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Infections in children with autism spectrum disorder: Study to Explore Early Development (SEED)
Katherine R Sabourin1, Ann Reynolds2, Diana Schendel3
1Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Insights
Children with autism spectrum disorder (ASD) face higher risks of early-life infections compared to the general population and those with other developmental conditions. This highlights a potential link between infection and ASD development.
Area of Science:
- Pediatric Health
- Neurodevelopmental Disorders
- Infectious Disease Epidemiology
Background:
- Immune system abnormalities are frequently observed in children with autism spectrum disorder (ASD).
- These immune differences may predispose children with ASD to an increased risk of infections during early development.
Purpose of the Study:
- To investigate the association between early-life infections and autism spectrum disorder (ASD).
- To compare infection rates in children with ASD to control groups, including those with developmental delay/disorder (DD) and the general population (POP).
- To examine infection risk in ASD cases with and without regression.
Main Methods:
- The Study to Explore Early Development (SEED) employed a multisite case-control design.
- Participants included children aged 30-69 months, with ASD cases identified from clinical and educational settings.
- Control groups comprised children with developmental delay/disorder (DD) and randomly sampled population controls (POP).
- Infection data were collected from medical records (neonatal period) and caregiver reports (first three years).
Main Results:
- Children with ASD showed significantly higher odds of neonatal infection (OR=1.5-1.8) and early childhood infection (OR=1.7) compared to POP controls.
- ASD cases also had greater odds of neonatal infection (OR=1.5) compared to DD controls.
- Children with ASD who experienced regression had higher odds of infection in the first year (OR=1.6) compared to ASD cases without regression.
Conclusions:
- The findings support the hypothesis that children with ASD are more susceptible to infections early in life.
- This increased infection risk is evident when compared to both the general population and children with other developmental conditions.
- Further research is warranted to explore the specific roles of infection timing, frequency, and severity in ASD etiology.
Abstract:
Immune system abnormalities have been widely reported among children with autism spectrum disorder (ASD), which may increase the risk of childhood infections. The Study to Explore Early Development (SEED) is a multisite case-control study of children aged 30-69 months, born in 2003-2006. Cases are children previously diagnosed and newly identified with ASD enrolled from education and clinical settings. Children with a previously diagnosed non-ASD developmental condition were included in the developmental delay/disorder (DD) control group. The population (POP) control group included children randomly sampled from birth certificates. Clinical illness from infection during the first 28 days ("neonatal," from medical records) and first three years of life (caregiver report) in cases was compared to DD and POP controls; and between cases with and without regression. Children with ASD had greater odds of neonatal (OR = 1.8; 95%CI: 1.1, 2.9) and early childhood infection (OR = 1.7; 95%CI: 1.5, 1.9) compared to POP children, and greater odds of neonatal infection (OR = 1.5; 95%CI: 1.1, 2.0) compared to DD children. Cases with regression had 1.6 times the odds (95%CI: 1.1, 2.3) of caregiver-reported infection during the first year of life compared to cases without regression, but neonatal infection risk and overall early childhood infection risk did not differ. Our results support the hypothesis that children with ASD are more likely to have infection early in life compared to the general population and to children with other developmental conditions. Future studies should examine the contributions of different causes, timing, frequency, and severity of infection to ASD risk. Autism Research 2019, 12: 136-146. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We looked at infections during early childhood in relation to autism spectrum disorder (ASD). We found that children with ASD were more likely to have an infection in the first 28 days of life and before age three compared to children with typical development. Children with ASD were also more likely than children with other developmental delays or disorders to have an infection in the first 28 days of life.
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