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Published on: October 3, 2018
Autism spectrum disorders in extremely preterm children
Samantha Johnson1, Chris Hollis, Puja Kochhar
1Institute for Women's Health, University College, London, United Kingdom. s.j.johnson@ucl.ac.uk
Insights
Extremely preterm children show higher rates of autism spectrum disorder (ASD) symptoms and diagnoses. Early factors like male sex and neurocognitive issues are linked to these outcomes, suggesting developmental origins.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Psychiatry
Background:
- Autism Spectrum Disorders (ASD) are complex neurodevelopmental conditions.
- Extremely preterm birth (<26 weeks gestation) is associated with various developmental challenges.
- Understanding ASD risk in this vulnerable population is crucial for early intervention.
Purpose of the Study:
- To determine the prevalence of ASD in extremely preterm children.
- To identify correlates and antecedents of ASD in this group.
- To explore the relationship between ASD symptoms and neurocognitive outcomes.
Main Methods:
- Prospective study of UK and Ireland births <26 weeks gestation in 1995.
- Assessment of 219 survivors at 11 years, compared to term-born classmates.
- Use of Social Communication Questionnaire (SCQ), psychiatric evaluation, IQ, and clinical assessments.
Main Results:
- 8% of extremely preterm children received an ASD diagnosis versus 0% in controls.
- Higher SCQ scores were observed in extremely preterm children.
- Early factors (male sex, low gestation, abnormal brain scans, no breast milk) and later neurocognitive issues were associated with ASD symptoms.
Conclusions:
- Extremely preterm children face an elevated risk for ASD symptoms and diagnoses in middle childhood.
- ASD in this population is linked to neurocognitive outcomes.
- Findings suggest abnormal brain development contributes to ASD in extremely preterm individuals.
Objectives:
To investigate the prevalence, correlates, and antecedents of autism spectrum disorders (ASD) in extremely preterm children.
Study Design:
We conducted a prospective study of all births <26 weeks gestation in the United Kingdom and Ireland in 1995. Of 307 survivors at 11 years, 219 (71%) were assessed and compared with 153 term-born classmates. Parents completed the Social Communication Questionnaire (SCQ) to assess autism spectrum symptoms, and ASD were diagnosed by using a psychiatric evaluation. An IQ test and clinical evaluation were also administered. Longitudinal outcome data were available for extremely preterm children.
Results:
Extremely preterm children had significantly higher SCQ scores than classmates (mean difference, 4.6 points; 95% CI, 3.4-5.8). Sixteen extremely preterm children (8%) were assigned an ASD diagnosis, compared with none of the classmates. By hospital discharge, male sex, lower gestation, vaginal breech delivery, abnormal cerebral ultrasound scanning results, and not having had breast milk were independently associated with autism spectrum symptoms. By 6 years, independent associates were cognitive impairment, inattention and peer problems, withdrawn behavior at 2.5 years, and not having had breast milk.
Conclusions:
Extremely preterm children are at increased risk for autism spectrum symptoms and ASD in middle childhood. These symptoms and disorders were associated with neurocognitive outcomes, suggesting that ASD may result from abnormal brain development in this population.
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