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Autism screening and diagnostic outcomes among toddlers born preterm
Taralee Hamner1, Georgina Perez Liz2, Kiva Kelly2
1Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
Autism screening using the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F) is effective for preterm infants. Higher autism rates were observed in extremely preterm infants, indicating screening should not be delayed.
Area of Science:
- Developmental Pediatrics
- Neonatology
- Autism Spectrum Disorder Research
Background:
- Preterm birth is a risk factor for developmental differences, including autism spectrum disorder (ASD).
- Early identification of ASD in preterm infants is crucial for timely intervention.
- The Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F) is a widely used screening tool.
Purpose of the Study:
- To evaluate the performance of the M-CHAT-R/F in toddlers born preterm.
- To assess screening and diagnostic outcomes based on gestational age.
- To examine diagnostic evaluation attendance after screening in preterm populations.
Main Methods:
- Cross-sectional study of 9725 toddlers screened using the M-CHAT-R/F at well-child visits.
- Analysis of screening performance and diagnostic outcomes stratified by preterm classification (extremely, very, moderate, full term).
- Evaluation of diagnostic evaluation attendance rates for screen-positive cases.
Main Results:
- Screen-positive rates were highest in extremely preterm infants (51.35%) and lowest in full-term infants (6.95%).
- Autism diagnosis rates were significantly higher in extremely preterm infants (16.05%) compared to full-term infants (1.49%).
- M-CHAT-R/F sensitivity decreased with increasing gestational age, while specificity improved; positive predictive value was highest for extremely preterm and full-term infants.
Conclusions:
- The M-CHAT-R/F demonstrates acceptable sensitivity and specificity for autism screening in preterm toddlers.
- Autism screening-positive rates and prevalence increase with earlier preterm birth.
- Extremely preterm infants have the highest likelihood of an autism diagnosis, supporting screening without adjusted age delay.
Aim:
To examine the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F), with follow-up screening and diagnostic outcomes for children born preterm. A secondary aim was to examine diagnostic evaluation attendance after screening to inform clinical practice.
Method:
Using a cross-sectional design, 9725 toddlers (4951 males; 4774 females) whose gestational age was reported were screened at 15-month, 18-month, or 24-month well-child visits; screen-positive children were invited for an autism evaluation. Screening measure performance and diagnostic outcomes were evaluated according to preterm classification (Screening: nExtPreterm = 111; nVeryPreterm = 186; nModPreterm = 1122; nFullTerm = 8306; Evaluation: nExtPreterm = 27; nVeryPreterm = 21; nModPreterm = 86; nFullTerm = 301).
Results:
Screen-positive rates were highest for children born extremely preterm (51.35%) and lowest for children born at term (6.95%). Evaluation attendance for screen-positive cases did not differ according to preterm classification. Rates of autism diagnoses differed depending on preterm birth status: for children born extremely preterm, it was 16.05%; for children born very preterm, it was 2.00%; for children born moderately preterm, it was 2.89%; and for children born at term, it was 1.49%. M-CHAT-R/F sensitivity decreased with increasing gestational age, whereas specificity improved with increasing gestational age. Positive predictive value was highest for children born extremely preterm and children born at term. Negative predictive value was consistently strong across all groups. The likelihood ratio for positive screening increased with gestational age.
Interpretation:
The sensitivity and specificity of the M-CHAT-R/F are acceptable in toddlers born preterm. Autism screening-positive rates and prevalence increased with earlier preterm birth. Those born extremely preterm showed the greatest likelihood of an autism diagnosis; screening should not be delayed based on adjusted age.
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