Screening for autism in extremely preterm infants: problems in interpretation
Tamanna Moore1, Samantha Johnson, Enid Hennessy
1Research Department of Academic Neonatology, Institute for Women's Health, University College London, London, UK.
Insights
Autism screens are common in extremely preterm infants, particularly those with developmental issues. Healthcare providers should consider other neurodevelopmental problems when interpreting positive Modified Checklist for Autism in Toddlers (M-CHAT) results.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Autism Spectrum Disorder Research
Background:
- Extremely preterm infants face heightened risks for developmental challenges.
- Early identification of developmental delays, including autism, is crucial for timely intervention.
- The Modified Checklist for Autism in Toddlers (M-CHAT) is a widely used screening tool.
Purpose of the Study:
- To determine the prevalence of positive M-CHAT screens in extremely preterm children in England.
- To identify risk factors associated with positive M-CHAT screens in this population.
- To inform clinical interpretation of M-CHAT results in extremely preterm infants.
Main Methods:
- A cohort of children born at <= 26 weeks' gestation in England in 2006 (EPICure-2 study) was assessed at 2 years corrected age.
- Postal questionnaires including the M-CHAT and other developmental questions were sent to parents of survivors.
- Data from 523 completed questionnaires were analyzed to determine M-CHAT screen positivity and associated factors.
Main Results:
- 41% of extremely preterm children screened positive on the M-CHAT.
- Risk factors included severe bronchopulmonary dysplasia, postnatal steroid use, late-onset bacteraemia, and male sex.
- Positive screens were significantly higher in children with neurodevelopmental impairments, including severe motor impairment (95.5%) and cognitive impairment (55.9%).
Conclusions:
- Positive M-CHAT screens are highly prevalent in extremely preterm children.
- The presence of other neurodevelopmental impairments significantly increases the likelihood of a positive screen.
- Clinicians should interpret positive M-CHAT results cautiously, considering the broader neurodevelopmental profile to prevent unnecessary referrals.
Aim:
The aim of this article was to report the prevalence of, and risk factors for, positive autism screens using the Modified Checklist for Autism in Toddlers (M-CHAT) in children born extremely preterm in England.
Method:
All children born at not more than 26 weeks' gestational age in England during 2006 were recruited to the EPICure-2 study. At 2 years of age, postal questionnaires incorporating the M-CHAT and additional developmental questions were sent to the parents of each survivor (n=1031; 499 male, 532 female), of which 523 (266 male, 257 female; 51%) were returned completed.
Results:
The prevalence of positive M-CHAT screens in this extremely preterm population was 41% (216/523; 130 male; 86 female). Severe bronchopulmonary dysplasia, administration of postnatal steroids, late-onset bacteraemia, and being male were statistically significantly associated with a positive screen. Coexisting disabilities were present in 320 (62%) children. Of 200 children without disability, 16.5% screened positive. In contrast, 63 (95.5%) of those with severe motor impairment (odds ratio 42; 95% confidence interval [CI] 12.9-135) and 175 (55.9%) of those with cognitive impairment (odds ratio 5.3; CI 3.5-8) screened positive. All children with a significant vision or hearing impairment screened positive.
Interpretation:
The prevalence of positive M-CHAT screens in extremely preterm children is high, especially in children with neurodevelopmental impairment. Positive screens should be interpreted in the light of other neurodevelopmental sequelae in clinical practice to avoid false-positive referrals.
