Screening for autism spectrum disorder in very preterm infants during early childhood
Peter H Gray1, Dawn M Edwards2, Michael J O'Callaghan3
1Growth and Development Unit, Mater Mothers' Hospital, South Brisbane, Queensland, Australia; Mater Research Institute, The University of Queensland, Mater Health Services, South Brisbane, Queensland, Australia.
Insights
Very preterm infants show higher rates of autism spectrum disorder (ASD) screening positivity. Maternal mental health and infant behaviors are linked to positive screens in this vulnerable group.
Area of Science:
- Neonatal development
- Developmental pediatrics
- Autism spectrum disorder research
Background:
- Very preterm infants face increased risks for developmental challenges.
- Autism spectrum disorder (ASD) screening in high-risk populations is crucial for early intervention.
- Understanding risk factors associated with ASD in preterm infants is essential.
Purpose of the Study:
- To screen very preterm infants for autism spectrum disorder (ASD) and compare with term-born controls.
- To identify maternal and neonatal risk factors associated with positive ASD screens in preterm infants.
- To examine developmental and behavioral outcomes in preterm infants with positive ASD screens.
Main Methods:
- Recruitment of preterm (≤30 weeks gestation) and term infants at two years of age.
- Administration of Modified Checklist for Autism in Toddlers (M-CHAT), Child Behaviour Checklist (CBCL), Depression, Anxiety and Stress Scales (DASS), and Edinburgh Postnatal Depression Scales (EPDS).
- Neurodevelopmental assessment using Bayley-III, followed by clinical assessment for ASD diagnosis in screen-positive infants.
Main Results:
- 13.4% of preterm infants screened positive on M-CHAT versus 3.9% of term infants (p=0.036).
- Positive screens in preterm infants were associated with younger, non-Caucasian mothers, lower birth weight, and small for gestational age (SGA).
- Preterm infants with positive screens exhibited lower Bayley-III scores, more behavioral issues, and mothers reported higher emotional distress.
Conclusions:
- Positive M-CHAT screening is more prevalent in very preterm infants compared to term infants.
- Internalizing behaviors and maternal mental health are significantly associated with positive ASD screens in the preterm cohort.
- Early screening and support are vital for very preterm infants and their families.
Aim:
The aim of the study was to screen very preterm infants for autism spectrum disorder (ASD) with comparisons to a group of term controls. The study also aimed to identify maternal and neonatal risk factors, development and behaviour associated with a positive screen in the preterm group.
Method:
Preterm infants born ≤ 30 weeks gestation and term infants were recruited at two years of age. The mothers were posted the questionnaires and completed the Modified Checklist for Autism in Toddlers (M-CHAT), the Child Behaviour Checklist (CBCL) and the Depression, Anxiety and Stress Scales (DASS). Previously collected data from the mothers at 12 months--the Edinburgh Postnatal Depression Scales (EPDS) were analysed. The children had neurodevelopmental assessment including the Bayley-III. Infants positive on M-CHAT screen had an M-CHAT follow-up interview by phone and then were assessed by a developmental paediatrician as indicated with a diagnosis of autism being made on clinical judgement.
Results:
13 (13.4%) of the 97 preterm infants screened positive on the M-CHAT compared to three (3.9%) of the 77 term infants (p = 0.036). On follow-up interview, three of the preterm infants remained positive (one was diagnosed with autism) compared to none of the term infants. The preterm infants who screened positive were born to younger, non-Caucasian mothers and were of lower birth weight and had a higher incidence of being small for gestational age (SGA). The infants had lower composite scores on Bayley-III and had more internalising and externalising behaviours on the CBCL. The mothers had more emotional problems on the DASS and higher scores on the EPDS. On multivariate analysis, SGA, greater internalising behaviours and higher EPDS scores remained statistically significant.
Conclusions:
A positive screen on the M-CHAT occurs more commonly in very preterm infants than those born at term. Internalising behaviours and maternal mental health are associated with a positive screen in the preterm cohort.
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