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Gale-Grant O, Chew A, Falconer S, França LGS, Fenn-Moltu S, Hadaya L, Harper N, Ciarrusta J, Charman T, Murphy D, Arichi T, McAlonan G, Nosarti C, Edwards AD, Batalle D. Clinical, socio-demographic, and parental correlates of early autism traits in a community cohort of toddlers. Sci Rep 2024; 14:8393. [PMID: 38600134 PMCID: PMC11006842 DOI: 10.1038/s41598-024-58907-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
Identifying factors linked to autism traits in the general population may improve our understanding of the mechanisms underlying divergent neurodevelopment. In this study we assess whether factors increasing the likelihood of childhood autism are related to early autistic trait emergence, or if other exposures are more important. We used data from 536 toddlers from London (UK), collected at birth (gestational age at birth, sex, maternal body mass index, age, parental education, parental language, parental history of neurodevelopmental conditions) and at 18 months (parents cohabiting, measures of socio-economic deprivation, measures of maternal parenting style, and a measure of maternal depression). Autism traits were assessed using the Quantitative Checklist for Autism in Toddlers (Q-CHAT) at 18 months. A multivariable model explained 20% of Q-CHAT variance, with four individually significant variables (two measures of parenting style and two measures of socio-economic deprivation). In order to address variable collinearity we used principal component analysis, finding that a component which was positively correlated with Q-CHAT was also correlated to measures of parenting style and socio-economic deprivation. Our results show that parenting style and socio-economic deprivation correlate with the emergence of autism traits at age 18 months as measured with the Q-CHAT in a community sample.
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Affiliation(s)
- Oliver Gale-Grant
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK.
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK.
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK.
| | - Andrew Chew
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - Shona Falconer
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - Lucas G S França
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
- Department of Computer and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle Upon Tyne, UK
| | - Sunniva Fenn-Moltu
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - Laila Hadaya
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nicholas Harper
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
| | - Judit Ciarrusta
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
- Department of Paediatric Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Bioengineering, Imperial College London, London, UK
| | - Grainne McAlonan
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Chiara Nosarti
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A David Edwards
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Dafnis Batalle
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16, De Crespigny Park, London, SE5 8AF, UK
- Centre for the Developing Brain, School of Imaging Sciences & Biomedical Engineering, King's College London, London, UK
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McFayden TC, Harrop C, Roell K, Joseph RM, Fry RC, O'Shea TM. Sex Differences in Autistic Youth Born Extremely Preterm. J Autism Dev Disord 2024:10.1007/s10803-024-06319-0. [PMID: 38489107 DOI: 10.1007/s10803-024-06319-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE To evaluate sex differences in autistic traits in youth born extremely preterm (EP; 23-27 weeks) who were later diagnosed with autism spectrum disorder (ASD) at 10-years. METHOD A longitudinal cohort design from the Extremely Low Gestational Age Newborn Study (ELGAN) followed N = 857 EP infants from birth through 10-years. EP infants later diagnosed with ASD (N = 61, 20 females) participated in the study. Group differences were evaluated via inferential and Bayesian statistics (values > 1 suggest evidence for alternate hypothesis) on ASD screeners (M-CHAT at 2-years, SCQ and SRS-2 at 10-years), and gold-standard diagnostic measures (ADOS-2, ADI-R) at 10-years. RESULTS Males scored significantly higher than females on measures of Social Affect from the ADOS-2, t(34.27)=-2.20, BF10 = 2.33, and measures of Repetitive and Restricted Behaviors from the ADI-R, t(40.52)=-2.85, BF10 = 5.26. Bayesian estimates suggested marginal evidence for sex differences in Nonverbal Communication, t(30.66)=-1.81, BF10 = 1.25, and Verbal Communication, t(24.64)=-1.89, BF10 = 1.39, from the ADI-R, wherein males scored higher than females. No statistically significant sex differences were identified on any of the ASD screeners at 2 (M-CHAT) or 10 years (SCQ). No significant sex differences were observed on any subscales of the SRS at 10 years. CONCLUSIONS EP autistic males present with more autistic traits than EP autistic females on gold-standard diagnostic measures of autism at 10-years of age, despite not presenting with higher autistic traits on screeners at either age. These results align with sex differences observed in full-term, autistic youth. These results suggest ASD screeners may under identify autism in EP youth, particularly females.
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Affiliation(s)
- Tyler C McFayden
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
| | - Clare Harrop
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- TEACCH Autism Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kyle Roell
- Gillings School of Global Public Health, Department of Environmental Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- The Institute for Environmental Health Solutions, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert M Joseph
- Department of Anatomy and Neurobiology, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Rebecca C Fry
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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3
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Potenzieri A, Uccella S, Preiti D, Pisoni M, Rosati S, Lavarello C, Bartolucci M, Debellis D, Catalano F, Petretto A, Nobili L, Fellin T, Tucci V, Ramenghi LA, Savardi A, Cancedda L. Early IGF-1 receptor inhibition in mice mimics preterm human brain disorders and reveals a therapeutic target. SCIENCE ADVANCES 2024; 10:eadk8123. [PMID: 38427732 PMCID: PMC10906931 DOI: 10.1126/sciadv.adk8123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/29/2024] [Indexed: 03/03/2024]
Abstract
Besides recent advances in neonatal care, preterm newborns still develop sex-biased behavioral alterations. Preterms fail to receive placental insulin-like growth factor-1 (IGF-1), a major fetal growth hormone in utero, and low IGF-1 serum levels correlate with preterm poor neurodevelopmental outcomes. Here, we mimicked IGF-1 deficiency of preterm newborns in mice by perinatal administration of an IGF-1 receptor antagonist. This resulted in sex-biased brain microstructural, functional, and behavioral alterations, resembling those of ex-preterm children, which we characterized performing parallel mouse/human behavioral tests. Pharmacological enhancement of GABAergic tonic inhibition by the U.S. Food and Drug Administration-approved drug ganaxolone rescued functional/behavioral alterations in mice. Establishing an unprecedented mouse model of prematurity, our work dissects the mechanisms at the core of abnormal behaviors and identifies a readily translatable therapeutic strategy for preterm brain disorders.
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Affiliation(s)
- Alberto Potenzieri
- Brain Development and Disease Laboratory, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genoa, Italy
- Università degli Studi di Genova, via Balbi, 5, 16126 Genoa, Italy
| | - Sara Uccella
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Patologia Neonatale, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Deborah Preiti
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Patologia Neonatale, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Matteo Pisoni
- Optical Approaches to Brain Function Laboratory, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genoa, Italy
| | - Silvia Rosati
- Brain Development and Disease Laboratory, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genoa, Italy
| | - Chiara Lavarello
- Core Facilities - Clinical Proteomics and Metabolomics, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147 Genoa, Italy
| | - Martina Bartolucci
- Core Facilities - Clinical Proteomics and Metabolomics, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147 Genoa, Italy
| | - Doriana Debellis
- Electron Microscopy Facility, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genoa, Italy
| | - Federico Catalano
- Electron Microscopy Facility, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genoa, Italy
| | - Andrea Petretto
- Core Facilities - Clinical Proteomics and Metabolomics, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147 Genoa, Italy
| | - Lino Nobili
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Tommaso Fellin
- Optical Approaches to Brain Function Laboratory, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genoa, Italy
| | - Valter Tucci
- Genetics and Epigenetics of Behavior (GEB) Laboratory, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genoa, Italy
| | - Luca A. Ramenghi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- Patologia Neonatale, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Annalisa Savardi
- Brain Development and Disease Laboratory, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genoa, Italy
| | - Laura Cancedda
- Brain Development and Disease Laboratory, Istituto Italiano di Tecnologia, via Morego, 30, 16163 Genoa, Italy
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4
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Al-Beltagi M. Pre-autism: What a paediatrician should know about early diagnosis of autism. World J Clin Pediatr 2023; 12:273-294. [PMID: 38178935 PMCID: PMC10762597 DOI: 10.5409/wjcp.v12.i5.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/07/2023] [Accepted: 09/25/2023] [Indexed: 12/08/2023] Open
Abstract
Autism, also known as an autism spectrum disorder, is a complex neurodevelopmental disorder usually diagnosed in the first three years of a child's life. A range of symptoms characterizes it and can be diagnosed at any age, including adolescence and adulthood. However, early diagnosis is crucial for effective management, prognosis, and care. Unfortunately, there are no established fetal, prenatal, or newborn screening programs for autism, making early detection difficult. This review aims to shed light on the early detection of autism prenatally, natally, and early in life, during a stage we call as "pre-autism" when typical symptoms are not yet apparent. Some fetal, neonatal, and infant biomarkers may predict an increased risk of autism in the coming baby. By developing a biomarker array, we can create an objective diagnostic tool to diagnose and rank the severity of autism for each patient. These biomarkers could be genetic, immunological, hormonal, metabolic, amino acids, acute phase reactants, neonatal brainstem function biophysical activity, behavioral profile, body measurements, or radiological markers. However, every biomarker has its accuracy and limitations. Several factors can make early detection of autism a real challenge. To improve early detection, we need to overcome various challenges, such as raising community awareness of early signs of autism, improving access to diagnostic tools, reducing the stigma attached to the diagnosis of autism, and addressing various culturally sensitive concepts related to the disorder.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatric, Faculty of Medicine, Tanta University, Tanta 31511, Algahrbia, Egypt
- Department of Pediatric, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Manama, Bahrain
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5
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Lean RE, Gerstein ED, Smyser TA, Smyser CD, Rogers CE. Socioeconomic disadvantage and parental mood/affective problems links negative parenting and executive dysfunction in children born very preterm. Dev Psychopathol 2023; 35:1092-1107. [PMID: 34725016 PMCID: PMC9058043 DOI: 10.1017/s0954579421000961] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Poverty increases the risk of poorer executive function (EF) in children born full-term (FT). Stressors associated with poverty, including variability in parenting behavior, may explain links between poverty and poorer EF, but this remains unclear for children born very preterm (VPT). We examine socioeconomic and parental psychosocial adversity on parenting behavior, and whether these factors independently or jointly influence EF in children born VPT. At age five years, 154 children (VPT = 88, FT = 66) completed parent-child interaction and EF tasks. Parental sensitivity, intrusiveness, cognitive stimulation, and positive and negative regard were coded with the Parent-Child Interaction Rating Scale. Socioeconomic adversity spanned maternal demographic stressors, Income-to-Needs ratio, and Area Deprivation Index. Parents completed measures of depression, anxiety, inattention/hyperactivity, parenting stress, and social-communication interaction (SCI) problems. Parental SCI problems were associated with parenting behavior in parents of children born VPT, whereas socioeconomic adversity was significant in parents of FT children. Negative parenting behaviors, but not positive parenting behaviors, were related to child EF. This association was explained by parental depression/anxiety symptoms and socioeconomic adversity. Results persisted after adjustment for parent and child IQ. Findings may inform research on dyadic interventions that embed treatment for parental mood/affective symptoms and SCI problems to improve childhood EF.
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Affiliation(s)
- Rachel E Lean
- Psychiatry, Washington University School of Medicine, St. Louis, USA
| | - Emily D Gerstein
- Psychological Sciences, University Missouri-St. Louis, St. Louis, USA
| | - Tara A Smyser
- Psychiatry, Washington University School of Medicine, St. Louis, USA
| | - Christopher D Smyser
- Neurology, Washington University School of Medicine, St. Louis, USA
- Radiology, Washington University School of Medicine, St. Louis, USA
- Pediatrics, Washington University School of Medicine, St. Louis, USA
| | - Cynthia E Rogers
- Psychiatry, Washington University School of Medicine, St. Louis, USA
- Pediatrics, Washington University School of Medicine, St. Louis, USA
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6
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Nagai Y, Mizutani Y, Nomura K, Uemura O, Saitoh S, Iwata O. Autistic traits of children born very preterm assessed using Autism Diagnostic Observation Schedule, Second Edition. Early Hum Dev 2023; 176:105716. [PMID: 36708635 DOI: 10.1016/j.earlhumdev.2023.105716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/21/2023] [Accepted: 01/21/2023] [Indexed: 01/26/2023]
Abstract
Preterm birth has been linked with increased incidence of autism spectrum disorder (ASD). Despite the remarkable difference in the clinical backgrounds between ASD children born preterm and term, cross-sectional studies have found no striking difference in their autistic traits. To highlight autistic traits related with preterm birth, children born very preterm (prospective birth cohort, n = 50) and term (case cohort, n = 16), who were diagnosed as "Autism" by the Autism Diagnostic Observation Schedule (ADOS), 2nd edition, were compared using the calibrated severity scores of ADOS-2 and T-scores of the Social Responsiveness Scale, 2nd edition. No significant difference was found in the calibrated severity scores between ASD children born preterm and term. There was a trend that T-scores were smaller for the preterm cohort, which did not reach a statistical significance. Even when detailed cross-sectional information was obtained using ADOS-2, no difference in autistic traits was observed between children born very preterm and term. Our findings were consistent with a previous study, which assessed the entire prospective cohort of children born very preterm and found no difference in original ADOS scores. Further studies are warranted to delineate how preterm birth affects the autistic traits and their parental perception in a large prospective cohort.
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Affiliation(s)
- Yukiyo Nagai
- Department of Pediatrics, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Aichi, Japan.
| | - Yuko Mizutani
- Center for Human Development and Family Science, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Kayo Nomura
- Department of Education, Gifu Shotoku Gakuen University, Gifu, Japan
| | - Osamu Uemura
- Department of Pediatrics, Ichinomiya Medical Treatment & Habilitation Center, Aichi, Japan
| | - Shinji Saitoh
- Center for Human Development and Family Science, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Osuke Iwata
- Center for Human Development and Family Science, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
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7
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Firestein MR, Myers MM, Feder KJ, Ludwig RJ, Welch MG. Effects of Family Nurture Intervention in the NICU on Theory of Mind Abilities in Children Born Very Preterm: A Randomized Controlled Trial. CHILDREN (BASEL, SWITZERLAND) 2022; 9:284. [PMID: 35205004 PMCID: PMC8870221 DOI: 10.3390/children9020284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 01/21/2023]
Abstract
Preterm infants are at risk for socioemotional deficits, neurodevelopmental disorders, and potentially theory of mind (ToM) deficits. Preterm infants enrolled in a randomized controlled trial in the neonatal intensive care unit (NICU) received Standard Care (SC) or Family Nurture Intervention (FNI). Children (N = 72; median age 61.8 ± 2.6 months; FNI: 35 (55%), SC:2 9 (45%)) completed a ToM task, of whom 64 (54% male; born to White (43.8%), Black (18.7%), and Hispanic (25.0%) mothers) contributed to this analysis. FNI and SC infants born extremely preterm to very preterm differed significantly: 78% (14 of 18) of FNI children passed vs. 30% (3 of 10) SC children (p = 0.01, effect size = 1.06). This large effect size suggests that FNI in the NICU may ameliorate deficits in social-cognitive skills of extreme to very preterm infants by school age.
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Affiliation(s)
- Morgan R. Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.M.M.); (M.G.W.)
| | - Michael M. Myers
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.M.M.); (M.G.W.)
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA;
| | | | - Robert J. Ludwig
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA;
| | - Martha G. Welch
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.M.M.); (M.G.W.)
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA;
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8
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Bosch T, Salavati S, Ter Horst HJ, Bos AF, den Heijer AE. Favorable parental perception of behaviour at two years' corrected age in very preterm-born children. Early Hum Dev 2021; 163:105504. [PMID: 34749129 DOI: 10.1016/j.earlhumdev.2021.105504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022]
Abstract
Problems in behavioural and emotional outcome are amongst the long-term sequelae of preterm birth. The exact prevalence and associations with perinatal risk factors are unknown. Minimal research has been performed in pre-school aged children, compared to school age. The primary aim of this study was to determine the prevalence of parent-reported behavioural and emotional problems at the age of two in children born at less than 30 weeks' gestational age and/or birth weight less than 1000 g. The secondary aim was to determine whether perinatal factors were associated with the behavioural and emotional outcome. Perinatal characteristics of 144 preterm-born children from the NeoLiFeS cohort were collected retrospectively. Of these children, 101 parents filled out a Childs Behaviour Checklist (CBCL) at the corrected age of two. The results of the CBCL tests were presented as Z-scores, a Z-score of 0 indicating the mean of behavioural scores in the norm population. A Z-score higher than zero indicates less behavioural problems than average, a negative Z-score indicates more problems. Associations between perinatal risk factors and CBCL-scores were analysed using linear regression analyses. Prevalences of clinically relevant CBCL scores were low, 4%, 2% and 5% for total score, internalizing score or externalizing score, respectively. Being part of a twin was associated with higher internalizing Z-scores, indicating less problems in emotional behaviour. Bronchopulmonary dysplasia was associated with lower Z-scores in total and externalizing behaviour. In conclusion, in our cohort generally very few problems in behavioural and emotional outcome were reported at the age of two.
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Affiliation(s)
- Tess Bosch
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands.
| | - Sahar Salavati
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Hendrik J Ter Horst
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Arend F Bos
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne E den Heijer
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
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9
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Moerman F, Warreyn P, Demurie E, Boterberg S, Vermeirsch J, Roeyers H. Play in Relation to Autism Traits in Young Children at Elevated Likelihood for Autism Spectrum Disorder. J Autism Dev Disord 2021; 53:1413-1430. [PMID: 34668127 DOI: 10.1007/s10803-021-05326-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/29/2022]
Abstract
Play of younger siblings of children with autism spectrum disorder (ASD) (siblings; n = 44), very preterm children (preterms; n = 44), and children at typical likelihood for ASD (n = 36) was observed at 24 months. Children with ASD and atypical development engaged less in spontaneous (pre-)symbolic play than typically developing children. Total duration of spontaneous and elicited (pre-)symbolic play was associated with later ASD traits in siblings. However, no association between most play variables and ASD traits was found in preterms. This suggests possible different ASD-trajectories between siblings and preterms. Thus, spontaneous (pre-)symbolic play may be indicative of developmental challenges across several populations, and results highlight the need to move beyond studying only siblings in order to broaden our understanding of ASD.
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Affiliation(s)
- Floor Moerman
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium.
| | - Petra Warreyn
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - Ellen Demurie
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - Sofie Boterberg
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - Julie Vermeirsch
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - Herbert Roeyers
- Research in Developmental Disorders Lab, Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
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10
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Laverty C, Surtees A, O’Sullivan R, Sutherland D, Jones C, Richards C. The prevalence and profile of autism in individuals born preterm: a systematic review and meta-analysis. J Neurodev Disord 2021; 13:41. [PMID: 34548007 PMCID: PMC8454175 DOI: 10.1186/s11689-021-09382-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/16/2021] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Preterm birth (<37 weeks) adversely affects development in behavioural, cognitive and mental health domains. Heightened rates of autism are identified in preterm populations, indicating that prematurity may confer an increased likelihood of adverse neurodevelopmental outcomes. The present meta-analysis aims to synthesise existing literature and calculate pooled prevalence estimates for rates of autism characteristics in preterm populations. METHODS Search terms were generated from inspection of relevant high-impact papers and a recent meta-analysis. Five databases were searched from database creation until December 2020 with PRISMA guidelines followed throughout. RESULTS 10,900 papers were retrieved, with 52 papers included in the final analyses, further classified by assessment method (screening tools N=30, diagnostic assessment N=29). Pooled prevalence estimates for autism in preterm samples was 20% when using screening tools and 6% when using diagnostic assessments. The odds of an autism diagnosis were 3.3 times higher in individuals born preterm than in the general population. CONCLUSIONS The pooled prevalence estimate of autism characteristics in individuals born preterm is considerably higher than in the general population. Findings highlight the clinical need to provide further monitoring and support for individuals born preterm.
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Affiliation(s)
- Catherine Laverty
- School of Psychology, University of Birmingham, Birmingham, B15 2TT UK
| | - Andrew Surtees
- School of Psychology, University of Birmingham, Birmingham, B15 2TT UK
- Forward Thinking Birmingham, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Rory O’Sullivan
- School of Psychology, Loughborough University, Loughborough, LE11 3TU UK
| | - Daniel Sutherland
- School of Psychology, Loughborough University, Loughborough, LE11 3TU UK
| | - Christopher Jones
- School of Psychology, Loughborough University, Loughborough, LE11 3TU UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Birmingham, B15 2TT UK
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Use of Machine Learning to Investigate the Quantitative Checklist for Autism in Toddlers (Q-CHAT) towards Early Autism Screening. Diagnostics (Basel) 2021; 11:diagnostics11030574. [PMID: 33810146 PMCID: PMC8004748 DOI: 10.3390/diagnostics11030574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 01/13/2023] Open
Abstract
In the past two decades, several screening instruments were developed to detect toddlers who may be autistic both in clinical and unselected samples. Among others, the Quantitative CHecklist for Autism in Toddlers (Q-CHAT) is a quantitative and normally distributed measure of autistic traits that demonstrates good psychometric properties in different settings and cultures. Recently, machine learning (ML) has been applied to behavioral science to improve the classification performance of autism screening and diagnostic tools, but mainly in children, adolescents, and adults. In this study, we used ML to investigate the accuracy and reliability of the Q-CHAT in discriminating young autistic children from those without. Five different ML algorithms (random forest (RF), naïve Bayes (NB), support vector machine (SVM), logistic regression (LR), and K-nearest neighbors (KNN)) were applied to investigate the complete set of Q-CHAT items. Our results showed that ML achieved an overall accuracy of 90%, and the SVM was the most effective, being able to classify autism with 95% accuracy. Furthermore, using the SVM–recursive feature elimination (RFE) approach, we selected a subset of 14 items ensuring 91% accuracy, while 83% accuracy was obtained from the 3 best discriminating items in common to ours and the previously reported Q-CHAT-10. This evidence confirms the high performance and cross-cultural validity of the Q-CHAT, and supports the application of ML to create shorter and faster versions of the instrument, maintaining high classification accuracy, to be used as a quick, easy, and high-performance tool in primary-care settings.
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Roman-Urrestarazu A, Yáñez C, López-Garí C, Elgueta C, Allison C, Brayne C, Troncoso M, Baron-Cohen S. Autism screening and conditional cash transfers in Chile: Using the Quantitative Checklist (Q-CHAT) for early autism detection in a low resource setting. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 25:932-945. [PMID: 33327735 DOI: 10.1177/1362361320972277] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Getting a diagnosis of autism can take long, because autism is different across people, but also because it depends on the way it gets diagnosed. This is especially important in poorer countries or in the case of poor people living in wealthier countries that have significant groups of disadvantaged communities. We adapted a 10-item version of the Q-CHAT-25 questionnaire for use in routine health check-ups programme in Chile and recruited 287 participants under the age of three divided into three groups: Controls (125), Developmental Delay (149) and Autism Spectrum Condition (13). Our results show that a short questionnaire for autism screening can be successfully applied in a health-check programme in poor resource settings. Our results show that our questionnaire had good overall performance, not different to its longer version, the Q-CHAT-25. Our questionnaire was autism specific, with good sensitivity and reliability, and is suitable to be used in a screening setting. This study provides evidence that the implementation of Autism Spectrum Condition screening programmes using the Q-CHAT-10 provides value for money and improves diagnosis of Autism Spectrum Condition in those participating in routine health check-up programmes in developing countries or poor areas of wealthy countries.
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Affiliation(s)
- Andres Roman-Urrestarazu
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.,Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Carolina Yáñez
- Pediatric Neuropsychiatry Service, San Borja Arriarán Hospital, University of Chile, Santiago, Chile
| | - Claudia López-Garí
- Pediatric Neuropsychiatry Service, San Borja Arriarán Hospital, University of Chile, Santiago, Chile
| | - Constanza Elgueta
- Pediatric Neuropsychiatry Service, San Borja Arriarán Hospital, University of Chile, Santiago, Chile
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Mónica Troncoso
- Pediatric Neuropsychiatry Service, San Borja Arriarán Hospital, University of Chile, Santiago, Chile
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
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Scarlytt de Oliveira Holanda N, Delgado Oliveira da Costa L, Suelen Santos Sampaio S, Gomes da Fonseca Filho G, Batista Bezerra R, Guerra Azevedo I, Alves Pereira S. Screening for Autism Spectrum Disorder in Premature Subjects Hospitalized in a Neonatal Intensive Care Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207675. [PMID: 33096698 PMCID: PMC7589640 DOI: 10.3390/ijerph17207675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 02/06/2023]
Abstract
Considering that the average age for diagnosis of autism spectrum disorder (ASD) is 4–5 years, testing screening methods for ASD risk in early infancy is a public health priority. This study aims to identify the risks for development of ASD in children born prematurely and hospitalized in a neonatal intensive care unit (NICU) and explore the association with pre-, peri- and postnatal factors. Methods: The children’s families were contacted by telephone when their child was between 18 and 24 months of age, to apply the Modified Checklist for Autism in Toddlers (M-CHAT). The sample consisted of 40 children (57.5% boys). M-CHAT screening revealed that 50% of the sample showed early signs of ASD. Although the frequency of delayed development was higher in boys, this difference was not statistically significant between the sexes (p = 0.11). Assessment of the association between perinatal conditions and early signs of autism in children hospitalized in an NICU exhibited no correlation between the factors analyzed (birth weight and type of delivery). The findings indicate a high risk of ASD in premature children, demonstrating no associations with gestational and neonatal variables or the hospitalization conditions of the NICUs investigated.
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Affiliation(s)
- Norrara Scarlytt de Oliveira Holanda
- Physiotherapy Course, Universidade Federal do Rio Grande do Norte (UFRN), Natal 59078-970, Rio Grande do Norte, Brazil; (N.S.d.O.H.); (L.D.O.d.C.); (S.A.P.)
| | - Lidiane Delgado Oliveira da Costa
- Physiotherapy Course, Universidade Federal do Rio Grande do Norte (UFRN), Natal 59078-970, Rio Grande do Norte, Brazil; (N.S.d.O.H.); (L.D.O.d.C.); (S.A.P.)
| | - Sabrinne Suelen Santos Sampaio
- Post-graduation Program of Physiotherapy, Universidade Federal do Rio Grande do Norte (UFRN), Natal 59078-970, Rio Grande do Norte, Brazil; (S.S.S.S.); (G.G.d.F.F.)
| | - Gentil Gomes da Fonseca Filho
- Post-graduation Program of Physiotherapy, Universidade Federal do Rio Grande do Norte (UFRN), Natal 59078-970, Rio Grande do Norte, Brazil; (S.S.S.S.); (G.G.d.F.F.)
- Instituto Santos Dumont, Macaíba 59280-000, Rio Grande do Norte, Brazil
| | - Ruth Batista Bezerra
- Rehabilitation Sciences Graduate Program, Faculty of Health Sciences of Trairi/ Universidade Federal do Rio Grande do Norte (FACISA/UFRN), Santa Cruz 59200-000, Rio Grande do Norte, Brazil;
| | - Ingrid Guerra Azevedo
- Department of Therapeutic Processes, Universidad Católica de Temuco, Temuco 4813302, La Araucania, Chile
- Correspondence:
| | - Silvana Alves Pereira
- Physiotherapy Course, Universidade Federal do Rio Grande do Norte (UFRN), Natal 59078-970, Rio Grande do Norte, Brazil; (N.S.d.O.H.); (L.D.O.d.C.); (S.A.P.)
- Rehabilitation Sciences Graduate Program, Faculty of Health Sciences of Trairi/ Universidade Federal do Rio Grande do Norte (FACISA/UFRN), Santa Cruz 59200-000, Rio Grande do Norte, Brazil;
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Diagnosing Autism Spectrum Disorder in Toddlers Born Very Preterm: Estimated Prevalence and Usefulness of Screeners and the Autism Diagnostic Observation Schedule (ADOS). J Autism Dev Disord 2020; 51:1508-1527. [DOI: 10.1007/s10803-020-04573-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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15
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Kittler PM, Kim SY, Flory MJ, Phan HTT, Karmel BZ, Gardner JM. Effects of motion and audio-visual redundancy on upright and inverted face and feature preferences in 4-13-month old pre- and full-term NICU graduates. Infant Behav Dev 2020; 60:101439. [PMID: 32438215 PMCID: PMC7671943 DOI: 10.1016/j.infbeh.2020.101439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/05/2020] [Accepted: 03/17/2020] [Indexed: 01/01/2023]
Abstract
NICU infants are reported to have diminished social orientation and increased risk of socio-communicative disorders. In this eye tracking study, we used a preference for upright compared to inverted faces as a gauge of social interest in high medical risk full- and pre-term NICU infants. We examined the effects of facial motion and audio-visual redundancy on face and eye/mouth preferences across the first year. Upright and inverted baby faces were simultaneously presented in a paired-preference paradigm with motion and synchronized vocalization varied. NICU risk factors including birth weight, sex, and degree of CNS injury were examined. Overall, infants preferred the more socially salient upright faces, making this the first report, to our knowledge, of an upright compared to inverted face preference among high medical risk NICU infants. Infants with abnormalities on cranial ultrasound displayed lower social interest, i.e. less of a preferential interest in upright faces, when viewing static faces. However, motion selectively increased their upright face looking time to a level equal that of infants in other CNS injury groups. We also observed an age-related sex effect suggesting higher risk in NICU males. Females increased their attention to the mouth in upright faces across the first year, especially between 7-10 months, but males did not. Although vocalization increased diffuse attention toward the screen, contrary to our predictions, there was no evidence that the audio-visual redundancy embodied in a vocalizing face focused additional attention on upright faces or mouths. This unexpected result may suggest a vulnerability in response to talking faces among NICU infants that could potentially affect later verbal and socio-communicative development.
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Affiliation(s)
- P M Kittler
- Department of Infant Development, New York State Institute for Basic Research in Developmental Disabilities, United States.
| | - S-Y Kim
- Department of Infant Development, New York State Institute for Basic Research in Developmental Disabilities, United States
| | - M J Flory
- Department of Infant Development, New York State Institute for Basic Research in Developmental Disabilities, United States
| | - H T T Phan
- Department of Infant Development, New York State Institute for Basic Research in Developmental Disabilities, United States
| | - B Z Karmel
- Department of Infant Development, New York State Institute for Basic Research in Developmental Disabilities and Department of Pediatrics, Richmond University Medical Center, United States
| | - J M Gardner
- Department of Infant Development, New York State Institute for Basic Research in Developmental Disabilities and Department of Pediatrics, Richmond University Medical Center, United States
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16
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Mateus V, Vieira EDAP, Martins C, Pachi PR, Osório A. Joint attention abilities in Brazilian preterm and full-term infants. Infant Behav Dev 2020; 60:101451. [PMID: 32512275 DOI: 10.1016/j.infbeh.2020.101451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 11/24/2022]
Abstract
Joint attention abilities of preterm and full-term Brazilian infants were assessed at 12- and 18-months, age corrected for prematurity. Results showed that preterm infants displayed significantly lower levels of correct responses to others' bids for joint attention at both time-points, compared to full-term infants. Both groups improved their responding to joint attention from 12 to 18 months of age. Contrastingly, prematurity did not impact infants' initiating joint attention behaviors, which remained stable over time for both groups. Findings were discussed in terms of the specific mental processes involved in distinct behavioural dimensions of joint attention.
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Affiliation(s)
- Vera Mateus
- Social and Cognitive Neuroscience Lab, Developmental Disorders Graduate Program, Mackenzie Presbyterian University, Brazil
| | - Elisangela Dos Anjos Paula Vieira
- Social and Cognitive Neuroscience Lab, Developmental Disorders Graduate Program, Mackenzie Presbyterian University, Brazil; Anhanguera University Centre of São Paulo - Pirituba Unit, Brazil
| | - Carla Martins
- School of Psychology, CIPsi, University of Minho, Portugal
| | - Paulo Roberto Pachi
- Faculty of Medical Sciences, Santa Casa de Misericórdia de São Paulo, Brazil
| | - Ana Osório
- Social and Cognitive Neuroscience Lab, Developmental Disorders Graduate Program, Mackenzie Presbyterian University, Brazil.
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17
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Vermandel A, Van Hall G, Van der Cruyssen K, Van Aggelpoel T, Neels H, De Win G, De Wachter S. 'Elimination signals' in healthy, NON toilet trained children aged 0-4 years: A systematic review. J Pediatr Urol 2020; 16:342-349. [PMID: 32253149 DOI: 10.1016/j.jpurol.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 03/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE An early start of toilet training, which is related to a younger age of acquiring full bladder control, can generate important health advantages. Children display different 'elimination signals' related to voiding or defaecation. The aim of this systematic review is to map these 'elimination signals' in young, healthy children aged 0-4 years. METHOD The systematic literature search was performed in two databases and was conducted using the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement). RESULTS Two main distinctions in elimination signals were made. The first could be classified as visual, auditory and tactile, most frequently involving a change in facial expression, often combined with body movements and verbal expressions such as a short cry or grunting. Secondly significant changes in heart rate, respiratory frequency or EEG frequency could be defined as 'clinically assessed elimination signals'. CONCLUSION Different 'elimination signals' could be detected in healthy children while voiding or defaecating and should be observed when initiating toilet training. Detection of noticeable visual, auditory and tactile signals will facilitate and shorten this process.
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Affiliation(s)
- Alexandra Vermandel
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Guido Van Hall
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium.
| | | | - Tinne Van Aggelpoel
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Hedwig Neels
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Gunter De Win
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Stefan De Wachter
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
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18
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Yang YC, Lu L, Jeng SF, Tsao PN, Cheong PL, Li YJ, Wang SY, Huang HC, Wu YT. Multidimensional Developments and Free-Play Movement Tracking in 30- to 36-Month-Old Toddlers With Autism Spectrum Disorder Who Were Full Term. Phys Ther 2019; 99:1535-1550. [PMID: 31392998 DOI: 10.1093/ptj/pzz114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/28/2019] [Accepted: 03/31/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND Few studies have investigated multidimensional developments and free-play movement performance in toddlers with an early diagnosis of autism spectrum disorder (ASD). OBJECTIVE This study compared cognitive, motor, and behavioral developments and free-play movement performance in toddlers with ASD who were full term (FT-ASD), toddlers who were full term and are typically developing (FT-TD), and toddlers who were born preterm and had a very low birth weight (VLBW-PT). DESIGN This was a prospective cross-sectional study. METHODS Forty-five 30- to 36-month-old age-matched toddlers were recruited and divided into FT-ASD, FT-TD, and VLBW-PT groups. Their developments were examined using the Mullen Scales of Early Learning; the Peabody Developmental Motor Scales, Second Edition; the Child Behavior Checklist for Ages 1.5 to 5; and the Repetitive Behavior Scale-Revised. In addition, the toddlers' free-play movements were tracked in laboratory settings using an automatic movement tracking system. RESULTS Toddlers with FT-ASD exhibited lower cognitive and motor scores and a higher degree of behavioral problems compared with toddlers with FT-TD or VLBW-PT. Furthermore, the movement tracking data in a free-play setting revealed that toddlers with FT-ASD displayed a higher degree of turning velocity, a higher moving time, and a higher frequency of moving toward the peripheral region compared with toddlers with FT-TD or VLBW-PT. Moreover, several motor developmental and movement-tracking indicators were found to correlate with behavioral problems and cognitive scores in toddlers with FT-ASD. LIMITATIONS The study results may have been affected by the small sample size, the cross-sectional design, and tracking only the whole body without subtle movements or segmental motions. CONCLUSIONS The findings suggest varied aspects of co-occurring developmental conditions and movement-based problems in toddlers with FT-ASD. Using standardized and sensitive measures for the early assessment of perceptuo-motor impairments is necessary for timely early intervention for such toddlers.
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Affiliation(s)
- Yu-Ching Yang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Lu Lu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Suh-Fang Jeng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Children Hospital, Taipei, Taiwan
| | - Pou-Leng Cheong
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yao-Jen Li
- Institute of Epidemiology and Prevention Medicine, National Taiwan University
| | - Shih-Ya Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University
| | - Hsiao-Ching Huang
- School and Graduate Institute of Psychology, National Taiwan University
| | - Yen-Tzu Wu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Room 317, Floor 3, No. 17, Xu-Zhou Road, Taipei 10055, Taiwan; and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital
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Mateus V, Osório A, Martins C. Effects of prematurity on infants' joint attention abilities: A meta‐analytic study. INFANT AND CHILD DEVELOPMENT 2019. [DOI: 10.1002/icd.2145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Vera Mateus
- School of Psychology, CIPsiUniversity of Minho Braga Portugal
| | - Ana Osório
- Social and Cognitive Neuroscience Lab, Developmental Disorders ProgramMackenzie Presbyterian University São Paulo Brazil
| | - Carla Martins
- School of Psychology, CIPsiUniversity of Minho Braga Portugal
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20
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Ruta L, Chiarotti F, Arduino GM, Apicella F, Leonardi E, Maggio R, Carrozza C, Chericoni N, Costanzo V, Turco N, Tartarisco G, Gagliano A, Allison C, Baron Cohen S, Pioggia G, Muratori F. Validation of the Quantitative Checklist for Autism in Toddlers in an Italian Clinical Sample of Young Children With Autism and Other Developmental Disorders. Front Psychiatry 2019; 10:488. [PMID: 31427993 PMCID: PMC6690232 DOI: 10.3389/fpsyt.2019.00488] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/21/2019] [Indexed: 12/19/2022] Open
Abstract
Background: The Quantitative Checklist for Autism in Toddlers (Q-CHAT) is parent-report screening questionnaire for detecting threshold and sub-threshold autistic features in toddlers. The Q-CHAT is a dimensional measure normally distributed in the general population sample and is able to differentiate between a group of children with a diagnosis of autism and unselected toddlers. Objectives: We aim to investigate the psychometric properties, score distribution, and external validity of the Q-CHAT in an Italian clinical sample of young children with autism versus children with developmental delay and typically developing children. Method: N = 126 typically developing children (TD), n = 139 children with autism, and n = 50 children presenting developmental delay (DD) were administered the Q-CHAT. Standardized measures of cognitive functions, language, and behaviors were also obtained. Results: The Q-CHAT scores were normally distributed and demonstrated adequate internal consistency and good item to total score correlations. The mean Q-CHAT score in the autism group was significantly higher than those found in the DD sample and TD children. No difference on the mean Q-CHAT score between DD and TD children was found. The accuracy of the Q-CHAT to discriminate between autism and TD was very good. Two different cut-points (27 and 31, respectively) maximized sensitivity and specificity for autism versus TD and DD, respectively. Finally, higher Q-CHAT scores were correlated with lower language and social communication skills. Conclusions: In clinical settings, the Q-CHAT demonstrated good psychometric properties and external validity to discriminate autism children not just from children with typical development but also from children with developmental delay.
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Affiliation(s)
- Liliana Ruta
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Messina, Italy.,Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
| | - Flavia Chiarotti
- Center for Behavioral Sciences and Mental Health, National Institute of Health, Rome, Italy
| | | | - Fabio Apicella
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
| | - Elisa Leonardi
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Messina, Italy
| | | | - Cristina Carrozza
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Messina, Italy
| | - Natasha Chericoni
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
| | - Valeria Costanzo
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
| | - Nazarena Turco
- Centro Autismo e Sindrome di Asperger ASLCN1, Mondovì, Italy
| | - Gennaro Tartarisco
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Messina, Italy
| | | | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Simon Baron Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Messina, Italy
| | - Filippo Muratori
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy.,University of Pisa, Pisa, Italy
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Long-Term Follow-Up of the Very Preterm Graduate. Neurology 2019. [DOI: 10.1016/b978-0-323-54392-7.00016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Okuno M, Uehara T. Early childhood behavioral features that discriminate autism from other developmental problems in Japan. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2018; 31:23-29. [PMID: 30156364 DOI: 10.1111/jcap.12205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/31/2018] [Accepted: 07/15/2018] [Indexed: 11/29/2022]
Abstract
PROBLEM The criteria for early detection of autism spectrum disorder (ASD) and its discrimination from other developmental problems (ODP) are not clear. The Social Attention and Communication Study, which identified methods for early identification of ASD in community settings, was modified to the Japanese situation, and we examined its discriminant validity. METHODS This study followed a cohort of newborns in one town for 4 years. Structured behavioral assessments were added to the standardized health examination and performed five times during toddlerhood. Of the 264 children included in the statistical analysis, four were diagnosed with ASD, and four were diagnosed with ODP. FINDINGS A canonical discrimination analysis indicated two significant functions. Canonical 1, which involved disturbances of "eye contact" at 27 months and "concept comprehension" at 38 months, characterized both ASD and ODP. Canonical 2, which involved disturbances of "response name call" at 15 months, "showing" at 27 months, and negative loading of vocabulary development at 20 months, discriminated between ASD and ODP. The canonical plot showed good separation, but a few cases were misclassified. CONCLUSIONS Evaluations of early behavioral signs by public health nurses during general toddler examinations could be useful and convenient.
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Affiliation(s)
- Midori Okuno
- Department of Nursing, Nihon Institute of Medical Science, Saitama, Japan
| | - Toru Uehara
- Department of Social Welfare, Graduate School of Health and Welfare, Takasaki University of Health and Welfare, Takasaki, Japan
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23
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Boldin AM, Geiger R, Emberson LL. The emergence of top-down, sensory prediction during learning in infancy: A comparison of full-term and preterm infants. Dev Psychobiol 2018; 60:544-556. [PMID: 29687654 DOI: 10.1002/dev.21624] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 02/01/2018] [Indexed: 01/05/2023]
Abstract
Prematurity alters developmental trajectories in preterm infants even in the absence of medical complications. Here, we use fNIRS and learning tasks to probe the nature of the developmental differences between preterm and full-term born infants. Our recent work has found that prematurity disrupts the ability to engage in top-down sensory prediction after learning. We now examine the neural changes during the learning that precede prediction. In full-terms, we found modulation of all cortical regions examined during learning (temporal, frontal, and occipital). By contrast, preterm infants had no evidence of neural changes in the occipital lobe selectively. This is striking as the learning task leads to the emergence of visual prediction. Moreover, the shape of individual infants' occipital lobe trajectories (regardless of prematurity) predicts subsequent visual prediction abilities. These results suggest that modulation of sensory cortices during learning is closely related to the emergence of top-down signals and further indicates that developmental differences in premature infants may be associated with deficits in top-down processing.
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Affiliation(s)
- Alex M Boldin
- Department of Psychology, Princeton University, Princeton, New Jersey
| | - Romin Geiger
- Department of Psychology, Tennessee State University, Nashville, Tennessee
| | - Lauren L Emberson
- Department of Psychology, Princeton University, Princeton, New Jersey
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Bröring T, Oostrom KJ, van Dijk-Lokkart EM, Lafeber HN, Brugman A, Oosterlaan J. Attention deficit hyperactivity disorder and autism spectrum disorder symptoms in school-age children born very preterm. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 74:103-112. [PMID: 29413425 DOI: 10.1016/j.ridd.2018.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 11/21/2017] [Accepted: 01/06/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Very preterm (VP) children face a broad range of neurodevelopmental sequelae, including behavioral problems. AIM To investigate prevalence, pervasiveness and co-occurrence of symptoms of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in school-age children born very preterm. METHODS Using questionnaire and diagnostic interview data, parent and teacher reported symptoms of ADHD and ASD of 57 VP-children (mean age = 9.2 years) were compared with 57 gender and age matched full-term children using t-tests. Intra-class correlation coefficients quantified parent-teacher agreement. Correlation analysis investigated co-occurrence of ADHD/ASD symptoms. ADHD/ASD measures were aggregated using principal component analysis. Regression analyses investigated the contribution of perinatal risk factors, sex and SES to ADHD/ASD symptoms. RESULTS VP-children showed higher levels of parent and teacher reported attention problems, social impairment and compromised communication skills. Fair to strong agreement was found between parent and teacher reported ADHD and ASD symptoms, indicating pervasiveness of observed difficulties. Co-occurrence of ADHD and ASD symptoms in VP-children was found. Lower gestational age was associated with higher ADHD and ASD symptom levels, male sex with higher ADHD symptom levels and lower SES with higher ASD symptom levels. CONCLUSION School-age VP-children show higher levels of ADHD and ASD symptoms, and attention, socialization and communication difficulties in particular. Routinely screening for these problems is recommended in follow-up care.
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Affiliation(s)
- Tinka Bröring
- Department of Medical Psychology, VU University Medical Center, de Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
| | - Kim J Oostrom
- Department of Medical Psychology, VU University Medical Center, de Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands; Psychosocial Department, Emma Children's Hospital/Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Elisabeth M van Dijk-Lokkart
- Department of Medical Psychology, VU University Medical Center, de Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
| | - Harrie N Lafeber
- Department of Pediatrics, VU University Medical Center, Amsterdam, de Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
| | - Anniek Brugman
- Department of Medical Psychology, VU University Medical Center, de Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
| | - Jaap Oosterlaan
- Department of Pediatrics, VU University Medical Center, Amsterdam, de Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands; Department of Pediatrics, Emma Children's Hospital/Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands; Clinical Neuropsychology section, Vrije Universiteit Amsterdam, van der Boechorstraat 1, 1081 BT, Amsterdam, The Netherlands.
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Child, Maternal and Demographic Factors Influencing Caregiver-Reported Autistic Trait Symptomatology in Toddlers. J Autism Dev Disord 2018; 48:1325-1337. [PMID: 29388148 DOI: 10.1007/s10803-018-3471-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Current research on children's autistic traits in the general population relies predominantly on caregiver-report, yet the extent to which individual, caregiver or demographic characteristics are associated with informants' ratings has not been sufficiently explored. In this study, caregivers of 396 Singaporean two-year-olds from a birth cohort study completed the Quantitative Checklist for Autism in Toddlers. Children's gender, cognitive functioning and birth order, maternal age, and ethnic group membership were not significant predictors of caregiver-reported autistic traits. Poorer child language development and higher maternal depressive symptoms significantly predicted more social-communicative autistic traits, while lower maternal education predicted more behavioural autistic traits. Children's language and informants' educational level and depressive symptomatology may need to be considered in caregiver-reports of autistic traits.
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Firestein MR, Abellar R, Myers MM, Welch MG. Increased trophoblast inclusions in placentas from prematurely born infants: A potential marker of risk for preterm neurodevelopmental outcomes. Placenta 2017; 60:61-63. [PMID: 29208241 DOI: 10.1016/j.placenta.2017.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/13/2017] [Accepted: 10/21/2017] [Indexed: 01/21/2023]
Abstract
Trophoblast inclusions (TIs) are placental abnormalities of the trophoblast bilayer. Present in 2-8% of full-term placentas, they are associated with poor neurodevelopment, including autism. Although previously unstudied, examination of chorionic villi from 108 preterm births revealed a ∼4 fold increase in the frequency of TIs (30.5%). Frequency of TIs was inversely related to gestational age (GA); 43% of placentas <30 weeks and 20% of placentas ≥32 weeks had TIs (χ2 = 4.41, p = 0.036). This increased prevalence in preterm infants suggests that TIs may indicate adverse intrauterine processes or undetected genetic abnormalities and could identify infants at risk for poor neurodevelopment.
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Affiliation(s)
| | - Rosanna Abellar
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Michael M Myers
- Department of Pediatrics, Columbia University Medical Center, New York, NY, 10032, USA; Department of Psychiatry, Columbia University Medical Center, New York, NY, 10032, USA
| | - Martha G Welch
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, NY, 10032, USA; Department of Pediatrics, Columbia University Medical Center, New York, NY, 10032, USA; Department of Psychiatry, Columbia University Medical Center, New York, NY, 10032, USA
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Linsell L, Malouf R, Morris J, Kurinczuk JJ, Marlow N. Risk Factor Models for Neurodevelopmental Outcomes in Children Born Very Preterm or With Very Low Birth Weight: A Systematic Review of Methodology and Reporting. Am J Epidemiol 2017; 185:601-612. [PMID: 28338817 DOI: 10.1093/aje/kww135] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/03/2016] [Indexed: 01/08/2023] Open
Abstract
The prediction of long-term outcomes in surviving infants born very preterm (VPT) or with very low birth weight (VLBW) is necessary to guide clinical management, provide information to parents, and help target and evaluate interventions. There is a large body of literature describing risk factor models for neurodevelopmental outcomes in VPT/VLBW children, yet few, if any, have been developed for use in routine clinical practice or adopted for use in research studies or policy evaluation. We sought to systematically review the methods and reporting of studies that have developed a multivariable risk factor model for neurodevelopment in surviving VPT/VLBW children. We searched the MEDLINE, Embase, and PsycINFO databases from January 1, 1990, to June 1, 2014, and identified 78 studies reporting 222 risk factor models. Most studies presented risk factor analyses that were not intended to be used for prediction, confirming that there is a dearth of specifically designed prognostic modeling studies for long-term outcomes in surviving VPT/VLBW children. We highlight the strengths and weaknesses of the research methodology and reporting to date, and provide recommendations for the design and analysis of future studies seeking to analyze risk prediction or develop prognostic models for VPT/VLBW children.
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Emberson LL, Boldin AM, Riccio JE, Guillet R, Aslin RN. Deficits in Top-Down Sensory Prediction in Infants At Risk due to Premature Birth. Curr Biol 2017; 27:431-436. [PMID: 28132814 DOI: 10.1016/j.cub.2016.12.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 11/08/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
A prominent theoretical view is that the brain is inherently predictive [1, 2] and that prediction helps drive the engine of development [3, 4]. Although infants exhibit neural signatures of top-down sensory prediction [5, 6], in order to establish that prediction supports development, it must be established that deficits in early prediction abilities alter trajectories. We investigated prediction in infants born prematurely, a leading cause of neuro-cognitive impairment worldwide [7]. Prematurity, independent of medical complications, leads to developmental disturbances [8-12] and a broad range of developmental delays [13-17]. Is an alteration in early prediction abilities the common cause? Using functional near-infrared spectroscopy (fNIRS), we measured top-down sensory prediction in preterm infants (born <33 weeks gestation) before infants exhibited clinically identifiable developmental delays (6 months corrected age). Whereas preterm infants had typical neural responses to presented visual stimuli, they exhibited altered neural responses to predicted visual stimuli. Importantly, a separate behavioral control confirmed that preterm infants detect pattern violations at the same rate as full-terms, establishing selectivity of this response to top-down predictions (e.g., not in learning an audiovisual association). These findings suggest that top-down sensory prediction plays a crucial role in development and that deficits in this ability may be the reason why preterm infants experience altered developmental trajectories and are at risk for poor developmental outcomes. Moreover, this work presents an opportunity for establishing a neuro-biomarker for early identification of infants at risk and could guide early intervention regimens.
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Affiliation(s)
- Lauren L Emberson
- Psychology Department, Princeton University, Peretsman-Scully Hall, Princeton, NJ 08544, USA; Brain and Cognitive Sciences Department and the Rochester Center for Brain Imaging, University of Rochester, PO Box 270268, Meliora Hall, Rochester, NY 14627, USA.
| | - Alex M Boldin
- Psychology Department, Princeton University, Peretsman-Scully Hall, Princeton, NJ 08544, USA
| | - Julie E Riccio
- Neonatology Unit, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Ronnie Guillet
- Neonatology Unit, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Richard N Aslin
- Brain and Cognitive Sciences Department and the Rochester Center for Brain Imaging, University of Rochester, PO Box 270268, Meliora Hall, Rochester, NY 14627, USA
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Verhaeghe L, Dereu M, Warreyn P, De Groote I, Vanhaesebrouck P, Roeyers H. Extremely Preterm Born Children at Very High Risk for Developing Autism Spectrum Disorder. Child Psychiatry Hum Dev 2016; 47:729-39. [PMID: 26546379 DOI: 10.1007/s10578-015-0606-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to provide a more comprehensive picture of the prevalence of autism spectrum disorder (ASD) in a geographic cohort of extremely preterm born adolescents by using established diagnostic instruments in addition to screening instruments. 53 participants passed a screening procedure with two screening instruments and a diagnostic evaluation with a semi-structured assessment and a parent interview. 28 % of the adolescents had a community based clinical diagnosis of ASD. When research diagnoses were also taken into account, this rate increased to 40 %. Intellectual disability, language impairment and behavioural difficulties are characteristic for these children with ASD. This study is to our knowledge the first to use ASD-specific diagnostic instruments to confirm ASD diagnoses in extremely preterm born children in early adolescence. The study expands findings of previous research and raises the need for follow-up into late childhood and early adolescence.
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Affiliation(s)
- Liedewij Verhaeghe
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium.
| | - Mieke Dereu
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - Petra Warreyn
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - Isabel De Groote
- Department of Child and Adolescent Psychiatry, University Hospital Ghent, Ghent, Belgium
| | - Piet Vanhaesebrouck
- Department of Neonatal Intensive Care, University Hospital Ghent, Ghent, Belgium
| | - Herbert Roeyers
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
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Yaari M, Yitzhak N, Harel A, Friedlander E, Bar-Oz B, Eventov-Friedman S, Mankuta D, Gamliel I, Yirmiya N. Stability of early risk assessment for autism spectrum disorder in preterm infants. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 20:856-67. [DOI: 10.1177/1362361315614758] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stability and change in early autism spectrum disorder risk were examined in a cohort of 99 preterm infants (⩽34 weeks of gestation) using the Autism Observation Scale for Infants at 8 and 12 months and the Autism Diagnostic Observation Schedule—Toddler Module at 18 months. A total of 21 infants were identified at risk by the Autism Observation Scale for Infants at 8 months, and 9 were identified at risk at 12 months, including 4 children who were not previously identified. At 18 months, eight children were identified at risk for autism spectrum disorder using the Autism Diagnostic Observation Schedule—Toddler Module, only half of whom had been identified using the original Autism Observation Scale for Infants cutoffs. Results are discussed in relation to early trajectories of autism spectrum disorder risk among preterm infants as well as identifying social-communication deficiencies associated with the early preterm behavioral phenotype.
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Abstract
OBJECTIVE Autism spectrum disorder (ASD) is common, life-long in nature, and can be very debilitating. Thus, an intensive search is on to identify the potential risk factors for the disorder. Premature birth has been identified as one potential factor that could influence potential symptoms of ASD. METHOD The sample for this study consisted of 1655 at risk children for developmental delays who were 17-37 months of age. Participants were divided into those diagnosed with ASD (n = 916) and children with atypical development only (n = 739). RESULTS Premature births were almost twice as common for the atypical development group versus the ASD group. CONCLUSIONS Implications of these data are discussed.
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Affiliation(s)
- Rachel L Goldin
- a Department of Psychology , Louisiana State University , Baton Rouge , LA , USA
| | - Johnny L Matson
- a Department of Psychology , Louisiana State University , Baton Rouge , LA , USA
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Montagna A, Nosarti C. Socio-Emotional Development Following Very Preterm Birth: Pathways to Psychopathology. Front Psychol 2016; 7:80. [PMID: 26903895 PMCID: PMC4751757 DOI: 10.3389/fpsyg.2016.00080] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/14/2016] [Indexed: 01/07/2023] Open
Abstract
Very preterm birth (VPT; < 32 weeks of gestation) has been associated with an increased risk to develop cognitive and socio-emotional problems, as well as with increased vulnerability to psychiatric disorder, both with childhood and adult onset. Socio-emotional impairments that have been described in VPT individuals include diminished social competence and self-esteem, emotional dysregulation, shyness and timidity. However, the etiology of socio-emotional problems in VPT samples and their underlying mechanisms are far from understood. To date, research has focused on the investigation of both biological and environmental risk factors associated with socio-emotional problems, including structural and functional alterations in brain areas involved in processing emotions and social stimuli, perinatal stress and pain and parenting strategies. Considering the complex interplay of the aforementioned variables, the review attempts to elucidate the mechanisms underlying the association between very preterm birth, socio-emotional vulnerability and psychopathology. After a comprehensive overview of the socio-emotional impairments associated with VPT birth, three main models of socio-emotional development are presented and discussed. These focus on biological vulnerability, early life adversities and parenting, respectively. To conclude, a developmental framework is used to consider different pathways linking VPT birth to psychopathology, taking into account the interaction between medical, biological, and psychosocial factors.
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Affiliation(s)
- Anita Montagna
- Department of Perinatal Imaging and Health, Centre for the Developing Brain, St. Thomas' Hospital, King's College LondonLondon, UK
| | - Chiara Nosarti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondon, UK
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Pritchard MA, de Dassel T, Beller E, Bogossian F, Johnston L, Paynter J, Russo S, Scott J. Autism in Toddlers Born Very Preterm. Pediatrics 2016; 137:e20151949. [PMID: 26798043 DOI: 10.1542/peds.2015-1949] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study aimed to determine the prevalence of autism spectrum disorder (ASD) by using the Autism Diagnostic Observation Schedule-Generic (ADOS-G) classifications in children born very preterm during their toddler years. METHODS Two birth cohorts of toddlers (2 and 4 years old) each recruited over 12 months and born at <29 weeks' gestation were administered the Modified Checklist of Autism in Toddlers-Follow-up Interview (M-CHAT-FI) screen, the ADOS-G, and developmental assessments. The ADOS-G was conducted on toddlers with M-CHAT-FI-positive screens. RESULTS Data were available on 88% (169/192) of children. In total, 22 (13%) toddlers screened positive and 3 (1.8%) were confirmed diagnostically with ASD. These 3 cases reached the highest ADOS-G threshold classification of autism. All but 1 child who scored below the ADOS-G thresholds (11/12) demonstrated some difficulty with social communication. Risk was significantly increased for co-occurring neurodevelopmental problems in 21 of the 22 positive-screen ASD cases. Adaptive behavior (P < .001) was the only co-occurring factor independently predictive of ASD in toddlers. CONCLUSIONS Children born very preterm are at increased risk of ASD. By using the ADOS-G, we found a lower incidence of ASD in children born at <29 weeks' gestation compared with previous studies. Children who screened positive for ASD on the M-CHAT-FI had developmental delays consistent with subthreshold communication impairment.
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Affiliation(s)
| | - Therese de Dassel
- Royal Brisbane Women's Hospital, Brisbane, Queensland, Australia; Bond University, Robina, Queensland, Australia
| | - Elaine Beller
- The University of Queensland, Brisbane, Queensland, Australia
| | | | | | - Jessica Paynter
- Autism Early Intervention and Ootcome Unit Foundation, Brisbane, Queensland, Australia
| | - Santo Russo
- Better Life Psychology, Brisbane, Queensland, Australia
| | - James Scott
- Australian Catholic University, Brisbane, Queensland, Australia; Bond University, Robina, Queensland, Australia
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Prognostic Factors for Behavioral Problems and Psychiatric Disorders in Children Born Very Preterm or Very Low Birth Weight: A Systematic Review. J Dev Behav Pediatr 2016; 37:88-102. [PMID: 26703327 PMCID: PMC5330463 DOI: 10.1097/dbp.0000000000000238] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Risk factors associated with adverse behavioral outcomes in very preterm (VPT) or very low birth weight (VLBW) infants are poorly understood. The aim of this article is to identify prognostic factors for behavioral problems and psychiatric disorders in children born ≤32 weeks gestational age or with birth weight ≤1250 g. METHOD A systematic review was conducted using MEDLINE, Embase, and Pyscinfo databases to identify studies published between January 1, 1990 and June 1, 2014 reporting multivariable prediction models for behavioral problems or psychiatric disorders in VPT/VLBW children. Fifteen studies were identified and 2 independent reviewers extracted key information on study design, outcome definition, risk factor selection, model development, reporting, and conducted a risk of bias assessment. RESULTS The 15 studies included reported risk factor analyses for the following domains: general behavioral problems (n = 8), any psychiatric disorder (n = 2), autism spectrum symptoms/disorders (n = 5), and attention deficit/hyperactivity disorder (n = 1). Findings were inconclusive because of the following: small number of studies in each domain, heterogeneity in outcome measures, lack of overlap in the risk factors examined, and differences in strategies for dealing with children with neurological impairments. CONCLUSION There is a lack of evidence concerning risk factors for behavior problems and psychiatric disorders among VPT/VLBW survivors. This review has identified the need for further research examining the etiology of disorders of psychological development in the VPT/VLBW population to refine risk prediction and identify targets for intervention. Large well-conducted studies that use standard diagnostic evaluations to assess psychiatric disorders throughout childhood and adolescence are required.
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Welch MG, Firestein MR, Austin J, Hane AA, Stark RI, Hofer MA, Garland M, Glickstein SB, Brunelli SA, Ludwig RJ, Myers MM. Family Nurture Intervention in the Neonatal Intensive Care Unit improves social-relatedness, attention, and neurodevelopment of preterm infants at 18 months in a randomized controlled trial. J Child Psychol Psychiatry 2015; 56:1202-11. [PMID: 25763525 DOI: 10.1111/jcpp.12405] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Preterm infants are at high risk for adverse neurodevelopmental and behavioral outcomes. Family Nurture Intervention (FNI) in the Neonatal Intensive Care Unit (NICU) is designed to counteract adverse effects of separation of mothers and their preterm infants. Here, we evaluate effects of FNI on neurobehavioral outcomes. METHODS Data were collected at 18 months corrected age from preterm infants. Infants were assigned at birth to FNI or standard care (SC). Bayley Scales of Infant Development III (Bayley-III) were assessed for 76 infants (SC, n = 31; FNI, n = 45); the Child Behavior Checklist (CBCL) for 57 infants (SC, n = 31; FNI, n = 26); and the Modified Checklist for Autism in Toddlers (M-CHAT) was obtained for 59 infants (SC, n = 33; FNI, n = 26). RESULTS Family Nurture Intervention significantly improved Bayley-III cognitive (p = .039) and language (p = .008) scores for infants whose scores were greater than 85. FNI infants had fewer attention problems on the CBCL (p < .02). FNI improved total M-CHAT scores (p < .02). Seventy-six percent of SC infants failed at least one of the M-CHAT items, compared to 27% of FNI infants (p < .001). In addition, 36% of SC infants versus 0% of FNI infants failed at least one social-relatedness M-CHAT item (p < .001). CONCLUSIONS Family Nurture Intervention is the first NICU intervention to show significant improvements in preterm infants across multiple domains of neurodevelopment, social-relatedness, and attention problems. These gains suggest that an intervention that facilitates emotional interactions between mothers and infants in the NICU may be key to altering developmental trajectories of preterm infants.
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Affiliation(s)
- Martha G Welch
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.,Department of Pathology & Cell Biology, Columbia University Medical Center, New York, NY, USA.,Department of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA
| | - Morgan R Firestein
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Judy Austin
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Amie A Hane
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Psychology, Williams College, Williamstown, MA, USA
| | - Raymond I Stark
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Myron A Hofer
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA
| | - Marianne Garland
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | | | - Susan A Brunelli
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA
| | - Robert J Ludwig
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Michael M Myers
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,Department of Pediatrics, Columbia University Medical Center, New York, NY, USA.,Department of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, USA
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Joo JW, Choi JY, Rha DW, Kwak EH, Park ES. Neuropsychological Outcomes of Preterm Birth in Children With No Major Neurodevelopmental Impairments in Early Life. Ann Rehabil Med 2015; 39:676-85. [PMID: 26605165 PMCID: PMC4654074 DOI: 10.5535/arm.2015.39.5.676] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/27/2015] [Indexed: 11/30/2022] Open
Abstract
Objectives To investigate cognition, social adaptive functioning, behavior, and emotional development in the preschool period and to determine the effects of the age of onset of walking on those developmental areas in children who were born preterm without major neurodevelopmental impairments (NDI) early in life. Methods Fifty-eight children who were born preterm without major NDI early in life participated in this study. The Korean versions of the Wechsler Preschool and Primary Scale of Intelligence or the Bayley Scales of Infant Development, the social maturity scale, the Korean version of the Child Behavior Checklist (CBCL), Conners' abbreviated parent/teacher rating scale, the Childhood Autism Rating Scale, and a speech developmental test were administered. The participants were divided into two groups: early walkers (group A) and late walkers (group B). Results The full-scale intelligence quotient (IQ) and performance IQ were significantly lower in group B than in group A, while the verbal IQ did not differ significantly between the groups. The children in group B had greater risks of cognitive deficits than did the children in group A, especially in performance skills. The social quotient (SQ) was significantly lower in group B than in group A (p<0.05). The rates of mild or significant deficits based on SQ and the CBCL did not differ significantly between the groups. Four children in group A and one child in group B had attention/hyperactivity problems. One child in group A had autistic behavior. Only one child in group B showed a significant speech developmental delay. Conclusions Problems in cognition, social adaptive functioning, and emotional and behavioral development can occur in children without major NDI early in life. Late walkers had significantly lower scores in cognition and social adaptive functioning than did early walkers.
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Affiliation(s)
- Ji Woon Joo
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ja Young Choi
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Wook Rha
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Hee Kwak
- Department of Rehabilitation Psychology, Severance Rehabilitation Hospital, Seoul, Korea
| | - Eun Sook Park
- Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
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Magiati I, Goh DA, Lim SJ, Gan DZQ, Leong JCL, Allison C, Baron-Cohen S, Rifkin-Graboi A, Broekman BFP, Saw SM, Chong YS, Kwek K, Gluckman PD, Lim SB, Meaney MJ. The psychometric properties of the Quantitative-Checklist for Autism in Toddlers (Q-CHAT) as a measure of autistic traits in a community sample of Singaporean infants and toddlers. Mol Autism 2015; 6:40. [PMID: 26124950 PMCID: PMC4484636 DOI: 10.1186/s13229-015-0032-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 06/03/2015] [Indexed: 12/27/2022] Open
Abstract
Background There is growing research evidence that subclinical autistic traits are elevated in relatives of individuals with autism spectrum disorder (ASD), continuously distributed in the general population and likely to share common etiology with ASD. A number of measures have been developed to assess autistic traits quantitatively in unselected samples. So far, the Quantitative-Checklist for Autism in Toddlers (Q-CHAT) is one of very few measures developed for use with toddlers as young as 18 months, but little is known about its measurement properties and factor structure. Methods The present study examined internal consistency, factor structure, test-retest stability, and convergent validity of the Q-CHAT in a sample of toddlers in Singapore whose caregivers completed the Q-CHAT at 18 (n = 368) and 24 months (n = 396). Results Three factors were derived accounting for 38.1 % of the variance: social/communication traits, non-social/behavioral traits, and a speech/language factor. Internal consistency was suboptimal for the total and speech/language scores, but acceptable for the social/communication and non-social/behavioral factor scores. Scores were generally stable between 18 and 24 months. Convergent validity was found with the Pervasive Developmental Disorders subscale of the Child Behavior Checklist (CBCL) completed by caregivers when their children were 24 months. Q-CHAT total scores in this sample were higher than those reported in other unselected samples from the UK. Conclusions The Q-CHAT was found to have a three-factor structure, acceptable internal consistency for its two main factor scores (social/communication and non-social/behavioral), normally distributed scores in an unselected sample, and similar structure and measurement properties as those reported in other published studies. Findings are discussed in relation to existing literature and future directions for the validation of the Q-CHAT.
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Affiliation(s)
- I Magiati
- Department of Psychology, National University of Singapore, #02-24, Block AS4, 9 Arts Link, 117570 Singapore, Singapore
| | - D A Goh
- Department of Psychology, National University of Singapore, #02-24, Block AS4, 9 Arts Link, 117570 Singapore, Singapore
| | - S J Lim
- Department of Psychology, National University of Singapore, #02-24, Block AS4, 9 Arts Link, 117570 Singapore, Singapore
| | - D Z Q Gan
- Department of Psychology, National University of Singapore, #02-24, Block AS4, 9 Arts Link, 117570 Singapore, Singapore
| | - J C L Leong
- Department of Psychology, National University of Singapore, #02-24, Block AS4, 9 Arts Link, 117570 Singapore, Singapore
| | - C Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - S Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - A Rifkin-Graboi
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A STAR), Singapore, Singapore
| | - B F P Broekman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A STAR), Singapore, Singapore ; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - S-M Saw
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Y-S Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A STAR), Singapore, Singapore ; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - K Kwek
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - P D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A STAR), Singapore, Singapore ; Liggins Institute, University of Auckland, Auckland, New Zealand
| | - S B Lim
- Department of Child Development, KK Women's and Children's Hospital, Singapore, Singapore
| | - M J Meaney
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A STAR), Singapore, Singapore ; Ludmer Centre for Neuroinformatics and Mental Health, McGill University, Verdun, Canada; Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Canada
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Meyer LR, Zhu V, Miller A, Roghair RD. Growth restriction, leptin, and the programming of adult behavior in mice. Behav Brain Res 2014; 275:131-5. [PMID: 25196633 DOI: 10.1016/j.bbr.2014.08.054] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/26/2014] [Accepted: 08/27/2014] [Indexed: 11/16/2022]
Abstract
Prematurity and neonatal growth restriction (GR) are risk factors for autism and attention deficit hyperactivity disorder (ADHD). Leptin production is suppressed during periods of undernutrition, and we have shown that isolated neonatal leptin deficiency leads to adult hyperactivity while neonatal leptin supplementation normalizes the brain morphology of GR mice. We hypothesized that neonatal leptin would prevent the development of GR-associated behavioral abnormalities. From postnatal day 4-14, C57BL/6 mice were randomized to daily injections of saline or leptin (80ng/g), and GR was identified by a weanling weight below the tenth percentile. The behavioral phenotypes of GR and control mice were assessed beginning at 4 months. Within the tripartite chamber, GR mice had significantly impaired social interaction. Baseline escape times from the Barnes maze were faster for GR mice (65+/-6s vs 87+/-7s for controls, p<0.05), but GR mice exhibited regression in their escape times on days 2 and 3 (56% regressed vs 22% of control saline mice, p<0.05). Compared to controls, GR mice entered the open arms of the elevated plus maze more often and stayed there longer (72+/-10s vs 36+/-5s, p<0.01). Neonatal leptin supplementation normalized the behavior of GR mice across all behavioral assays. In conclusion, GR alters the social interactions, learning and activity of mice, and supplementation with the neurotrophic hormone leptin mitigates these effects. We speculate neonatal leptin deficiency may contribute to the adverse neurodevelopmental outcomes associated with postnatal growth restriction, and postnatal leptin therapy may be protective.
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Affiliation(s)
- Lauritz R Meyer
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, United States of America.
| | - Vivian Zhu
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, United States of America
| | - Alise Miller
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, United States of America
| | - Robert D Roghair
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, United States of America
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Hofheimer JA, Sheinkopf SJ, Eyler LT. Autism risk in very preterm infants--new answers, more questions. J Pediatr 2014; 164:6-8. [PMID: 24359898 DOI: 10.1016/j.jpeds.2013.09.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 09/27/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Julie A Hofheimer
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Stephen J Sheinkopf
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Lisa T Eyler
- Department of Psychiatry and Autism Center, University of California at San Diego, Mental Illness, Research, Education, and Clinical Center, VA San Diego Healthcare System, San Diego, California
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