Developmental Trajectories of Autistic Social Traits in Youth Born Extremely Preterm

Autistic social traits (ASTs), evident in the general population, are associated with mental health challenges. ASTs have not been evaluated in youth born extremely preterm (EP), despite their increased prevalence of autism. The current research evaluates AST change from 10 to 17 years in a well-characterized sample of EP youth, including sex differences and associations with health and quality of life.

Participants included 527 EP youth (n = 275 female, 67.8% White), assessed at 10 and 17 years, from the Extremely Low Gestational Age Newborn (ELGAN) Study. Adolescents were born at an average of 26 weeks gestation. ASTs were parent-reported via the Social Responsiveness Scale at 10 and 17 years. Adolescents self-reported quality of life, health, and psychopathology at 17 years. AST change scores were calculated to evaluate change over time. AST change scores and increasing, decreasing, and stable trajectories were analyzed in relation to sex and quality-of-life scores.

ASTs in EP youth increased an average of 19 raw points from age 10 to 17 years, reflecting a change of 8 standardized points and a change in qualitative description from the "normal" to "mild concern" range. The majority of youth (70%) exhibited an "Increasing" trajectory, reflecting increasing AST as a preterm phenotype. No sex differences emerged in AST change score or trajectory group. Higher AST change scores were associated with worse adolescent-reported health, self-esteem, and externalizing psychopathology.

Increasing ASTs were consistent in this sample of EP youth. Increases in ASTs were not associated with child's sex or demographics, suggesting a unique preterm phenotype of social trajectories. These findings have implications for quality of life as adolescents enter young adulthood.

Extremely preterm (EP) infants, born before 27 weeks' gestation, are considered a high-risk group for receiving an autism diagnosis, though no prior research has assessed autistic social traits (ASTs). The current study examined the changes in ASTs of 527 participants from ages 10 to 17 years as part of the Extremely Low Gestational Age Newborn (ELGAN) Study. Results showed a significant increase in ASTs in both males and females for the majority of participants (n = 368), suggesting a worsening of social performance, which was significantly associated with many child-reported quality of life measures at age 17, including lower self-esteem and more externalizing problems. These results underscore the social vulnerability of EP youth through adolescence.