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Autism in Toddlers Born Very Preterm
Margo Anne Pritchard1, Therese de Dassel2, Elaine Beller3
1Australian Catholic University, Brisbane, Queensland, Australia; margo.pritchard@acu.edu.au.
Insights
Very preterm infants (<29 weeks gestation) have an increased risk for autism spectrum disorder (ASD). This study found a 1.8% ASD incidence using the Autism Diagnostic Observation Schedule-Generic (ADOS-G) in toddlers, with adaptive behavior predicting diagnosis.
Area of Science:
- Neonatal research
- Developmental pediatrics
- Child psychology
Background:
- Infants born very preterm (<29 weeks gestation) face developmental challenges.
- Autism spectrum disorder (ASD) risk is a concern in this vulnerable population.
- Accurate ASD diagnosis in toddlers requires validated assessment tools.
Purpose of the Study:
- To determine the prevalence of autism spectrum disorder (ASD) in very preterm toddlers.
- To utilize Autism Diagnostic Observation Schedule-Generic (ADOS-G) classifications for diagnosis.
- To investigate early ASD indicators in this high-risk group.
Main Methods:
- Two cohorts of very preterm toddlers (2 and 4 years old) were assessed.
- The Modified Checklist of Autism in Toddlers-Follow-up Interview (M-CHAT-FI) screening was employed.
- Autism Diagnostic Observation Schedule-Generic (ADOS-G) was administered to screen-positive toddlers.
Main Results:
- Data were available for 88% of the cohort (169/192).
- 3 toddlers (1.8%) were diagnosed with ASD, meeting the highest ADOS-G autism classification.
- 21 of 22 screen-positive cases showed social communication difficulties; adaptive behavior predicted ASD.
Conclusions:
- Very preterm birth (<29 weeks gestation) is associated with increased ASD risk.
- The study identified a lower ASD incidence (1.8%) compared to prior research using ADOS-G.
- M-CHAT-FI positive toddlers exhibited subthreshold communication impairments, indicating developmental delays.
Objective:
This study aimed to determine the prevalence of autism spectrum disorder (ASD) by using the Autism Diagnostic Observation Schedule-Generic (ADOS-G) classifications in children born very preterm during their toddler years.
Methods:
Two birth cohorts of toddlers (2 and 4 years old) each recruited over 12 months and born at <29 weeks' gestation were administered the Modified Checklist of Autism in Toddlers-Follow-up Interview (M-CHAT-FI) screen, the ADOS-G, and developmental assessments. The ADOS-G was conducted on toddlers with M-CHAT-FI-positive screens.
Results:
Data were available on 88% (169/192) of children. In total, 22 (13%) toddlers screened positive and 3 (1.8%) were confirmed diagnostically with ASD. These 3 cases reached the highest ADOS-G threshold classification of autism. All but 1 child who scored below the ADOS-G thresholds (11/12) demonstrated some difficulty with social communication. Risk was significantly increased for co-occurring neurodevelopmental problems in 21 of the 22 positive-screen ASD cases. Adaptive behavior (P < .001) was the only co-occurring factor independently predictive of ASD in toddlers.
Conclusions:
Children born very preterm are at increased risk of ASD. By using the ADOS-G, we found a lower incidence of ASD in children born at <29 weeks' gestation compared with previous studies. Children who screened positive for ASD on the M-CHAT-FI had developmental delays consistent with subthreshold communication impairment.
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