Screening for autism spectrum disorders in extremely preterm infants

Area of Science:

• Neonatal development
• Neurodevelopmental disorders
• Pediatric screening

Background:

• Extremely preterm (EP) infants exhibit high rates of positive autism spectrum disorder (ASD) screens.
• Uncertainty exists whether high rates reflect true ASD prevalence or false positives due to underlying neurodevelopmental impairments.
• Combining parent questionnaires and direct observation may improve ASD screening accuracy in EPs.

Purpose of the Study:

• Determine positive ASD screening rates at 18-22 months in EPs using three distinct screening tools.
• Identify factors associated with positive ASD screens in this cohort.
• Evaluate the efficacy of multi-tool screening for ASD in extremely preterm infants.

Main Methods:

• Screened 554 infants born before 27 weeks gestation at 18-22 months.
• Utilized the Pervasive Developmental Disorders Screening test (PDDST) Stage 2, and Autism Diagnostic Observation Schedule (ADOS) items for response to name and joint attention.
• Excluded infants with severe cerebral palsy, deafness, or blindness; analyzed associations between positive screens and neonatal/infant characteristics.

Main Results:

• 113 (20%) of infants had at least one positive screen.
• Individual screen positivity rates were 10% for PDDST, 6% for response to name, and 9% for response to joint attention.
• Positive screens correlated with male gender, longer hospital stays, white race, lower maternal education, abnormal behavioral scores, and cognitive/language delay.

Conclusions:

• Employing three ASD screening tools increases positive screen rates in extremely preterm infants compared to a single tool.
• Diagnostic confirmation is crucial to ascertain the actual prevalence of ASD in extremely preterm infants.
• Multi-tool screening highlights a need for further investigation into neurodevelopmental outcomes in EPs.