Assisted Reproductive Techniques, ADHD, and School Performance

Pediatrics. 2021 Jul;148(1):e2020033183. doi: 10.1542/peds.2020-033183. Epub 2021 Jun 25.


Objectives: To examine the long-term impact of assisted reproductive techniques (ART) on offspring neurodevelopment, accounting for parental factors and the role of infertility.

Methods: Linkage of national registers allowed follow-up of >2.4 million children born in Sweden 1986-2012. Information on ART was retrieved from fertility clinics, medical records, and maternal self-report. Attention-deficit/hyperactivity disorder (ADHD) was identified from specialist diagnosis and/or use of medication through 2018. School performance was assessed from records of ninth year final grade averages (0-20) and eligibility for upper secondary school through 2017.

Results: Children conceived with ART had lower risk of ADHD (hazard ratio 0.83; 95% confidence interval [CI]: 0.80 to 0.87) and did better in school (grade mean difference 1.15; 95% CI: 1.09 to 1.21 and eligibility odds ratio 1.53; 95% CI: 1.45 to 1.63) compared with all other children. Differences in parental characteristics explained and even reversed associations, whereas no disadvantage was seen when the comparison was restricted to children of couples with known infertility (adjusted hazard ratio 0.95; 95% CI: 0.90 to 1.00, adjusted mean difference 0.05; 95% CI: -0.01 to 0.11, and adjusted odds ratio 1.03; 95% CI: 0.96 to 1.10). Among children conceived with ART, there was furthermore no indication that intracytoplasmic sperm injection (compared with standard in vitro fertilization) or frozen (compared with fresh) embryo transfer had any adverse influence.

Conclusions: With this nationwide, long-term follow-up, we provide additional reassurance concerning offspring neurodevelopment after use of ART, finding no indication for concern about risk of ADHD or school performance in adolescence.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Performance*
  • Adolescent
  • Adult
  • Attention Deficit Disorder with Hyperactivity / etiology*
  • Child
  • Child Development*
  • Female
  • Follow-Up Studies
  • Humans
  • Infertility / etiology
  • Infertility / therapy
  • Male
  • Maternal Age
  • Reproductive Techniques, Assisted / adverse effects*
  • Risk Factors
  • Sweden
  • Young Adult