- Design
- Prospective multi-site cohort (ECHO Cohort)
- Population
- 2,771 singleton boys, 66% circumcised within 28 days of birth, 192 with autism
- Primary outcome
- Autism diagnosis, and autism trait scores (SRS-2, CBCL)
- Effect
- Adjusted OR 0.83 (95% CI 0.59 to 1.17); 6% vs 9% diagnosed
This prospective cohort drew on 14 sites in the Environmental Influences on Child Health Outcomes programme. It included 2,771 singleton boys, of whom 1,840 (66%) were circumcised in a medical setting within 28 days of birth and 192 (7%) had an autism diagnosis.
Autism was diagnosed in 6% of circumcised and 9% of uncircumcised boys. After adjustment there was no association (OR 0.83, 95% CI 0.59 to 1.17), and results were similar after stratifying by region, preterm birth and neonatal intensive care admission. Autism trait scores on the Social Responsiveness Scale and the Child Behavior Checklist also showed no association.
The finding is reassuring but observational, and diagnosis was by parent report or clinical assessment. It addresses a public concern, not the broader case for or against circumcision.
- Autism was diagnosed in 6% of circumcised vs 9% of uncircumcised boys.
- After adjustment the odds ratio was 0.83 (95% CI 0.59 to 1.17).
- Autism trait scores showed no association either.
- Use this when parents ask whether circumcision raises the risk of autism.
- It says nothing about other benefits or harms of circumcision.
Why it matters
Anxiety about a link has circulated widely and this gives clinicians numbers to answer it.
Don't overread it
An observational cohort cannot rule out confounding, and the analysis is not a judgement on circumcision itself.
The statistics, in plain English
An adjusted odds ratio of 0.83 with an interval of 0.59 to 1.17 is compatible with a modest reduction, no difference or a small increase. It excludes a large increase, which is the size of risk that public concern implied.
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