BACKGROUND: Preterm children seem to be at increased risk for autism spectrum disorders (ASD). METHODS: Parents of 157 children with birth weights less than 1,500 g (age 2 years, corrected for prematurity; 88 boys, 69 girls) completed screening questionnaires. The screening battery included the Modified Checklist for Autism in Toddlers (M-CHAT), Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist (CSBS-DP-ITC), and the Infant/Toddler Sensory Profile (ITSP). Children with disabilities were excluded. All children who screened positive on any of the screening tools were subsequently assessed by clinical examination including the Autism Diagnostic Observation Schedule. RESULTS: Fifty-six children (35.7%) screened positive on at least one of the parental screening questionnaires. Of the 56 children who tested positive, 33 participated in the detailed clinical follow-up assessment. A diagnosis of ASD was confirmed in 13 of the 33 children. The ASD prevalence was 9.7% of the sample. Analysis of children with and without an ASD diagnosis found significant differences relative to gestational age (26.9 weeks vs 28.3 weeks, P=0.033) and length of the stay in hospital (89.5 days vs 75.4 days, P=0.042). The screening tool with the most positive results was CSBS-DP-ITC (42 positive screens [PS]), followed by M-CHAT (28 PS), and ITSP (22 PS). Differences in the frequency of PS among the tests were significant (P=0.008). CSBS-DP-ITC had the highest sensitivity (0.846), followed by M-CHAT (0.692) and ITSP (0.462). CONCLUSION: Our results indicate a higher prevalence of autism in children with birth weights <1,500 g at 2 years of age compared to the general population prevalence. The ASD diagnosis was associated with shorter gestation times and longer hospital stays. Our findings support the simultaneous use of more than one screening tests in order to increase screening sensitivity.

Department of Child Psychiatry Charles University 2nd Faculty of Medicine and University Hospital Motol Prague Czech Republic

Department of Pediatrics and Adolescent Medicine Charles University 1st Faculty of Medicine and General University Hospital Prague Czech Republic

Department of Pediatrics Charles University 2nd Faculty of Medicine and University Hospital Motol Prague Czech Republic

Department of Pediatrics Charles University Faculty of Medicine and University Hospital Hradec Kralove Czech Republic

Institute of Psychology Academy of Sciences Brno Czech Republic

Zobrazit více v PubMed

Hack M, Taylor HG, Schluchter M, Andreias L, Drotar D, Klein N. Behavioral outcomes of extremely low birth weight children at age 8 years. J Dev Behav Pediatr. 2009;30:122–130. PubMed PMC

Johnson S, Hollis C, Kochhar P, Hennessy E, Wolke D, Marlow N. Autism spectrum disorders in extremely preterm children. J Pediatr. 2010;156:525–531. PubMed

Pinto-Martin JA, Levy SE, Feldman JF, Lorenz JM, Paneth N, Whitaker AH. Prevalence of autism spectrum disorders in adolescents born weighing <2,000 grams. Pediatrics. 2011;128:883–891. PubMed PMC

Dudova I, Kasparova M, Markova D, et al. Screening for autism in preterm children with extremely low and very low birth weight. Neuropsychiatr Dis Treat. 2014;10:277–282. PubMed PMC

Baron-Cohen S, Scott FJ, Allison C, et al. Prevalence of autism-spectrum conditions: UK school-based population study. Br J Psychiatry. 2009;194:500–509. PubMed

Baio J. Prevalence of autism spectrum disorders among children aged 8 years – Autism and Developmental Disabilities Monitoring Network, 11 sites, United States, 2010. MMWR Surveill Summ. 2014;63(2):1–21. PubMed

Indredavik MS, Vik T, Skranes J, Brubakk AM. Positive screening results for autism in ex-preterm infants. Pediatrics. 2008;122:222–223. PubMed

Johnson S, Marlow N. Growing up after extremely preterm birth: lifespan mental health outcomes. Semin Fetal Neonatal Med. 2014;19:97–104. PubMed

Amaral DG, Dawson G, Geschwind DH, editors. Autism Spectrum Disorders. New York: Oxford University Press; 2011.

Helt M, Kelley E, Kinsbourne M, et al. Can children with autism recover? If so, how? Neuropsychol Rev. 2008;18:339–366. PubMed

Kamio Y, Tobimatsu S, Fukui H. Developmental disorders. In: Decety J, Cacioppo JT, editors. The Oxford Handbook of Social Neuroscience. New York: Oxford University Press; 2011. pp. 848–858.

Hrdlicka M, Dudova I. Controversies in autism: is a broader model of social disorders needed? Child Adolesc Psychiatry Ment Health. 2013;7:9. PubMed PMC

Yarri M, Eventov-Freidman S, Mankuta D, Bar-Oz B, Yirmiya N. Prematurity and autism spectrum disorders. In: Patel VB, Preedy VR, Martin CR, editors. Comprehensive Guide to Autism. New York: Springer; 2014. pp. 1371–1387.

Williamson KE, Jakobson LS. Social perception in children born at very low birthweight and its relationship with social/behavioral outcomes. J Child Psychol Psychiatry. 2014;55:990–998. PubMed PMC

Losh M, Esserman D, Anckarsater H, Sullivan PF, Lichtenstein P. Lower birth weight indicates higher risk of autistic traits in discordant twin pairs. Psychol Med. 2012;42:1091–1102. PubMed PMC

Kuzniewicz MW, Wi S, Qian Y, Walsh EM, Armstrong MA, Croen LA. Prevalence and neonatal factors associated with autism spectrum disorders in preterm infants. J Pediatr. 2014;164:20–25. PubMed

Leavey A, Zwaigenbaum L, Heavner K, Burstyn I. Gestational age at birth and risk of autism spectrum disorders in Alberta, Canada. J Pediatr. 2013;162:361–368. PubMed

Buchmayer S, Johansson S, Johansson A, Hultman CM, Sparen P, Cnattingius S. Can association between preterm birth and autism be explained by maternal or neonatal morbidity? Pediatrics. 2009;124:e817–e825. PubMed

Mackay DF, Smith GCS, Dobbie R, Cooper SA, Pell JP. Obstetric factors and different causes of special educational need: retrospective cohort study of 407 503 schoolchildren. BJOG. 2013;120:297–308. PubMed

Moore GS, Kneitel AW, Walker CK, Gilbertz WM, Xing G. Autism risk in small- and large-for-gestational-age infants. Am J Obstet Gynecol. 2012;206:314.e1–314.e9. PubMed PMC

Abel KM, Dalman C, Svensson AC, et al. Deviance in fetal growth and risk of autism spectrum disorder. Am J Psychiatry. 2013;170:391–398. PubMed

Robins DL, Fein D, Barton ML, Green A. The modified checklist for autism in toddlers: an initial study investigating the early detection of autism and pervasive developmental disorders. J Autism Dev Disord. 2001;31:131–144. PubMed

Wetherby AM, Brosnan-Maddox S, Peace V, Newton L. Validation of the infant-toddler checklist as a broadband screener for autism spectrum disorders from 9 to 24 months of age. Autism. 2008;12:487–511. PubMed PMC

Dunn W. Infant/Toddler Sensory Profile. User’s Manual. San Antonio, TX: The Psychological Corporation; 2002.

Lord C, Risi S, Lambrecht L, et al. The autism diagnostic observation schedule-generic: a standard measure of social and communication deficits associated with the spectrum of autism. J Autism Dev Disord. 2000;30:205–223. PubMed

Kim SH, Lord C. Combining information from multiple sources for the diagnosis of autism spectrum disorders for toddlers and young preschoolers from 12 to 47 months of age. J Child Psychol Psychiatry. 2012;53:143–151. PubMed PMC

World Health Organization . International Classification of Diseases. 10th ed. Geneva: WHO; 1992.

R Core Team . R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2013. Available from: http://www.R-project.org/

Hervé M. RVAideMemoire: Diverse Basic Statistical and Graphical Functions. R Package Version 0.9-27. 2013. Available from: http://CRAN.Rproject.org/package=RVAideMemoire.

Robin X, Turck N, Hainard A, et al. pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics. 2011;12:77. PubMed PMC

Kleinman JM, Robins DL, Ventola PE, et al. The modified checklist for autism in toddlers: a follow-up study investigating the early detection of autism spectrum disorders. J Autism Dev Disord. 2008;38:827–839. PubMed PMC

Kuban KC, O’Shea M, Allred EN, Tager-Flusberg H, Goldstein DJ, Leviton A. Positive screening of the Modified Checklist for Autism in Toddlers (M-CHAT) in extremely low gestational age newborns. J Pediatr. 2009;154:535–540. PubMed PMC

Moore T, Johnson S, Hennessy E, Marlow N. Screening for autism in extremely preterm infants: problems in interpretation. Dev Med Child Neurol. 2012;54:514–520. PubMed

Pierce K, Carter C, Weinfeld M, et al. Detecting, studying, and treating autism early: the one-year well-baby check-up approach. J Pediatr. 2011;159:458–465. PubMed PMC

Ben-Sasson A, Hen L, Fluss R, Cermak SA, Engel-Yeger B, Gal E. A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. J Autism Dev Disord. 2009;39:1–11. PubMed

Eeles AL, Spittle AJ, Anderson PJ, et al. Assessment of sensory processing in infants: a systematic review. Dev Med Child Neurol. 2013;55:314–326. PubMed

Wiggins LD, Robins DL, Bakeman R, Adamson LB. Brief report: sensory abnormalities as distinguishing symptoms of autism spectrum disorders in young children. J Autism Dev Disord. 2009;39:1087–1091. PubMed

Hrdlicka M, Vodicka J, Havlovicova M, Urbanek T, Blatny M, Dudova I. Brief report: significant differences in perceived odor pleasantness found in children with ASD. J Autism Dev Disord. 2011;41:524–527. PubMed

Stephens BE, Bann CM, Watson VE, et al. Screening for autism spectrum disorders in extremely preterm infants. J Dev Behav Pediatr. 2012;33:535–541. PubMed PMC

A possible role of the Infant/Toddler Sensory Profile in screening for autism: a proof-of-concept study in the specific sample of prematurely born children with birth weights <1,500 g