European Child & Adolescent Psychiatry

, Volume 28, Issue 3, pp 377–388 | Cite as

Head circumference and child ADHD symptoms and cognitive functioning: results from a large population-based cohort study

  • Muriel Ferrer
  • Raquel García-Esteban
  • Carmen Iñiguez
  • Olga Costa
  • Ana Fernández-Somoano
  • Cristina Rodríguez-Delhi
  • Jesús Ibarluzea
  • Aitana Lertxundi
  • Cathryn Tonne
  • Jordi Sunyer
  • Jordi JulvezEmail author
Original Contribution


The aim of this study is to understand the association between prenatal, newborn and postnatal head circumference (HC) and preschool neurodevelopment in a large population-based birth cohort. The INMA project followed 1795 children from 12 weeks of pregnancy to preschool years. HC measurements were carried out prospectively, and following a standardized protocol during pregnancy (12, 20 and 34 weeks), birth, and child ages of 1–1.5 and 4 years old; and z-scores were further estimated. Prenatal head growth was assessed using conditional z-scores between weeks 12–20 and 20–34. Several neuropsychological tests [MSCA (cognition), CPT (attention)] and behavioral rating scales [DSM-IV-ADHD, CAST (autism), CPSCS (social competence)] were carried out during the last follow-up (5 years old). Multivariable models adjusted for family and child characteristics were applied to analyze associations between HC and neurodevelopment. In fully adjusted models, prenatal HC and head growth showed little or no associations with the neurodevelopment outcomes. Independent associations were observed between HC z-scores at birth, 1–1.5 years and 4 years and MSCA global cognitive scores and DSM-IV inattention symptoms. Specifically, z-score at birth was positively associated with general cognitive scores [β 1.22, 95% confidence interval (CI) 0.59, 1.85], and we observed a protective association with ADHD-DSM-IV total symptoms, mean ratio (MR) 0.85 (0.75, 0.96). Prenatal HC and head growth measurements gave little information about child cognitive abilities and behavior at preschool years. However, HC at birth and early childhood was positively associated with a range of neuropsychological outcomes, including protective associations with ADHD symptoms.


Head circumference, neuropsychological development ADHD symptoms Cohort study 



Autism spectrum conditions


Autism spectrum disorder


Bayley scales of infant development


Childhood autism spectrum test


Confidence interval


Conner’s kiddie continuous performance test


California preschool social competence scale


Child behavior check list


Attention-deficit/hyperactivity disorder criteria of the diagnostic and statistical manual of mental disorders, fourth edition form list


Extremely low birth weight


False discovery rate


Head Circumference


Infancia y medio ambiente [environment and childhood]


Standard deviation


McCarthy scales of children’s abilities


Mean ratio



We would like to thank all the participants of the INMA Project for their collaboration as well as the project investigators at each cohort center as well as the coordination centers. A full roster of the INMA Project investigators can be found at Wilma Zijlema did English edits in the manuscript.


Sabadell: This work was supported by grants from the Spanish Ministry of Health [FIS-PI041436]; Instituto de Salud Carlos III [Red INMA G03/176 and CB06/02/0041 and predoctoral grant PFIS 2010, Register FI10/00399]; the Generalitat de Catalunya-CIRIT [1999SGR 00241]; the EU sixth framework project NEWGENERIS [FP6-2003-Food-3-A-016320]; Fundació Roger Torné, and Fundació La Mataró de TV3 (Project No. 090430 & No. 20162210). This study has been funded by Instituto de Salud Carlos III through the projects “CP14/00108 & PI16/00261” (co-funded by European Regional Development Fund “A way to make Europe”). Asturias: This study was funded by grants from Instituto de Salud Carlos III (Red INMA G03/176 and CB06/02/0041), FISS-PI042018, FISS-PI09/02311, FISS-PI1302429, Obra Social Cajastur/Fundación Liberbank and Universidad de Oviedo. Guipuzkoa: This study was funded by grants from Instituto de Salud Carlos III (FIS-PI06/0867 and FIS-PS09/00090), Department of Health of the Basque Government (2005111093 and 2009111069), and the Provincial Government of Gipuzkoa (DFG06/004 and DFG08/001). Valencia: This study was funded by grants from UE (FP7-ENV-2011 cod 282957 and HEALTH.2010.2.4.5-1, Instituto de Salud Carlos III (Red INMA G03/176, CB06/02/0041, FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314, 09/02647, 11/01007, 11/02591, and CP11/00178), and the Conselleria de Sanitat Generalitat Valenciana; all in Spain. FIS-DENAMIC: PI/11/02038. Jordi Julvez holds a Miguel Servet contract (MS14/00108) awarded by the Spanish Institute of Health Carlos III (Ministry of Economy and Competitiveness). This study was also funded by grants from UE (FP7-ENV-2011 cod 282957 and HEALTH.2010.2.4.5-1), Instituto de Salud Carlos III (Red INMA G03/176, CB06/02/0041, FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314, 09/02647, 11/01007, 11/02591, 17/00663, and CP11/00178), Alicia Koplowitz Foundation 2017, and the Conselleria de Sanitat Generalitat Valenciana; all in Spain.

Compliance with ethical standards

Conflict of interest

None of the authors have conflicts of interest to disclose. None of the authors have financial relationships relevant to this article to disclose.

Supplementary material

787_2018_1202_MOESM1_ESM.docx (108 kb)
Supplementary material 1 (DOCX 108 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Muriel Ferrer
    • 1
  • Raquel García-Esteban
    • 1
    • 2
    • 3
  • Carmen Iñiguez
    • 3
    • 4
  • Olga Costa
    • 4
  • Ana Fernández-Somoano
    • 3
    • 5
  • Cristina Rodríguez-Delhi
    • 6
  • Jesús Ibarluzea
    • 3
    • 7
    • 8
  • Aitana Lertxundi
    • 3
    • 8
  • Cathryn Tonne
    • 1
  • Jordi Sunyer
    • 1
    • 2
    • 3
    • 9
  • Jordi Julvez
    • 1
    • 2
    • 3
    • 9
    Email author
  1. 1.ISGlobal, Instituto de Salud Global de Barcelona-Campus MARPRBBBarcelonaSpain
  2. 2.IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
  3. 3.CIBER Epidemiologia y Salud Pública (CIBERESP)MadridSpain
  4. 4.Epidemiology and Environmental Health Joint Research UnitValenciaSpain
  5. 5.Departamento de MedicinaUniversidad de OviedoOviedoSpain
  6. 6.Servicio de PediatríaHospital San AgustínAvilésSpain
  7. 7.Public Health Division of GipuzkoaBioDonostia Research InstituteGipuzkoa, San SebastianSpain
  8. 8.Faculty of PsychologyUniversity of the Basque Country (UPV/EHU)San SebastianSpain
  9. 9.Universitat Pompeu Fabra (UPF)BarcelonaSpain

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