Screening for Autism in Preterm Children: A Systematic Review

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.