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Comparison of three screening tests for autism in preterm children with birth weights less than 1,500 grams
Iva Dudova1, Daniela Markova2, Martina Kasparova3
1Department of Child Psychiatry, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic.
Insights
Children born weighing less than 1,500 grams show a higher autism spectrum disorder (ASD) prevalence. Shorter gestation and longer hospital stays were linked to ASD diagnosis in these high-risk infants.
Area of Science:
- Neonatal research
- Developmental pediatrics
- Autism spectrum disorder (ASD) research
Background:
- Preterm infants are recognized as a population at higher risk for developing autism spectrum disorders (ASD).
- Early identification and intervention are crucial for improving outcomes in preterm children.
- Understanding the specific risk factors associated with prematurity and ASD is essential for targeted screening.
Purpose of the Study:
- To investigate the prevalence of autism spectrum disorders (ASD) in children born with very low birth weights (<1,500 g).
- To identify potential risk factors, such as gestational age and hospital stay duration, associated with ASD in this cohort.
- To evaluate the effectiveness of different screening tools in identifying potential ASD cases in preterm infants.
Main Methods:
- A cohort of 157 children with birth weights <1,500 g (corrected age 2 years) underwent screening using the Modified Checklist for Autism in Toddlers (M-CHAT), Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist (CSBS-DP-ITC), and Infant/Toddler Sensory Profile (ITSP).
- Children with pre-existing disabilities were excluded from the study.
- Children who screened positive on any tool were further assessed with a clinical examination, including the Autism Diagnostic Observation Schedule.
Main Results:
- A total of 35.7% of children screened positive on at least one questionnaire; 9.7% were ultimately diagnosed with ASD.
- Children diagnosed with ASD had significantly shorter gestational ages (26.9 vs. 28.3 weeks) and longer hospital stays (89.5 vs. 75.4 days).
- The CSBS-DP-ITC demonstrated the highest sensitivity (0.846) for screening, followed by M-CHAT (0.692) and ITSP (0.462), with significant differences in positive screen rates among the tools.
Conclusions:
- Children born with very low birth weights (<1,500 g) exhibit a higher prevalence of ASD at 2 years of age compared to the general population.
- Shorter gestation and prolonged hospital stays are significant risk factors associated with ASD diagnosis in this vulnerable population.
- The findings underscore the importance of using multiple screening tools concurrently to enhance the sensitivity and accuracy of ASD detection in preterm infants.
Background:
Preterm children seem to be at increased risk for autism spectrum disorders (ASD).
Methods:
Parents of 157 children with birth weights less than 1,500 g (age 2 years, corrected for prematurity; 88 boys, 69 girls) completed screening questionnaires. The screening battery included the Modified Checklist for Autism in Toddlers (M-CHAT), Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist (CSBS-DP-ITC), and the Infant/Toddler Sensory Profile (ITSP). Children with disabilities were excluded. All children who screened positive on any of the screening tools were subsequently assessed by clinical examination including the Autism Diagnostic Observation Schedule.
Results:
Fifty-six children (35.7%) screened positive on at least one of the parental screening questionnaires. Of the 56 children who tested positive, 33 participated in the detailed clinical follow-up assessment. A diagnosis of ASD was confirmed in 13 of the 33 children. The ASD prevalence was 9.7% of the sample. Analysis of children with and without an ASD diagnosis found significant differences relative to gestational age (26.9 weeks vs 28.3 weeks, P=0.033) and length of the stay in hospital (89.5 days vs 75.4 days, P=0.042). The screening tool with the most positive results was CSBS-DP-ITC (42 positive screens [PS]), followed by M-CHAT (28 PS), and ITSP (22 PS). Differences in the frequency of PS among the tests were significant (P=0.008). CSBS-DP-ITC had the highest sensitivity (0.846), followed by M-CHAT (0.692) and ITSP (0.462).
Conclusion:
Our results indicate a higher prevalence of autism in children with birth weights <1,500 g at 2 years of age compared to the general population prevalence. The ASD diagnosis was associated with shorter gestation times and longer hospital stays. Our findings support the simultaneous use of more than one screening tests in order to increase screening sensitivity.
