Older Fathers, Worse Psychiatric and Educational Outcomes

March 5, 2014

Older Fathers, Worse Psychiatric and Educational Outcomes

  1. Barbara Geller, MD

Results from a large, carefully performed epidemiological study

  1. Barbara Geller, MD

A greater number of de novo mutations, as occurs in sperm of older men, is associated with higher rates of autism spectrum disorders (ASD) in offspring (Nat Rev Genet 2014; 15:133). To further investigate the relationship of advanced paternal age to other psychiatric disorders and academic achievements, researchers used Swedish registries of all children born between 1973 and 2001 (N=2,615,081). Comparisons among siblings, cousins, and first-born cousins controlled for genetic and environmental factors.

In sibling analyses, paternal age 45 or higher at birth compared with paternal age 20 to 24 was associated with significantly greater risks for the following:

  • ASD, hazard ratio (HR), 3.45

  • Attention-deficit/hyperactivity disorder (ADHD), HR, 13.13

  • Psychosis, HR, 2.07

  • Bipolar disorders, HR, 24.70

  • Suicide attempts, HR, 2.72

  • Substance use problems, HR, 2.44

  • Failing grades, OR, 1.59

  • Low educational attainment, OR, 1.70

Sensitivity analyses among cousins and first-born cousins yielded similar results.


Among the study's limitations, diagnoses (except for ADHD and ASD) relied on inpatient records, even though outpatient treatment of bipolar and other psychotic disorders has been increasing. Also, the study included premature infants (ages, ≥23 weeks), who are at greater risk for mental and intellectual disorders (JAMA Psychiatry 2013; 70:1231).

Even with these provisos, this study demonstrates strikingly higher risks for children's mental disorders at advanced paternal age. Furthermore, the sibling design obviates the need for data on parenting behaviors of older versus younger fathers. If patients ask, freezing sperm at a young age is currently problematic to recommend because the risks of assisted reproduction are not yet known (NEJM JW Psychiatry Sep 10 2012).

Editor Disclosures at Time of Publication

  • Disclosures for Barbara Geller, MD at time of publication Nothing to disclose


Reader Comments (6)

Gregory Jameson PhD (Statistics) Other, Private Practice

I read somewhere (it's not widely documented) that these results were obtained by comparing children born when the father was age 24 to children born to the SAME father when he was age 45. Was any cognisance taken of the fact that (as far as I know) the rates of ADHD, autism etc have exploded over the last 30 years? In other words, maybe the higher rates of occurrence among the children born when the father was 45 could be due to the fact that the CHILDREN were younger (ie more contemporaneous with the higher rates in the general population), rather than that the FATHER was older when they were conceived? Seems to me the study has jumped very quickly from correlation to causation.

McHenry, Bruce MD Physician, Psychiatry, Massachusetts General Hospital

This editors comment needs attention, "The sibling design obviates the need for data on parenting behavior of older versus younger parents."

It may be that parenting behavior is the dominant factor in the observed differences. One needs to examine two parts to this: 1) behavior that increases risks, 2) increased likelihood of seeking professional attention resulting in diagnosis.

ROBERT ROSS Other Healthcare Professional, Psychiatry, Private practice

Curious as to what the age range of the fathers was...

Karen Lindekugel Psychiatry

This strikes close to home. I was the first born of 3 children of my father ( who's parents were both from Sweden ) he was 48 when I was born in 1957, 52 when my brother was born with CP & 1 month premature (I believe he also has a form of autism as well though never diagnosed ), the my sister born two after my brother when my father was 54. All three of us have various types of mental health issues ~ mine were the only ones realized and correctly diagnosed recently. I'm working on them - little by little.

Susumu Inoue, MD Physician, Health Law/Ethics/Public Policy, Hurley children's Hospital

I wonder if this would explain the reason of ever increainge incidence of ASD and ADHD, and also a high prevalence rate of ASD among the children of professionals.

Ziad Shaman Physician, Pulmonary Medicine

So there is more attack on onlder men having kids. It seems that people have startd asking about freezing sperm, but the commnet says it's not yet to be advised.

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