Infants born late/moderately preterm are at increased risk for a positive autism screen at 2 years of age
Alexa Guy1, Sarah E Seaton2, Elaine M Boyle2
1Department of Health Sciences, University of Leicester, Leicester, United Kingdom; School of Psychology, University of Warwick, Coventry, United Kingdom.
Insights
Late and moderately preterm infants show a higher risk of positive autism screens. A follow-up interview is crucial for accurate autism spectrum disorder screening in preterm populations.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Child psychology
Background:
- Preterm birth is associated with various developmental challenges.
- Early identification of developmental risks, including autism spectrum disorder (ASD), is critical for timely intervention.
- The Modified Checklist for Autism in Toddlers (M-CHAT) is a common screening tool, but its utility in preterm populations requires further investigation.
Purpose of the Study:
- To determine the prevalence of positive M-CHAT screens in late and moderately preterm (LMPT) infants compared to term-born infants.
- To evaluate the necessity and impact of a follow-up interview for M-CHAT screening in preterm infants.
- To explore the association between false positive M-CHAT screens and subsequent cognitive/behavioral outcomes.
Main Methods:
- A population-based prospective cohort study involving 1130 LMPT infants (32-36 weeks gestation) and 1255 term-born controls.
- Parents completed the M-CHAT questionnaire at 2 years corrected age.
- Infants with positive screens underwent a telephone interview to clarify M-CHAT items, followed by re-scoring to classify true/false positives. Neurosensory, cognitive, and behavioral outcomes were assessed via parent report.
Main Results:
- LMPT infants had a significantly higher risk of a positive M-CHAT questionnaire screen (14.5%) compared to term infants (9.2%).
- After follow-up, LMPT infants had a significantly higher rate of true positive autism screens (2.4%) versus controls (0.5%).
- This increased risk persisted even after excluding infants with neurosensory impairments.
Conclusions:
- Late and moderately preterm infants are at a significantly elevated risk for positive autism screens.
- An M-CHAT follow-up interview is essential for accurate autism spectrum disorder screening, particularly in preterm populations where results can be confounded.
- Infants with false positive M-CHAT screens may be at risk for cognitive and behavioral issues, warranting further monitoring.
Objectives:
To assess the prevalence of positive screens using the Modified Checklist for Autism in Toddlers (M-CHAT) questionnaire and follow-up interview in late and moderately preterm (LMPT; 32-36 weeks) infants and term-born controls.
Study Design:
Population-based prospective cohort study of 1130 LMPT and 1255 term-born infants. Parents completed the M-CHAT questionnaire at 2-years corrected age. Parents of infants with positive questionnaire screens were followed up with a telephone interview to clarify failed items. The M-CHAT questionnaire was re-scored, and infants were classified as true or false positives. Neurosensory, cognitive, and behavioral outcomes were assessed using parent report.
Results:
Parents of 634 (57%) LMPT and 761 (62%) term-born infants completed the M-CHAT questionnaire. LMPT infants had significantly higher risk of a positive questionnaire screen compared with controls (14.5% vs 9.2%; relative risk [RR] 1.58; 95% CI 1.18, 2.11). After follow-up, significantly more LMPT infants than controls had a true positive screen (2.4% vs 0.5%; RR 4.52; 1.51, 13.56). This remained significant after excluding infants with neurosensory impairments (2.0% vs 0.5%; RR 3.67; 1.19, 11.3).
Conclusions:
LMPT infants are at significantly increased risk for positive autistic screen. An M-CHAT follow-up interview is essential as screening for autism spectrum disorders is especially confounded in preterm populations. Infants with false positive screens are at risk for cognitive and behavioral problems.
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