In this study, we demonstrate the complexities of performing a sibling analysis with a re-examination of associations between cell phone exposures and behavioral problems observed previously in the Danish National Birth Cohort. Children (52,680; including 5441 siblings) followed up to age 7 were included. We examined differences in exposures and behavioral problems between siblings and non-siblings and by birth order and birth year. We estimated associations between cell phone exposures and behavioral problems while accounting for the random family effect among siblings. The association of behavioral problems with both prenatal and postnatal exposure differed between siblings (odds ratio (OR): 1.07; 95% confidence interval (CI): 0.69-1.66) and non-siblings (OR: 1.54; 95% CI: 1.36-1.74) and within siblings by birth order; the association was strongest for first-born siblings (OR: 1.72; 95% CI: 0.86-3.42) and negative for later-born siblings (OR: 0.63; 95% CI: 0.31-1.25), which may be because of increases in cell phone use with later birth year. Sibling analysis can be a powerful tool for (partially) accounting for confounding by invariant unmeasured within-family factors, but it cannot account for uncontrolled confounding by varying family-level factors, such as those that vary with time and birth order. Keywords: sibling analysis; cellular phone; child; behavior; confounding INTRODUCTION A number of epidemiological studies have shown associations between cell phone exposures and behavioral and cognitive changes in children. Findings have included poorer accuracy of working memory and associative learning, shorter reaction times for simple learning tasks, and longer completion times for Stroop color-word naming tasks in children reporting more cell phone voice calls. 1 Associations between radiofrequency exposure and behavioral problems among adolescents and conduct problems among children were reported in one study. 2 Another more recent study indicated a positive association between cell phone voice calls and attention-deficit hyperactivity symptoms among children with high blood lead levels; however, reverse causation could have produced these results. 3 Conversely, another investigation did not detect an association between prenatal cell phone use and behavioral problems in children, albeit this study was based on a small sample size, particularly a small number of exposed cases. 4 Two analyses conducted among children in the Danish National Birth Cohort (DNBC) by Divan et al. 5,6 in 2008 and 2010 reported associations between prenatal and postnatal cell phone exposures and behavioral problems at age 7. Overall behavioral problems and specific behavioral outcomes were assessed using the Strengths and Difficulties Questionnaire (SDQ). 7 The original analysis included 13,159 children, and reported odds ratios (ORs) for higher overall behavioral problems scores of 1.80 (95% confidence interval (CI): 1.45-2.23) in children with both prenatal and postnatal exposure to cell phones. 5 They also reported associations...