","year":"2010","journal-title":"J Am Diet Assoc"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1186\/s13052-017-0407-3","article-title":"Iron deficiency parameters in autism spectrum disorder: Clinical correlates and associated factors","volume":"43","author":"Gunes","year":"2017","journal-title":"Ital J Pediatr"},{"key":"B13","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1146\/annurev.nutr.23.020102.075739","article-title":"Iron status and neural functions","volume":"23","author":"Beard","year":"2003","journal-title":"Annu Rev Nutr"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1753-4887.2006.tb00243.x","article-title":"Long-lasting neural and behavioral effects of iron deficiency during infancy","volume":"64","author":"Lozoff","year":"2006","journal-title":"Nutr Rev"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2007.08.014","article-title":"Effects of iron supplementation on attention deficit hyperactivity disorder in children","volume":"38","author":"Konofal","year":"2008","journal-title":"Pediatr Neurol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s13312-024-3253-6","article-title":"Iron supplementation in children with attention deficit hyperactivity disorder: A single center study","volume":"61","author":"Kumar","year":"2024","journal-title":"Indian Pediatr"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1097\/DBP.0000000000000993","article-title":"Effect of iron supplementation in children with attention-deficit\/hyperactivity disorder and iron deficiency: A randomized controlled trial","volume":"43","author":"Pongpitakdamrong","year":"2022","journal-title":"J Dev Behav Pediatr"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1177\/15648265070284S409","article-title":"Iron deficiency and child development","volume":"28","author":"Lozoff","year":"2007","journal-title":"Food Nutr Bull"},{"key":"B19","volume-title":"Guideline: Daily Iron Supplementation in Infants and Children","year":"2016"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0213242","article-title":"Development and validation of DSM-5 based diagnostic tool for children with autism spectrum disorder","volume":"14","author":"Gulati","year":"2019","journal-title":"PloS One"},{"key":"B21","volume-title":"Manual for the ASEBA School-Age Forms and Profiles","author":"Achenbach","year":"2001"},{"key":"B22","unstructured":"Geneva\n          World Health Organization\n          WHO Guideline on the Use of Ferritin Concentrations to Assess Iron Status in Individuals and Populations\n          \n          2020"},{"key":"B23","volume-title":"Guideline on Hemoglobin Cutoffs to Define Anemia in Individuals and Populations","year":"2024"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1542\/peds.105.4.e51","article-title":"Poor behavioral and developmental outcomes >10 years after treatment for iron deficiency in infants","volume":"105","author":"Lozoff","year":"2000","journal-title":"Pediatrics"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.rasd.2024.102396","article-title":"Micronutrient deficiencies in children with autism spectrum disorders compared with typically developing children: A scoping review","volume":"114","author":"Marinov","year":"2024","journal-title":"Res Autism Spectr Disord"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-0900M","article-title":"Iron status in children with autism spectrum disorder","volume":"130","author":"Reynolds","year":"2012","journal-title":"Pediatrics"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2019.07.015","article-title":"Randomized, placebo-controlled trial of ferrous sulfate to treat insomnia in children with autism spectrum disorders","volume":"104","author":"Reynolds","year":"2020","journal-title":"Pediatr Neurol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2006.11.004","article-title":"Children with autism: Effects of iron supplementation on sleep quality and ferritin","volume":"36","author":"Dosman","year":"2007","journal-title":"Pediatr Neurol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2025.121128","article-title":"Alterations in brain iron and myelination in children with ASD: A susceptibility source separation imaging study","volume":"310","author":"Zhou","year":"2025","journal-title":"Neuroimage"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-025-03231-8","article-title":"Causal associations between iron levels in subcortical brain regions and psychiatric disorders: A Mendelian randomization study","volume":"15","author":"Du","year":"2025","journal-title":"Transl Psychiatry"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.3390\/nu10020227","article-title":"Approaches to reduce the risk of early life iron-deficiency-induced brain dysfunction in children","volume":"10","author":"Cusick","year":"2018","journal-title":"Nutrients"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1900958\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:31:18Z","timestamp":1789018278000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1900958\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":31,"alternative-id":["10.3389\/fpsyt.2026.1900958"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1900958","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]},"article-number":"1900958"}}