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Published on: August 25, 2014
Early Neurodevelopmental Trajectories for Autism Spectrum Disorder in Children Born Very Preterm
Li-Wen Chen1,2, Shan-Tair Wang3,4, Lan-Wan Wang5,6,7
1Graduate Institutes of Clinical Medicine and huangped@mail.ncku.edu.tw.
Insights
Children born preterm with a declining early mental development trajectory show a significantly higher risk for autism spectrum disorder (ASD). This finding may help identify vulnerable preterm infants for early ASD diagnosis and intervention.
Area of Science:
- Neurodevelopmental disorders
- Pediatric medicine
- Developmental psychology
Background:
- Children born preterm face elevated risks for autism spectrum disorder (ASD).
- Current developmental markers for identifying ASD risk in preterm infants are insufficient.
- Early identification of ASD risk is crucial for timely intervention.
Purpose of the Study:
- To investigate the association between early mental performance trajectories and the later diagnosis of ASD in very preterm survivors.
- To identify potential developmental markers for ASD in the preterm population.
- To explore factors influencing mental performance trajectories in preterm infants.
Main Methods:
- A population-based cohort of 414 very preterm infants was established.
- 319 infants without severe neurosensory impairment had developmental quotients assessed before age 2 using the Bayley Scales of Infant Development.
- Group-based trajectory modeling analyzed mental performance from 6 to 24 months; ASD diagnosis at 5 years used standardized assessments.
Main Results:
- Three distinct mental performance trajectories were identified: low declining, high declining, and high stable.
- ASD prevalence at age 5 was 35% in the low-declining group, 9% in the high-declining group, and 3% in the high-stable group.
- Infants in the low-declining trajectory had 15 times higher odds of ASD compared to the high-stable group; male sex, longer oxygen therapy, and lower maternal education were linked to the low-declining trajectory.
Conclusions:
- Early mental trajectory patterns, assessed by the Bayley Scales of Infant Development, can potentially identify preterm children at high risk for ASD.
- These trajectory patterns may serve as valuable developmental markers for early ASD diagnosis in preterm infants.
- Identifying these vulnerable infants can facilitate targeted interventions to improve outcomes.
Background:
Children born preterm are at high risk for autism spectrum disorder (ASD). However, there is still a lack of appropriate developmental markers. In this study, we aim to examine whether early mental performance trajectory is related to ASD outcome in the preterm population.
Methods:
The population-based cohort included 414 very preterm survivors born between 2008 and 2014. After excluding children with severe neurosensory impairment, 319 children with available records of developmental quotients before age 2 years were enrolled. The trajectory of mental performance evaluated by using the Bayley Scales of Infant Development across 6, 12, and 24 months of age was analyzed with group-based trajectory modeling. At 5 years of age, the ASD diagnosis was established by using the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised.
Results:
There were 29 children with ASD and 290 children without ASD. The mental performances from age 6 to 24 months could be classified into 3 trajectory patterns: low declining, high declining, and high stable, which corresponded to ASD prevalence at age 5 years of 35%, 9%, and 3%, respectively. ASD odds was 15 times higher in the low-declining group than in the high-stable group (odds ratio 15; 95% confidence interval 3.8-59; P < .001). Through the analysis of multinomial logistic regression, we found that male infants with longer exposure to oxygen therapy whose mothers had lower maternal education levels tended to follow the low-declining trajectory.
Conclusions:
The early-life mental trajectory patterns, by using the Bayley Scales of Infant Development, may lead to identification of vulnerable children born preterm for early ASD diagnosis and targeted intervention.
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