Screening for Autism in Preterm Children: A Systematic Review
Karen E Thomas1, Kamini Raghuram2, Rudaina Banihani3,4
1Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Insights
Autism spectrum disorder (ASD) screening tools show variable accuracy in preterm children. Refinement is needed to improve early identification and intervention for this high-risk group.
Area of Science:
- Neurodevelopmental disorders
- Pediatric screening tools
- Autism spectrum disorder (ASD)
Background:
- Preterm children have a higher prevalence of autism spectrum disorder (ASD) compared to the general population.
- Unique neurodevelopmental profiles in preterm infants pose challenges for accurate ASD screening and diagnosis.
- Existing systematic reviews on ASD screening tools for preterm populations are lacking.
Purpose of the Study:
- To systematically review and meta-analyze the diagnostic performance of current autism spectrum disorder (ASD) screening tools in preterm children.
- To evaluate the effectiveness of various screening instruments in identifying ASD within this specific pediatric cohort.
Main Methods:
- A comprehensive database search was performed across MEDLINE, PsycINFO, PubMed, Embase, and CINAHL in July 2024.
- Included studies quantified the diagnostic accuracy of ASD screening tools in preterm populations.
- Nine studies were included in the review, with four contributing to the meta-analyses; all studies underwent risk of bias and applicability assessments.
Main Results:
- Sensitivity for ASD screening tools in preterm children varied widely, ranging from 0% to 100%.
- Specificity demonstrated a range from 38% to 98%.
- Pooled data for the Modified Checklist for Autism in Toddlers and the Social Communication Questionnaire showed sensitivities of 55% and 53%, respectively, with specificities of 85% and 90%.
Conclusions:
- Significant heterogeneity among studies limited the pooling of diagnostic accuracy data.
- The efficacy of screening tools in detecting ASD in preterm children varies, potentially confounded by overlapping behavioral phenotypes.
- There is an urgent need to refine and validate ASD screening tools specifically for preterm infants to enable timely interventions.
Objective:
Preterm children exhibit a higher prevalence of autism spectrum disorder (ASD) than the general population. The unique neurodevelopmental characteristics of preterm children present challenges in screening for and diagnosing ASD. To date, a systematic review of screening tools for ASD in this population has not been completed. This systematic review and meta-analysis evaluates the diagnostic performance of currently used ASD screening tools in the preterm population.
Methods:
The database search was conducted by using MEDLINE, PsycINFO, PubMed, Embase, and CINAHL in July 2024. Articles that quantified the diagnostic accuracy of ASD screening tools in the preterm population were included. Nine studies were included in this review, and only 4 studies in the meta-analyses. All studies were assessed for risk of bias, applicability, and certainty.
Results:
Sensitivity of screening tools for ASD in preterm children ranged from 0% to 100%, whereas specificity ranged from 38% to 98%. Pooled data were available for the Modified Checklist for Autism in Toddlers (2 studies) and Social Communication Questionnaire. (2 studies), with pooled sensitivities of 55% and 53% and specificities 85% and 90%, respectively.
Conclusions:
There was significant study heterogeneity, limiting the number of studies from which to pool diagnostic accuracy data. Screening tools vary in their ability to identify ASD in the preterm population, underscoring how overlapping behavioral phenotypes may confound early identification. There is a critical need to refine and assess ASD screening tools in preterm children, facilitating timely interventions in this cohort.
