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Sex Differences in Autistic Youth Born Extremely Preterm

Tyler C McFayden1, Clare Harrop2,3, Kyle Roell4,5

  • 1Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. tyler_mcfayden@med.unc.edu.

Journal of Autism and Developmental Disorders
|March 15, 2024
PubMed

Insights

Extremely preterm autistic males show more autistic traits than females on diagnostic measures, but not screeners. This suggests autism screeners may miss cases in extremely preterm youth, especially females.

Area of Science:

  • Neurodevelopmental Disorders
  • Pediatric Psychology
  • Genetics and Genomics

Background:

  • Autism Spectrum Disorder (ASD) is a neurodevelopmental condition affecting social interaction and communication.
  • Sex differences in ASD prevalence and symptom presentation are well-documented in full-term populations.
  • Extremely preterm (EP) birth is a risk factor for ASD, but sex-specific autistic traits in this population are less understood.

Purpose of the Study:

  • To investigate sex differences in autistic traits among children diagnosed with ASD who were born extremely preterm (EP).
  • To compare autistic traits using gold-standard diagnostic measures and screening tools at 10 years of age.

Main Methods:

  • A longitudinal cohort of 857 EP infants (23-27 weeks gestation) from the Extremely Low Gestational Age Newborn Study (ELGAN) was followed to 10 years.
  • Sixty-one EP infants diagnosed with ASD (20 females) were analyzed for sex differences in autistic traits.
  • Data were collected using ASD screeners (M-CHAT, SCQ, SRS-2) and diagnostic measures (ADOS-2, ADI-R), with analyses including inferential and Bayesian statistics.

Main Results:

  • Males scored significantly higher than females on Social Affect (ADOS-2) and Repetitive and Restricted Behaviors (ADI-R).
  • Marginal evidence suggested males scored higher on Nonverbal and Verbal Communication (ADI-R).
  • No significant sex differences were found on ASD screeners (M-CHAT, SCQ, SRS-2) at 2 or 10 years.

Conclusions:

  • Extremely preterm autistic males exhibit more autistic traits than females on diagnostic assessments at 10 years.
  • These findings parallel sex differences observed in full-term autistic youth.
  • Current ASD screeners may under-identify autism in EP youth, particularly females, highlighting a need for improved diagnostic approaches.
Abstract

Keywords:
AutismLow birthweightPretermSex differences

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