Tung, Chia-JungChia-JungTungYang, Jia-HwaJia-HwaYangCHINGCHUN LINCHIA-YANG CHENHsieh, Wu-ShiunWu-ShiunHsiehChen, Mei-HueiMei-HueiChenPAU-CHUNG CHEN2026-03-232026-03-232026-03-15https://scholars.lib.ntu.edu.tw/handle/123456789/736565Introduction: Per- and polyfluoroalkyl substances (PFAS) are persistent organic pollutants with potential adverse neurobehavioral effects. However, research on the effects of alternative PFAS and PFAS mixture on children's behavior is limited. Methods: Children from the Taiwan Birth Panel Study II (TBPS II) were enrolled, and their serum was analyzed for 11 types of PFAS. Behavioral performance was assessed using the Conners' Kiddie Continuous Performance Test, 2nd Edition (K-CPT 2). Linear regression and quantile g-computation (QGC) analyses were performed to determine the relationships between PFAS exposure and children's behavioral performance. Results: A total of 448 children aged between 6 and 7 years were included in the study. PFAS concentrations varied considerably, with perfluorobutanoic acid (PFBA) showing the highest geometric mean (6.54 ng/mL) and PFDoDA the lowest (0.05 ng/mL). Among girls, perfluoropentanoic acid (PFPeA) levels were adversely associated with omissions (adjusted β = 3.72, 95 % confidence interval = 0.80, 6.63). There is no strong evidence for the joint effect of the PFAS mixture on K-CPT 2 scores. However, negative joint effects on K-CPT 2 indicators for boys and positive joint effects for girls are observed for perfluorobutanesulfonic acid (PFBS)and perfluorohexanoic acid (PFHxA). Conclusion: This study highlights the modest adverse effects of alternative PFAS on child behavioral performance and the importance of sex differences. Future research should focus on the toxicological characteristics and health risks of short-chain PFAS substitutes.enAlternative PFASChildren's behavioral performancePer- and polyfluoroalkyl substances (PFAS)Perfluoropentanoic acid (PFPeA)Sex differencejournal article10.1016/j.envres.2026.12390141617103