Screening for Autism Spectrum Disorders in Extremely Preterm Infants
1Department of Pediatrics, Women & Infants’ Hospital, Brown University, Providence, RI
2Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC
3Department of Psychiatry & Human Behavior, Center for the Study of Children at Risk, Brown Alpert Medical School, Women & Infants Hospital, Providence, RI
4Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL
5Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT
6Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH
7Department of Pediatrics, Duke University, Durham, NC
8Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
9Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH
10Department of Pediatrics, University of Iowa, Iowa City, IA
11Department of Pediatrics, Wayne State University, Detroit, MI
12Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA
13Department of Pediatrics, Division of Newborn Medicine, Floating Hospital for Children, Tufts Medical Center, Boston, MA
14Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
15Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
16Department of Pediatrics, Yale University School of Medicine, New Haven, CT
17University of New Mexico Health Sciences Center, Albuquerque, NM
18Statistics and Epidemiology Unit, RTI International, Rockville, MD
19Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
Of the 784 children eligible for follow-up during the study period, 13 (2%) were hearing impaired, 5 (1%) were blind, and 18 (3%) had severe cerebral palsy (CP); 5 children had both severe CP and either blindness or hearing impairment. Among the remaining children, 45 (6%) were seen at follow-up but did not have data on the autism screeners and 153 (20%) were lost to follow-up). The study population consisted of the remaining 554 infants, with a mean gestational age of 25 weeks and mean birth weight of 786 grams, who were seen at 18 months and screened for ASD. Of those, 52% were male; 20% were multiples; 34% were black, 44% white and 18% Hispanic. Rates of neonatal morbidities were similar to those previously reported.20, 21
Compared to children who were lost to follow-up, those in the analyses were born at greater gestational age, had fewer ventilation days, were less likely to have BPD or sepsis, and had mothers with lower education (p < .05); there were no significant differences between the two groups by gender, multiple birth, birth weight, advanced maternal age, race, Medicaid, NEC, IVH/PVL, or length of hospital stay.
Twenty percent of infants screened positive on one or more ASD screens. () English and non-English speakers had similar rates of positive screen (χ2(1)=3.14, p = .076; ). There was little overlap among the 3 screens; 10% had a positive PDDST II, 6% response to name and 9% response to joint attention; 16% had only one positive screen with a rate of 3–8% for each screen; only 3% had 2 positive screens and in 1% all three screens were positive ().
Autism PDDST-II and ADOS Item Screening Results by Language Used for Administration of Screeners
The most commonly positive items on the PDDST II were: hard to get to “talk” back (31%) and walking on toes (30%) (). The least common were stopped using gestures he/she had mastered (5%) and cries when you leave but doesn’t notice when you return (6%).
Percentage of Children Exhibiting Behaviors Measured by the PDDST-II Items
Infants with one positive screen were more likely to be male and have less educated mothers.() Infants with one or more positive screens were more likely to be white, non-Hispanic. Smaller, sicker infants were more likely to have two or more positive screens. One or more positive screen was associated with higher rates of other impairments.
Neonatal and Maternal Characteristics and 18-Month Neurodevelopmental Outcomes by Autism Screening Results
Of the 7 infants for whom all 3 screens were positive, the majority (5/7) were white males. Five had elevated BITSEA Problem scores and 6 had low BITSEA Competence scores. Only 2 of these infants were cognitively impaired but all had language impairment.
The regression models are shown in . While birth weight, male gender and non-white race were associated with a positive ASD screen at 18–22 months, only male gender remained a significant predictor of positive ASD screen when cognitive and language outcomes were added to the model. Lower cognitive and language scores on the Bayley III, higher BITSEA Problem score and lower BITSEA Competence score were associated with greater odds of a positive ASD screen. The AUCs for the models in were: Model 1 (0.77), Model 2 (0.85), and Model 3 (0.88). The AUCs for the three models differed significantly from each other, suggesting the inclusion of the Bayley III and BITSEA scores improved the ability of the model to predict positive ASD screens beyond neonatal and maternal characteristics alone: Model 1 vs. 2 (p < .001), Model 1 vs. 3 (p < .001), and Model 2 vs. 3 (p=.022).
Logistic Regression Models of One or More Positive Autism Screens by Neonatal and Maternal Characteristics and 18-Month Bayley and BITSEA Scores