Family Environment, Neurodevelopmental Risk, and the Environmental Influences on Child Health Outcomes (ECHO) Initiative: Looking Back and Moving Forward

Abstract

The family environment, with all its complexity and diverse components, plays a critical role in shaping neurodevelopmental outcomes in children. Herein we review several domains of the family environment (family socioeconomic status, family composition and home environment, parenting behaviors and interaction styles, parental mental health and functioning, and parental substance use) and discuss how these domains influence neurodevelopment, with particular emphasis on mental health outcomes. We also highlight a new initiative launched by the National Institutes of Health, the Environmental influences on Child Health Outcomes (ECHO) program. We discuss the role that ECHO will play in advancing our understanding of the impact of the family environment on children's risk for psychiatric outcomes. Lastly, we conclude with important unanswered questions and controversies in this area of research, highlighting how ECHO will contribute to resolving these gaps in our understanding, clarifying relationships between the family environment and children's mental health.

Keywords: family; fetal programming; home; neurodevelopment; parenting.

Figure 1

Family environment and neurodevelopment. Our review focuses on four primary domains of the family environment with a strong evidence base supporting their impact on the neurodevelopment of children (green ovals): Family composition, Home environment, Parenting behaviors and interaction styles, and Parental mental health and functioning (including parental substance use). Family socioeconomic status (large blue oval) intersects with each of these domains. Four cross-cutting themes impacting each of the four family environment domains are also highlighted (brown rectangles): Developmental timing (the neurodevelopmental influence of the family environment varies depending on the developmental stage of the child), Individual differences (the neurodevelopmental influence of the family environment varies depending on traits of the child), Bidirectional (the family environment influences the child, but the child also influences the family environment), and Interactions (the neurodevelopmental influence of one family environment domain may be contingent on the others).

Figure 2

ECHO recruitment sites. Red dots represent the locations of the recruitment sites for the ECHO cohorts. States and regions are color-coded by poverty rates.