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Pivodic A, Hansson M, Löfqvist C, Sävman K, Elfvin A, Jacobson L, Dinkler L, Hallberg B, Ley D, Morsing E, Lundgren P, Gyllén J, Pfeiffer-Mosesson C, Hellström A. Challenges of parenting children born before 24 weeks of gestation. Acta Paediatr 2024. [PMID: 38984707 DOI: 10.1111/apa.17350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 07/11/2024]
Abstract
AIM To assess experience of care, well-being of parents and children's development in a cohort of extremely premature infants born <24 weeks of gestation in Sweden from 2007 to 2018. METHODS A survey based on multiple questionnaires answered by 124/349 (35.5%) parents. RESULTS The median age of parents and children was 43 and 9 years, respectively; 74.2% were mothers. Parents expressed high healthcare satisfaction. Following discharge from neonatal care, the satisfaction with the infant's treatment, support from personnel and being respected as a parent significantly declined but remained high. The criteria for suspected developmental deviation according to the screening test early symptomatic syndromes eliciting neurodevelopmental clinical examinations-questionnaire was fulfilled by 84.3%, 55.6% had suspected avoidant restrictive food intake disorder and 47.9% had visual perception problems. Parents experienced severe fatigue (48.6%) despite strong social support and family self-efficacy. Economic support was provided to 30.6%, and 37.9% of children were enrolled in habilitation services. CONCLUSION This study highlighted the substantial challenges faced by parents of infants born before 24 weeks of gestation, including decreased satisfaction post-discharge, fatigue and concerns about children's well-being. The findings underscore the need for comprehensive family-centred support and long-term multi-professional follow-up centres.
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Affiliation(s)
- Aldina Pivodic
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Ophthalmology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Malin Hansson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research and Development Primary Healthcare, Gothenburg, Sweden
| | - Chatarina Löfqvist
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Sävman
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neonatology, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Anders Elfvin
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neonatology, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Lena Jacobson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Lisa Dinkler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Boubou Hallberg
- Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - David Ley
- Department of Pediatrics, Institute of Clinical Sciences, Skåne University Hospital Lund, Lund, Sweden
| | - Eva Morsing
- Department of Pediatrics, Clinical Sciences, Lund University, Lund, Sweden
| | - Pia Lundgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Ophthalmology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Jenny Gyllén
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carola Pfeiffer-Mosesson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann Hellström
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Ophthalmology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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2
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Torchin H, Tafflet M, Charkaluk ML, Letouzey M, Twillhaar S, Kana G, Benhammou V, Marret S, Basson E, Cambonie G, Datin-Dorrière V, Guellec I, Lebeaux C, Muller JB, Nuytten A, Kaminski M, Ancel PY, Pierrat V. Screening preterm-born infants for autistic traits may help to identify social communication difficulties at five years of age. Acta Paediatr 2024; 113:1546-1554. [PMID: 38501897 DOI: 10.1111/apa.17214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/27/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
AIM This study compared neurodevelopmental screening questionnaires completed when preterm-born children reached 2 years of corrected age with social communication skills at 5.5 years of age. METHODS Eligible subjects were born in 2011 at 24-34 weeks of gestation, participated in a French population-based epidemiological study and were free of motor and sensory impairment at 2 years of corrected age. The Ages and Stages Questionnaire (ASQ) and the Modified Checklist for Autism in Toddlers (M-CHAT) were used at 2 years and the Social Communication Questionnaire (SCQ) at 5.5 years of age. RESULTS We focused on 2119 children. At 2 years of corrected age, the M-CHAT showed autistic traits in 20.7%, 18.5% and 18.2% of the children born at 24-26, 27-31 and 32-34 weeks of gestation, respectively (p = 0.7). At 5.5 years of age, 12.6%, 12.7% and 9.6% risked social communication difficulties, with an SCQ score ≥90th percentile (p = 0.2). A positive M-CHAT score at 2 years was associated with higher risks of social communication difficulties at 5.5 years of age (odds ratio 3.46, 95% confidence interval 2.04-5.86, p < 0.001). Stratifying ASQ scores produced similar results. CONCLUSION Using parental neurodevelopmental screening questionnaires for preterm-born children helped to identify the risk of later social communication difficulties.
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Affiliation(s)
- Héloise Torchin
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
- Department of Neonatal Medicine, Cochin-Port Royal Hospital, FHU PREMA, AP-HP Centre, Paris, France
| | - Muriel Tafflet
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
| | - Marie-Laure Charkaluk
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
- Department of neonatology, Saint Vincent de Paul Hospital, GHICL, Lille, France
| | - Mathilde Letouzey
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
- Department of Neonatal Pediatrics, Poissy Saint Germain Hospital, Poissy, France
| | - Sabrina Twillhaar
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
| | - Gildas Kana
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
| | - Valérie Benhammou
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
| | - Stéphane Marret
- Department of Neonatal medicine - Intensive Care - Neuropediatrics, Rouen University Hospital, Rouen, France
- INSERM U1254 - Neovasc team - Perinatal handicap, Institute of Biomedical Research and Innovation, Normandy University, Rouen, France
| | - Eliane Basson
- Réseau AURORE-ECLAUR, Hôpital de la Croix-Rousse, Lyon, France
| | - Gilles Cambonie
- Department of Neonatal Medicine, Montpellier University Hospital, Montpellier, France
| | - Valérie Datin-Dorrière
- Centre hospitalier universitaire Caen, Department of neonatology, Caen, France
- Universite de Paris, CNRS UMR 8240 "LaPsyDE", Paris, France
| | - Isabelle Guellec
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
- Neonatal intensive care unit, Nice University Hospital, Côte d'Azur University, Nice, France
| | - Cécile Lebeaux
- Department of Neonatalogy, Centre Hospitalier Intercommunal de Créteil and Reseau Perinatal du Val de Marne, Créteil, France
| | | | - Alexandra Nuytten
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Monique Kaminski
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
| | - Pierre-Yves Ancel
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
- Assistance Publique-Hôpitaux de Paris, Clinical Investigation Center P1419, Paris, France
| | - Véronique Pierrat
- Université Paris Cite, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPE, French Institute for Medical Research and Health INSERM, INRAE, Paris, France
- Department of Neonatalogy, Centre Hospitalier Intercommunal de Créteil and Reseau Perinatal du Val de Marne, Créteil, France
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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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4
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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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5
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Levick S, Staples AD, Warschausky S, Huth-Bocks A, Taylor HG, Gidley Larson JC, Peterson C, Lukomski A, Lajiness-O'Neill R. Caregiver-reported infant motor and imitation skills predict M-CHAT-R/F. Child Neuropsychol 2024:1-19. [PMID: 38275156 PMCID: PMC11272902 DOI: 10.1080/09297049.2024.2304378] [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] [Received: 05/10/2023] [Accepted: 12/08/2023] [Indexed: 01/27/2024]
Abstract
Altered motor and social-communicative abilities in infancy have been linked to later ASD diagnosis. Most diagnostic instruments for ASD cannot be utilized until 12 months, and the average child is diagnosed substantially later. Imitation combines motor and social-communicative skills and is commonly atypical in infants at risk for ASD. However, few measures have been developed to assess infant imitation clinically. One barrier to the diagnostic age gap of ASD is accessibility of screening and diagnostic services. Utilization of caregiver report to reliably screen for ASD mitigates such barriers and could aid in earlier detection. The present study developed and validated a caregiver-report measure of infant imitation at 4, 6, and 9 months and explored the relationship between caregiver-reported imitation and motor abilities with later ASD risk. Participants (N = 571) were caregivers of term and preterm infants recruited as part of a large multi-site study of PediaTrac™, a web-based tool for monitoring and tracking infant development. Caregivers completed online surveys and established questionnaires on a schedule corresponding to well-child visits from birth to 18 months, including the M-CHAT-R/F at 18 months. Distinct imitation factors were derived from PediaTrac at 4, 6, and 9 months via factor analysis. The results supported validity of the imitation factors via associations with measures of infant communication (CSBS; ASQ). Imitation and motor skills at 9 months predicted 18-month ASD risk over and above gestational age. Implications for assessment of infant imitation, detecting ASD risk in the first year, and contributing to access to care are discussed.
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Affiliation(s)
- Samantha Levick
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Angela D Staples
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | - Seth Warschausky
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Alissa Huth-Bocks
- Merrill Palmer Skillman Institute, Wayne State University, Detroit, MI, USA
| | - H Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Pediatrics, The Ohio State University, Columbus, OH, USA
| | | | - Catherine Peterson
- Pediatric Psychology and Neuropsychology, Atrium Health Levine Children's Rea Village Pediatrics, Charlotte, NC, USA
| | | | - Renée Lajiness-O'Neill
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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6
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Hadaya L, Vanes L, Karolis V, Kanel D, Leoni M, Happé F, Edwards AD, Counsell SJ, Batalle D, Nosarti C. Distinct Neurodevelopmental Trajectories in Groups of Very Preterm Children Screening Positively for Autism Spectrum Conditions. J Autism Dev Disord 2024; 54:256-269. [PMID: 36273367 DOI: 10.1007/s10803-022-05789-4] [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] [Accepted: 10/09/2022] [Indexed: 10/24/2022]
Abstract
Very preterm (VPT; < 33 weeks' gestation) toddlers screening positively for autism spectrum conditions (ASC) may display heterogenous neurodevelopmental trajectories. Here we studied neonatal brain volumes and childhood ASC traits evaluated with the Social Responsiveness Scale (SRS-2) in VPT-born toddlers (N = 371; median age 20.17 months) sub-divided into three groups based on their Modified-Checklist for Autism in Toddlers scores. These were: those screening positively failing at least 2 critical items (critical-positive); failing any 3 items, but less than 2 critical items (non-critical-positive); and screening negatively. Critical-positive scorers had smaller neonatal cerebellar volumes compared to non-critical-positive and negative scorers. However, both positive screening groups exhibited higher childhood ASC traits compared to the negative screening group, suggesting distinct aetiological trajectories associated with ASC outcomes.
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Affiliation(s)
- Laila Hadaya
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Lucy Vanes
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Vyacheslav Karolis
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Dana Kanel
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Marguerite Leoni
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Francesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - A David Edwards
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Serena J Counsell
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Dafnis Batalle
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Chiara Nosarti
- Centre for the Developing Brain, Department of Perinatal Imaging and Health, School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
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7
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Shuster CL, Sheinkopf SJ, McGowan EC, Hofheimer JA, O'Shea TM, Carter BS, Helderman JB, Check J, Neal CR, Pastyrnak SL, Smith LM, Loncar C, Dansereau LM, DellaGrotta SA, Marsit C, Lester BM. Neurobehavioral and Medical Correlates of Autism Screening: 2-Year Outcomes for Infants Born Very Preterm. J Pediatr 2023; 260:113536. [PMID: 37271496 PMCID: PMC10526642 DOI: 10.1016/j.jpeds.2023.113536] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To identify neonatal characteristics and 2-year neurodevelopmental outcomes associated with positive screening for risk of autism. STUDY DESIGN Nine university-affiliated neonatal intensive care units (NICUs) enrolled infants born at <30 weeks of gestation. Infants underwent the NICU Network Neurobehavioral Scale examination before discharge and the Bayley Scales of Infant and Toddler Development, Third Edition, the Child Behavior Checklist, and the Modified Checklist for Autism in Toddlers, revised with follow-up (M-CHAT-R/F) at 2 years of corrected age. Generalized estimating equations examined associations between M-CHAT-R/F, neurobehavioral test results, and neonatal medical morbidities. RESULTS At 2 years of corrected age, data were available for 466 of 744 enrolled infants without cerebral palsy. Infants with hypoaroused NICU Network Neurobehavioral Scale profiles were more likely to screen M-CHAT-R/F-positive (OR 2.76, 95% CI 1.38-5.54). Infants with ≥2 medical morbidities also were more likely to screen positive (OR 2.65, 95% CI 1.27-5.54). Children with positive M-CHAT-R/F scores had lower Bayley Scales of Infant and Toddler Development, Third Edition, Cognitive (t [451] = 5.43, P < .001, d = 0.82), Language (t [53.49] = 7.82, P < .001, d = 1.18), and Motor (t [451] = 7.98, P < .001, d = 1.21) composite scores and significantly greater Child Behavior Checklist Internalizing (t [457] -6.19, P < .001, d = -0.93) and Externalizing (t [57.87] = -5.62, P < .001, d = -0.84) scores. CONCLUSIONS Positive M-CHAT-R/F screens at 2 years of corrected age were associated with neonatal medical morbidities and neurobehavioral examinations as well as toddler developmental and behavioral outcomes. These findings demonstrate the potential utility of the M-CHAT-R/F as a global developmental screener in infants born very preterm, regardless of whether there is a later autism diagnosis.
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Affiliation(s)
- Coral L Shuster
- Department of Pediatrics, Women and Infants Hospital, Providence, RI.
| | - Stephen J Sheinkopf
- Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO
| | | | | | - T Michael O'Shea
- Deparment of Pediatrics, UNC School of Medicine, Chapel Hill, NC
| | - Brian S Carter
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO
| | | | - Jennifer Check
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Charles R Neal
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI
| | - Steven L Pastyrnak
- Department of Pediatrics, Spectrum Health-Helen Devos Hospital, Grand Rapids, MI
| | - Lynne M Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Los Angeles, CA
| | - Cynthia Loncar
- Department of Pediatrics, Brown Alpert Medical School, Providence, RI; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI
| | - Lynne M Dansereau
- Department of Pediatrics, Women and Infants Hospital, Providence, RI
| | | | - Carmen Marsit
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA
| | - Barry M Lester
- Department of Pediatrics, Women and Infants Hospital, Providence, RI; Department of Pediatrics, Brown Alpert Medical School, Providence, RI; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI
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8
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Shehzad I, Raju M, Jackson I, Beeram M, Govande V, Chiruvolu A, Vora N. Evaluation of Autism Spectrum Disorder Risk in Infants With Intraventricular Hemorrhage. Cureus 2023; 15:e45541. [PMID: 37868372 PMCID: PMC10586226 DOI: 10.7759/cureus.45541] [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: 07/25/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Background This study evaluates the long-term risk of autism spectrum disorder (ASD) in infants with intraventricular hemorrhage (IVH) using the Modified Checklist for Autism in Toddlers-Revised with Follow-Up (M-CHAT-R/F) screening tool. Methods This retrospective cohort study compared IVH (exposed) infants across all gestational age groups with no-IVH (non-exposed) infants admitted to level IV neonatal intensive care unit (NICU). The M-CHAT-R/F screening tool was used to assess the ASD risk at 16-30 months of age. Discharge cranial ultrasound (CUS) findings also determined the ASD risk. Descriptive statistics comprised median and interquartile range for skewed continuous data and frequencies and percentages for categorical variables. Comparisons for non-ordinal categorical measures in bivariate analysis were carried out using the χ2 test or Fisher exact test. Results Of the 334 infants, 167 had IVH, and 167 had no IVH. High ASD risk (43% vs. 20%, p = 0.044) and cerebral palsy (19% vs. 5%, p = 0.004) were significantly associated with severe IVH. Infants with CUS findings of periventricular leukomalacia had 3.24 odds of developing high ASD risk (odds ratios/OR: 3.24, 95% confidence interval/CI: 0.73-14.34), and those with hydrocephalus needing ventriculoperitoneal (VP) shunt had 4.75 odds of developing high ASD risk (OR: 4.75, 95% CI: 0.73-30.69). Conclusion Severe IVH, but not mild IVH, increased the risk of ASD and cerebral palsy. This study demonstrates the need for timely screening for ASD in high-risk infants. Prompt detection leads to earlier treatment and better outcomes.
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Affiliation(s)
- Irfan Shehzad
- Neonatology, Baylor Scott & White Health, Temple, USA
| | - Muppala Raju
- Neonatology, Baylor Scott & White Health, Temple, USA
| | | | | | | | | | - Niraj Vora
- Neonatology, Baylor Scott & White Health, Temple, USA
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9
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Malak R, Fechner B, Stankowska M, Wiecheć K, Szczapa T, Kasperkowicz J, Matthews-Kozanecka M, Brzozowska TM, Komisarek O, Daroszewski P, Samborski W, Mojs E. The Importance of Monitoring Neurodevelopmental Outcomes for Preterm Infants: A Comparison of the AIMS, GMA, Pull to Sit Maneuver and ASQ-3. J Clin Med 2022; 11:6295. [PMID: 36362524 PMCID: PMC9657223 DOI: 10.3390/jcm11216295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/04/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Clinicians and parents should closely monitor the neurodevelopment of very preterm infants. The aim of our study was to compare whether neurodevelopmental assessments completed by parents and those done by specialists yielded similar outcomes. We wanted to check whether the assessments completed by specialists and parents were comparable in outcomes to emphasize the important roles of early assessment of a child and of the parents in their child's treatment and medical care. Another aim was to check whether or not the pull to sit maneuver from the Neonatal Behavioral Assessment Scale (NBAS) is still a parable item in well-known scales of neurodevelopment. METHODS We assessed 18 preterm neonates in the fourth month of corrected age with scales such as the General Movement Assessment (GMA), the Alberta Infant Motor Scale (AIMS), and the pull to sit maneuver from the NBAS. Finally, we asked parents to complete the Ages and Stages Questionnaire, Third Edition (ASQ-3). RESULTS We found that the respective assessments completed by specialists and parents are comparable in outcomes. We also found that the pull to sit item from the NBAS was still a valid test since it showed similar findings to those from the AIMS, the GMA, and the ASQ-3. CONCLUSIONS The pull to sit item from the NBAS is an important item for assessment of very preterm infants. Specialists should also take into consideration the input and concerns of parents when planning for treatment and intervention.
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Affiliation(s)
- Roksana Malak
- Department and Clinic of Rheumatology, Rehabilitation and Internal Medicine, Poznań University of Medical Sciences, 61-545 Poznan, Poland
| | - Brittany Fechner
- Department and Clinic of Rheumatology, Rehabilitation and Internal Medicine, Poznań University of Medical Sciences, 61-545 Poznan, Poland
| | - Marta Stankowska
- Department and Clinic of Rheumatology, Rehabilitation and Internal Medicine, Poznań University of Medical Sciences, 61-545 Poznan, Poland
| | - Katarzyna Wiecheć
- Department of Clinical Psychology, Poznań University of Medical Sciences, 60-812 Poznan, Poland
| | - Tomasz Szczapa
- Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, II Department of Neonatology, Poznan University of Medical Sciences, 60-535 Poznan, Poland
| | - Joanna Kasperkowicz
- Department and Clinic of Rheumatology, Rehabilitation and Internal Medicine, Poznań University of Medical Sciences, 61-545 Poznan, Poland
| | - Maja Matthews-Kozanecka
- Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Teresa Matthews Brzozowska
- Department of Orthodontics and Masticatory Dysfunction, Poznan University of Medical Sciences, 60-812 Poznan, Poland
| | - Oskar Komisarek
- The Chair and Clinic of Maxillofacial Orthopaedics and Orthodontics, Poznan University of Medical Sciences, 60-812 Poznan, Poland
- Department of Plastic, Reconstructive and Aesthetic Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-821 Bydgoszcz, Poland
| | - Przemysław Daroszewski
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, 61-545 Poznan, Poland
| | - Włodzimierz Samborski
- Department and Clinic of Rheumatology, Rehabilitation and Internal Medicine, Poznań University of Medical Sciences, 61-545 Poznan, Poland
| | - Ewa Mojs
- Department of Clinical Psychology, Poznań University of Medical Sciences, 60-812 Poznan, Poland
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10
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Ardalan M, Chumak T, Quist A, Hermans E, Hoseinpoor Rafati A, Gravina G, Jabbari Shiadeh SM, Svedin P, Alabaf S, Hansen B, Wegener G, Westberg L, Mallard C. Reelin cells and sex-dependent synaptopathology in autism following postnatal immune activation. Br J Pharmacol 2022; 179:4400-4422. [PMID: 35474185 PMCID: PMC9545289 DOI: 10.1111/bph.15859] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 04/07/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Autism spectrum disorders (ASD) are heterogeneous neurodevelopmental disorders with considerably increased risk in male infants born preterm and with neonatal infection. Here, we investigated the role of postnatal immune activation on hippocampal synaptopathology by targeting Reelin+ cells in mice with ASD-like behaviours. EXPERIMENTAL APPROACH C57/Bl6 mouse pups of both sexes received lipopolysaccharide (LPS, 1 mg·kg-1 ) on postnatal day (P) 5. At P45, animal behaviour was examined by marble burying and sociability test, followed by ex vivo brain MRI diffusion kurtosis imaging (DKI). Hippocampal synaptogenesis, number and morphology of Reelin+ cells, and mRNA expression of trans-synaptic genes, including neurexin-3, neuroligin-1, and cell-adhesion molecule nectin-1, were analysed at P12 and P45. KEY RESULTS Social withdrawal and increased stereotypic activities in males were related to increased mean diffusivity on MRI-DKI and overgrowth in hippocampus together with retention of long-thin immature synapses on apical dendrites, decreased volume and number of Reelin+ cells as well as reduced expression of trans-synaptic and cell-adhesion molecules. CONCLUSION AND IMPLICATIONS The study provides new insights into sex-dependent mechanisms that may underlie ASD-like behaviour in males following postnatal immune activation. We identify GABAergic interneurons as core components of dysmaturation of excitatory synapses in the hippocampus following postnatal infection and provide cellular and molecular substrates for the MRI findings with translational value.
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Affiliation(s)
- Maryam Ardalan
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Clinical Medicine, Translational Neuropsychiatry UnitAarhus UniversityAarhusDenmark
| | - Tetyana Chumak
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Alexandra Quist
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Eva Hermans
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Developmental Origins of Disease, Utrecht Brain Center and Wilhelmina Children's HospitalUtrecht UniversityUtrechtNetherlands
| | - Ali Hoseinpoor Rafati
- Department of Clinical Medicine, Translational Neuropsychiatry UnitAarhus UniversityAarhusDenmark
| | - Giacomo Gravina
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Seyedeh Marziyeh Jabbari Shiadeh
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Clinical Medicine, Translational Neuropsychiatry UnitAarhus UniversityAarhusDenmark
| | - Pernilla Svedin
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Setareh Alabaf
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Brian Hansen
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience‐SKSAarhus UniversityAarhusDenmark
| | - Gregers Wegener
- Department of Clinical Medicine, Translational Neuropsychiatry UnitAarhus UniversityAarhusDenmark
| | - Lars Westberg
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Carina Mallard
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
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11
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Cogley C, O'Reilly H, Bramham J, Downes M. A Systematic Review of the Risk Factors for Autism Spectrum Disorder in Children Born Preterm. Child Psychiatry Hum Dev 2021; 52:841-855. [PMID: 32980936 DOI: 10.1007/s10578-020-01071-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 12/16/2022]
Abstract
Preterm birth is associated with an increased risk for autism spectrum disorder, with various factors proposed to underlie this relationship. The aim of this systematic review was to provide a narrative synthesis of the literature regarding the prenatal, perinatal and postnatal factors associated with autism spectrum disorder in children born preterm. Medline, Embase and PsycINFO databases were searched via Ovid to identify studies published from January 1990 to December 2019. Original studies in which a standardized diagnostic tool and/or clinical assessment was used to diagnose autism, along with a risk factor analysis to identify associated predictors, were included. A total of 11 eligible studies were identified. Male sex, being born small for gestational age and general cognitive impairment were the most robust findings, with each reported as a significant factor in at least two studies. Comparisons across studies were limited by variation in risk factor measurement and gestational age ranges investigated.
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Affiliation(s)
- Clodagh Cogley
- School of Psychology, University College Dublin, Newman Building, Belfield, Dublin 4, Ireland.
| | - Helen O'Reilly
- School of Psychology, University College Dublin, Newman Building, Belfield, Dublin 4, Ireland
| | - Jessica Bramham
- School of Psychology, University College Dublin, Newman Building, Belfield, Dublin 4, Ireland
| | - Michelle Downes
- School of Psychology, University College Dublin, Newman Building, Belfield, Dublin 4, Ireland
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12
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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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13
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O'Reilly H, Ni Y, Johnson S, Wolke D, Marlow N. Extremely preterm birth and autistic traits in young adulthood: the EPICure study. Mol Autism 2021; 12:30. [PMID: 33957985 PMCID: PMC8101117 DOI: 10.1186/s13229-021-00414-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background A high prevalence of autism spectrum disorder is reported in children born extremely preterm (EP), but an even larger proportion of survivors are affected by subclinical difficulties than meet diagnostic criteria. The aims of this study were to investigate autistic traits associated with the broader autism phenotype in a cohort of young adults born EP, and explore how these traits relate to emotion recognition, empathy and autism symptom presentation in childhood. The prevalence of autism diagnoses was also investigated. Methods One hundred and twenty-nine young adults born before 26 weeks of gestation and 65 term-born controls participated in the 19-year follow-up phase of the EPICure studies. In addition to a clinical interview, participants completed the Broader Autism Phenotype Questionnaire (BAPQ), the Empathy Quotient questionnaire, and the Frankfurt Test and Training of Facial Affect Recognition. The Social Communication Questionnaire (SCQ) was completed by the participants’ parents at age 11 years. Results EP born young adults scored significantly higher on the BAPQ in comparison with their term-born peers, indicating greater autistic traits. Among EP participants, BAPQ scores were correlated with SCQ scores in childhood (r = 0.484, p < 0.001). EP young adults had significantly lower scores in emotion recognition and empathy in comparison with controls; however, this effect was mediated by IQ. At 19 years, a diagnosis of autism was reported by 10% of EP participants versus 1.6% of controls, whereas 31% of EP participants scored above the cut-off for the broader autism phenotype in comparison with 8.5% of term-born controls. Limitations The high attrition of EP participants from lower socio-economic backgrounds and with lower cognitive functioning may have led to an underrepresentation of those presenting with difficulties associated with autism. Conclusions A larger proportion of EP survivors are affected by difficulties associated with autism than have confirmed diagnoses, with a moderate correlation between autism symptom scores in childhood and autistic traits in young adulthood. EP young adults had significantly higher autism symptom scores and a larger proportion had a diagnosis of autism than controls. Screening for autistic traits at set points throughout childhood will help identify those EP individuals at risk of social difficulties who may benefit from intervention. Supplementary information The online version contains supplementary material available at 10.1186/s13229-021-00414-0.
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Affiliation(s)
- Helen O'Reilly
- Institute for Women's Health, University College London, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK. h.o'.,School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland. h.o'
| | - Yanyan Ni
- Institute for Women's Health, University College London, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, George Davies Centre, University Road, Leicester, LE1 7RH, UK
| | - Dieter Wolke
- Department of Psychology, and Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Neil Marlow
- Institute for Women's Health, University College London, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK
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14
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Imafuku M, Kawai M, Niwa F, Shinya Y, Myowa M. Longitudinal assessment of social attention in preterm and term infants: Its relation to social communication and language outcome. INFANCY 2021; 26:617-634. [PMID: 33856110 DOI: 10.1111/infa.12402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 02/10/2021] [Accepted: 02/28/2021] [Indexed: 11/26/2022]
Abstract
Preterm birth has been reported to be associated with an increased risk of social communication and language problems. Recently, we found that preterm infants showed atypical patterns of social attention compared with term infants. However, it is still unknown how social attention develops and whether the individual differences are associated with developmental outcomes for social communication and language in preterm infants. The social attention of preterm and term infants at 6, 12, and 18 months was investigated using two types of social attention tasks (human-geometric preference task and gaze-following task). The Modified Checklist for Autism in Toddlers (M-CHAT) and the MacArthur Communicative Development Inventory adapted for Japanese were measured at 18 months. We found that compared with term infants, preterm infants spent less time looking toward dynamic human images and followed another's gaze directions less frequently through 6, 12, and 18 months. Moreover, hierarchical multiple regression analysis revealed that less preference for dynamic human images and gaze-following abilities was associated with high M-CHAT and low language scores in preterm and term infants, respectively. These findings suggest that birth status affects development of social attention through 18 months and individual differences in social attention reflect differences in social communication and language outcomes.
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Affiliation(s)
- Masahiro Imafuku
- Department of Early Childhood Education and Care, Faculty of Education, Musashino University, Tokyo, Japan
| | - Masahiko Kawai
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Fusako Niwa
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuta Shinya
- Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Masako Myowa
- Graduate School of Education, Kyoto University, Kyoto, Japan
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15
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Luu J, Jellett R, Yaari M, Gilbert M, Barbaro J. A Comparison of Children Born Preterm and Full-Term on the Autism Spectrum in a Prospective Community Sample. Front Neurol 2020; 11:597505. [PMID: 33343497 PMCID: PMC7744721 DOI: 10.3389/fneur.2020.597505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/12/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction: Previous research suggests children diagnosed with autism spectrum disorder (ASD or “autism”) born extremely and very preterm face substantially delayed development than their peers born full-term. Further, children born preterm are proposed to show a unique behavioral phenotype, which may overlap with characteristics of autism, making it difficult to disentangle their clinical presentation. To clarify the presentation of autism in children born preterm, this study examined differences in key indicators of child development (expressive language, receptive language, fine motor, and visual reception) and characteristics of autism (social affect and repetitive, restricted behaviors). Materials and Methods: One fifty-eight children (136 full-term, twenty-two preterm) diagnosed with autism, aged 22–34 months, were identified prospectively using the Social Attention and Communication Surveillance tools during community-based, developmental surveillance checks in the second year of life. Those identified at “high likelihood” of an autism diagnosis were administered the Mullen Scales of Early Learning and the Autism Diagnostic Observation Schedule. Results: The children born preterm and full-term did not differ significantly in their fine motor, visual reception, expressive language, or receptive language skills. No significant differences in social affect and repetitive and restrictive behavior traits were found. Discussion: The findings of this study differs from previous research where children diagnosed with autism born very or extremely preterm were developmentally delayed and had greater autistic traits than their term-born peers. These null findings may relate to the large proportion of children born moderate to late preterm in this sample. This study was unique in its use of a community-based, prospectively identified sample of children diagnosed with autism at an early age. It may be that children in these groups differ from clinic- and hospital-based samples, that potential differences emerge later in development, or that within the autism spectrum, children born preterm and full-term develop similarly. It was concluded that within the current sample, at 2 years of age, children diagnosed with autism born preterm are similar to their peers born full-term. Thus, when clinicians identify characteristics of autism in children born preterm, it is important to refer the child for a diagnostic assessment for autism.
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Affiliation(s)
- Jenny Luu
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Rachel Jellett
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Maya Yaari
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.,Goshen - Community Child Health and Well-Being, Haruv Campus for Children, Jerusalem, Israel
| | - Melissa Gilbert
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Indooroopilly, QLD, Australia
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16
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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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17
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Abstract
Social problems are an important feature of the preterm behavioral phenotype but are diverse and multidimensional. A model of social competence comprised of the three interrelated components of social cognition, social interaction, and social adjustment is useful in conceptualizing these problems. Weaknesses in social cognition in very preterm (VPT) children, although rarely studied, are found on tasks involving interpretation of social cues. Difficulties in social interaction in VPT infants and young children are documented by structured observations of their interactions with adults. Problems in social adjustment are endorsed on parent and teacher ratings of VPT infants and youth and on self-reports of VPT adults. These multiple deficits likely stem from early disruptions in neural development, are related to other consequences of preterm birth, and subject to postnatal environment influences. Further research is needed to more fully account for the effects of VPT birth on the development of social competence.
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Affiliation(s)
- H Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA.
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ADHD symptoms and their neurodevelopmental correlates in children born very preterm. PLoS One 2020; 15:e0224343. [PMID: 32126073 PMCID: PMC7053718 DOI: 10.1371/journal.pone.0224343] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/12/2020] [Indexed: 11/19/2022] Open
Abstract
This study investigated the association between attention-deficit/hyperactivity disorder (ADHD) symptomatology in preschool-aged children who were born very preterm (<33 weeks) and cognitive outcomes, clinical risk and socio-demographic characteristics. 119 very preterm children who participated in the Evaluation of Preterm Imaging Study at term-equivalent age were assessed at a mean age of 4.5 years. Parents completed the ADHD Rating Scale IV, a norm-referenced checklist that evaluates ADHD symptomatology according to diagnostic criteria, and the Behavior Rating Inventory of Executive Function-Preschool version. Children completed the Wechsler Preschool and Primary Scales of Intelligence and the Forward Digit Span task. Longitudinal data including perinatal clinical, qualitative MRI classification, socio-demographic variables and neurodevelopmental disabilities were investigated in relation to ADHD symptomatology. All results were corrected for multiple comparisons using false discovery rate. Results showed that although the proportion of very preterm children with clinically significant ADHD did not differ from normative data after excluding those with neurodevelopmental disabilities, 32.7% met criteria for subthreshold ADHD inattentive type and 33.6% for combined type, which was higher than the expected 20% in normative samples. Higher ADHD symptom scores (all) were associated with greater executive dysfunction (inhibitory self-control, flexibility, and emergent metacognition, corrected p<0.001 for all tests). Higher inattentive ADHD symptom scores were associated with lower IQ (ρ = -0.245, p = 0.011) and higher perinatal clinical risk (more days on mechanical ventilation (ρ = 0.196, p = 0.032) and more days on parenteral nutrition (ρ = 0.222, p = 0.015). Higher hyperactive ADHD symptom scores instead were associated with lower socio-economic status (ρ = 0.259, p = 0.004). These results highlight the importance of monitoring and supporting the development of very preterm children throughout the school years, as subthreshold ADHD symptoms represent risk factors for psychosocial problems and for receiving a future clinical diagnosis of ADHD.
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Abstract
OBJECTIVE Most autism spectrum disorder (ASD) screening measures have been developed for use with low-risk (LR) children; however, measures may perform differently in high-risk (HR) younger sibling populations. The current study sought to investigate the performance of an ASD screening measure, the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F), in a sample of HR younger siblings and directly compared its performance with that in an LR sample. METHODS High-risk younger siblings (n = 187) and LR children (n = 15,848) were screened using the M-CHAT-R/F. Screen-positive children completed comprehensive evaluations. The M-CHAT-R/F psychometric properties and clinical characteristics were compared across the samples. RESULTS The M-CHAT-R/F demonstrated a significantly higher screen-positive rate and ASD detection rate in the HR sample compared with the LR sample. Children with ASD in the HR sample had stronger verbal, nonverbal, and overall cognitive abilities compared with children with ASD in the LR sample despite comparable ASD severity and adaptive functioning. High positive predictive value of the M-CHAT-R at initial screen, with only incremental change after Follow-Up, suggests that Follow-Up is less critical in HR than LR samples. A significantly lower number of changed responses during Follow-Up further supports improved reporting accuracy of parents with ASD experience compared with parents less familiar with ASD. CONCLUSION The findings suggest that the M-CHAT-R/F can distinguish between ASD and non-ASD at 18 to 24 months in an HR sibling sample, with performance comparable with or better than its performance in the general population.
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Modi N, Ashby D, Battersby C, Brocklehurst P, Chivers Z, Costeloe K, Draper ES, Foster V, Kemp J, Majeed A, Murray J, Petrou S, Rogers K, Santhakumaran S, Saxena S, Statnikov Y, Wong H, Young A. Developing routinely recorded clinical data from electronic patient records as a national resource to improve neonatal health care: the Medicines for Neonates research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background
Clinical data offer the potential to advance patient care. Neonatal specialised care is a high-cost NHS service received by approximately 80,000 newborn infants each year.
Objectives
(1) To develop the use of routinely recorded operational clinical data from electronic patient records (EPRs), secure national coverage, evaluate and improve the quality of clinical data, and develop their use as a national resource to improve neonatal health care and outcomes. To test the hypotheses that (2) clinical and research data are of comparable quality, (3) routine NHS clinical assessment at the age of 2 years reliably identifies children with neurodevelopmental impairment and (4) trial-based economic evaluations of neonatal interventions can be reliably conducted using clinical data. (5) To test methods to link NHS data sets and (6) to evaluate parent views of personal data in research.
Design
Six inter-related workstreams; quarterly extractions of predefined data from neonatal EPRs; and approvals from the National Research Ethics Service, Health Research Authority Confidentiality Advisory Group, Caldicott Guardians and lead neonatal clinicians of participating NHS trusts.
Setting
NHS neonatal units.
Participants
Neonatal clinical teams; parents of babies admitted to NHS neonatal units.
Interventions
In workstream 3, we employed the Bayley-III scales to evaluate neurodevelopmental status and the Quantitative Checklist of Autism in Toddlers (Q-CHAT) to evaluate social communication skills. In workstream 6, we recruited parents with previous experience of a child in neonatal care to assist in the design of a questionnaire directed at the parents of infants admitted to neonatal units.
Data sources
Data were extracted from the EPR of admissions to NHS neonatal units.
Main outcome measures
We created a National Neonatal Research Database (NNRD) containing a defined extract from real-time, point-of-care, clinician-entered EPRs from all NHS neonatal units in England, Wales and Scotland (n = 200), established a UK Neonatal Collaborative of all NHS trusts providing neonatal specialised care, and created a new NHS information standard: the Neonatal Data Set (ISB 1595) (see http://webarchive.nationalarchives.gov.uk/±/http://www.isb.nhs.uk/documents/isb-1595/amd-32–2012/index_html; accessed 25 June 2018).
Results
We found low discordance between clinical (NNRD) and research data for most important infant and maternal characteristics, and higher prevalence of clinical outcomes. Compared with research assessments, NHS clinical assessment at the age of 2 years has lower sensitivity but higher specificity for identifying children with neurodevelopmental impairment. Completeness and quality are higher for clinical than for administrative NHS data; linkage is feasible and substantially enhances data quality and scope. The majority of hospital resource inputs for economic evaluations of neonatal interventions can be extracted reliably from the NNRD. In general, there is strong parent support for sharing routine clinical data for research purposes.
Limitations
We were only able to include data from all English neonatal units from 2012 onwards and conduct only limited cross validation of NNRD data directly against data in paper case notes. We were unable to conduct qualitative analyses of parent perspectives. We were also only able to assess the utility of trial-based economic evaluations of neonatal interventions using a single trial. We suggest that results should be validated against other trials.
Conclusions
We show that it is possible to obtain research-standard data from neonatal EPRs, and achieve complete population coverage, but we highlight the importance of implementing systematic examination of NHS data quality and completeness and testing methods to improve these measures. Currently available EPR data do not enable ascertainment of neurodevelopmental outcomes reliably in very preterm infants. Measures to maintain high quality and completeness of clinical and administrative data are important health service goals. As parent support for sharing clinical data for research is underpinned by strong altruistic motivation, improving wider public understanding of benefits may enhance informed decision-making.
Future work
We aim to implement a new paradigm for newborn health care in which continuous incremental improvement is achieved efficiently and cost-effectively by close integration of evidence generation with clinical care through the use of high-quality EPR data. In future work, we aim to automate completeness and quality checks and make recording processes more ‘user friendly’ and constructed in ways that minimise the likelihood of missing or erroneous entries. The development of criteria that provide assurance that data conform to prespecified completeness and quality criteria would be an important development. The benefits of EPR data might be extended by testing their use in large pragmatic clinical trials. It would also be of value to develop methods to quality assure EPR data including involving parents, and link the NNRD to other health, social care and educational data sets to facilitate the acquisition of lifelong outcomes across multiple domains.
Study registration
This study is registered as PROSPERO CRD42015017439 (workstream 1) and PROSPERO CRD42012002168 (workstream 3).
Funding
The National Institute for Health Research Programme Grants for Applied Research programme (£1,641,471). Unrestricted donations were supplied by Abbott Laboratories (Maidenhead, UK: £35,000), Nutricia Research Foundation (Schiphol, the Netherlands: £15,000), GE Healthcare (Amersham, UK: £1000). A grant to support the use of routinely collected, standardised, electronic clinical data for audit, management and multidisciplinary feedback in neonatal medicine was received from the Department of Health and Social Care (£135,494).
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Affiliation(s)
- Neena Modi
- Department of Medicine, Imperial College London, London, UK
| | - Deborah Ashby
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | | | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Kate Costeloe
- Centre for Genomics and Child Health, Queen Mary University of London, London, UK
| | | | - Victoria Foster
- Department of Social Sciences, Edge Hill University, Ormskirk, UK
| | - Jacquie Kemp
- National Programme of Care, NHS England, London, UK
| | - Azeem Majeed
- School of Public Health, Imperial College London, London, UK
| | | | - Stavros Petrou
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Katherine Rogers
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | | | - Hilary Wong
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Alys Young
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Chen LW, Wang ST, Wang LW, Kao YC, Chu CL, Wu CC, Hsieh YT, Chiang CH, Huang CC. Behavioral characteristics of autism spectrum disorder in very preterm birth children. Mol Autism 2019; 10:32. [PMID: 31367295 PMCID: PMC6647137 DOI: 10.1186/s13229-019-0282-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/10/2019] [Indexed: 12/27/2022] Open
Abstract
Background Lower gestational age may increase autism spectrum disorder (ASD) vulnerability; however, the incidence of ASD diagnosis through a direct assessment on every very preterm birth child on the population base remains unclear. Moreover, the behavioral characteristics of preterm birth ASD are unknown. Methods Every very preterm birth child (gestational age < 32 weeks; birth weight < 1500 g) who was discharged from neonatal intensive care units in Southern Taiwan and prospectively followed to 5 years of age was evaluated using the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R). The term birth (gestational age > 37 weeks) ASD children characterized by ADOS and ADI-R were group matched to the preterm birth ASD by age at examination for comparison. ADOS severity scores were calculated by the Mann-Whitney U test and ADI-R by multivariate analysis of variance and canonical discriminant analysis. Results Two hundred forty-six (87%) of the 283 very preterm survivors were followed prospectively to 5 years of age. Nineteen (7.7%) of the 246 children fulfilled the diagnostic criteria of ASD. After excluding 1 patient with cerebral palsy and profound mental disability, 18 preterm ASD children were compared with 44 term birth ASD children. The two ASD groups were comparable for age at examination, gender, and intelligence quotient. The two groups showed comparable ADOS severity scores in social affect deficits, restricted repetitive behaviors, and total score, but had differences in qualitative abnormalities in reciprocal social interaction (Wilks lambda F value = 6.2, P < 0.001) of ADI-R. Compared to term birth ASD children, preterm birth ASD children exhibited worse nonverbal behaviors that regulate social interaction (OR 2.59, 95% CI 1.41-4.73, P = 0.002) but more favorable peer relationships (OR 0.58, 95% CI 0.38-0.90, P = 0.01) and socioemotional reciprocity (OR 0.55, 95% CI 0.33-0.92, P = 0.02). In contrast to the heterogeneous severity of social reciprocity in the term ASD group, the behavioral characteristics of the preterm ASD group showed a homogeneous reciprocal social interaction pattern. Conclusions The 5-year incidence rate of ASD was high in very preterm birth children. Preterm birth ASD exhibited a specific behavioral phenotype of reciprocal social interaction.
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Affiliation(s)
- Li-Wen Chen
- 1Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70403 Taiwan.,2Graduate Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shan-Tair Wang
- 3Graduate Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Lan-Wan Wang
- 4Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan.,5Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei, Taiwan.,6Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Yu-Chia Kao
- 2Graduate Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,7Department of Pediatrics, E-Da Hospital, Kaohsiung, Taiwan
| | - Ching-Lin Chu
- 8Department of Educational Psychology and Counseling, National Pingtung University, Pingtung, Taiwan
| | - Chin-Chin Wu
- 9Department of Psychology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ting Hsieh
- 10Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Hsin Chiang
- 11Department of Psychology, National Chengchi University, Taipei, Taiwan.,12Research Center for Mind, Brain and Learning, National Chengchi University, Taipei, Taiwan
| | - Chao-Ching Huang
- 1Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70403 Taiwan.,5Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei, Taiwan
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22
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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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23
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Risk for ASD in Preterm Infants: A Three-Year Follow-Up Study. AUTISM RESEARCH AND TREATMENT 2018; 2018:8316212. [PMID: 30534432 PMCID: PMC6252203 DOI: 10.1155/2018/8316212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/08/2018] [Accepted: 10/29/2018] [Indexed: 01/30/2023]
Abstract
Background The aim of this study was to examine the long-term risk for autism spectrum disorders (ASD) in individuals who are born preterm and full-term using both observational instruments and parental reports. Neonatal risk factors and developmental characteristics associated with ASD risk were also examined. Method Participants included 110 preterm children (born at a gestational age of ≤ 34 weeks) and 39 full-term children assessed at ages 18, 24, and 36 months. The Autism Diagnostic Observation Schedule, the Modified Checklist for Autism in Toddlers, the Autism Diagnostic Interview-Revised, the Social Communication Questionnaire, and the Mullen Scales of Early Learning were administered. Results and Conclusions The long-term risk for ASD was higher when parental reports were employed compared to observational instruments. At 18 and 24 months, a higher long-term risk for ASD was found for preterm children compared to full-term children. At 36 months, only one preterm child and one full-term child met the cutoff for ASD based on the ADOS, yet clinical judgment and parental reports supported an ASD diagnosis for the preterm child only. Earlier gestational age and lower general developmental abilities were associated with elevated ASD risk among preterm children.
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Peralta-Carcelen M, Schwartz J, Carcelen AC. Behavioral and Socioemotional Development in Preterm Children. Clin Perinatol 2018; 45:529-546. [PMID: 30144853 DOI: 10.1016/j.clp.2018.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Prematurity is a significant risk factor for impaired neurodevelopmental outcomes. These include motor, cognitive, language, behavioral, and socioemotional competence. Long-term overall function depends on healthy socioemotional functioning. The vulnerability of the preterm brain during critical periods of development contributes to behavioral and socioemotional problems in preterm children. Attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) clinical features are more frequent in preterm children compared with their full-term counterparts; however, true rates of ASD and ADHD vary across studies. Early detection of behavioral and socioemotional problems in preterm children would enable timely early intervention to improve long-term functional outcomes.
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Affiliation(s)
- Myriam Peralta-Carcelen
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Alabama at Birmingham, Dearth Tower Suite 5602, McWane. 1600 7th Avenue South, Birmingham, AL 35233-1711, USA.
| | - Justin Schwartz
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Alabama at Birmingham, Dearth Tower Suite 5602, McWane. 1600 7th Avenue South, Birmingham, AL 35233-1711, USA
| | - Andrea C Carcelen
- International Health Department, John Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room 5517, Baltimore, MD, USA
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Boone KM, Brown AK, Keim SA. Screening Accuracy of the Brief Infant Toddler Social-Emotional Assessment to Identify Autism Spectrum Disorder in Toddlers Born at Less Than 30 Weeks' Gestation. Child Psychiatry Hum Dev 2018; 49:493-504. [PMID: 29147839 DOI: 10.1007/s10578-017-0768-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Despite the higher prevalence of autism spectrum disorder (ASD) in children born preterm, valid screening tools for use in preterm populations are lacking. We aimed to evaluate the screening accuracy of the Brief Infant Toddler Social-Emotional Assessment (BITSEA) and to compare it to the Pervasive Developmental Disorders Screening Test-II, Stage 2, Developmental Clinic Screener (PDDST-II-DCS) in identifying ASD diagnosis in toddlers born at < 30 weeks' gestation. Caregivers (94% mothers) of 555 children completed questionnaires (BITSEA, PDDST-II-DCS, socio-demographics) when the children (58% male) were 18-36 months. Medical charts were abstracted 3.5 years later and showed that 4% (n = 24) of children had an ASD diagnosis. BITSEA competence (sensitivity = .74; specificity = .76) and ASD (sensitivity = .70; specificity = .73) subscales demonstrated better accuracy in identifying ASD compared to the recommended PDDST-II-DCS cut-score (sensitivity = .73; specificity = .64), specifically as it related to specificity. Additional studies are needed in other preterm populations to replicate these findings.
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Affiliation(s)
- Kelly M Boone
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
- Crane Center for Early Childhood Research and Policy and Schoenbaum Family Center, The Ohio State University, 175 East 7th Avenue, Columbus, OH, 43201, USA.
| | - Anne K Brown
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Sarah A Keim
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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Altay MA, Görker I, Aslanova R, Bozatlı L, Turan N, Kaplan PB. Association between Beta-Sympathomimetic Tocolysis and Risk of Autistic Spectrum Disorders, Behavioural and Developmental Outcome in Toddlers. Open Access Maced J Med Sci 2017; 5:730-735. [PMID: 29104681 PMCID: PMC5661710 DOI: 10.3889/oamjms.2017.153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 11/05/2022] Open
Abstract
AIM To investigate whether maternal intravenous beta-mimetic tocolytic therapy increases the risk of autistic spectrum disorders (ASD) and poorer behavioural and developmental outcomes. METHOD Our study is a prospective case-control study among 90 children between 1.5 and three years old. Cases (n = 46) were toddlers with betamimetic tocolytic exposure; control group toddlers (n = 44) were tocolytic untreated. Treated and untreated groups were also divided into subgroups: term and preterm delivered. The gestational age of tocolytic treatment start, the dose and duration of exposure in hours were obtained from obstetric medical records. The Brief Infant-Toddler Social and Emotional Assessment (BITSEA), the Modified Checklist for Autism in Toddlers (M-CHAT) and the Denver Developmental Screening Test (DDST) tests were applied for evaluation of social, emotional problems, autism and developmental disorders. RESULTS Term and preterm born toddlers treated tocolytically in utero didn't demonstrate a higher risk of autistic disorders or poorer behavioural and developmental results than controls. In the preterm group, the earliest start of tocolytic treatment was correlated with toddlers lower score of the Competencies Scale (p = 0.009) and a higher score of the Problems Scale (p = 0.048). Also, we concluded that preterm membrane rupture was associated with higher ASD risk in the untreated group (p = 0.043). CONCLUSION Exposure to betamimetics during pregnancy was not associated with an increased risk of autism, behavioural and developmental disorders.
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Affiliation(s)
- Mengühan Araz Altay
- Department of Child and Adolescent Psychiatry, Edirne Sultan 1. Murat State Hospital, Edirne, Turkey
| | - Işık Görker
- Department of Child and Adolescent Psychiatry, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Rakhshanda Aslanova
- Department of Obstetrics and Gynecology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Leyla Bozatlı
- Department of Child and Adolescent Psychiatry, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Nesrin Turan
- Department of Biostatistics and Medical Informatics, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Petek Balkanlı Kaplan
- Department of Obstetrics and Gynecology, Trakya University Faculty of Medicine, Edirne, Turkey
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Kamp-Becker I, Poustka L, Bachmann C, Ehrlich S, Hoffmann F, Kanske P, Kirsch P, Krach S, Paulus FM, Rietschel M, Roepke S, Roessner V, Schad-Hansjosten T, Singer T, Stroth S, Witt S, Wermter AK. Study protocol of the ASD-Net, the German research consortium for the study of Autism Spectrum Disorder across the lifespan: from a better etiological understanding, through valid diagnosis, to more effective health care. BMC Psychiatry 2017; 17:206. [PMID: 28577550 PMCID: PMC5455122 DOI: 10.1186/s12888-017-1362-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/19/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) is a severe, lifelong neurodevelopmental disorder with early onset that places a heavy burden on affected individuals and their families. Due to the need for highly specialized health, educational and vocational services, ASD is a cost-intensive disorder, and strain on health care systems increases with increasing age of the affected individual. METHODS The ASD-Net will study Germany's largest cohort of patients with ASD over the lifespan. By combining methodological expertise from all levels of clinical research, the ASD-Net will follow a translational approach necessary to identify neurobiological pathways of different phenotypes and their appropriate identification and treatment. The work of the ASD-Net will be organized into three clusters concentrating on diagnostics, therapy and health economics. In the diagnostic cluster, data from a large, well-characterized sample (N = 2568) will be analyzed to improve the efficiency of diagnostic procedures. Pattern classification methods (machine learning) will be used to identify algorithms for screening purposes. In a second step, the developed algorithm will be tested in an independent sample. In the therapy cluster, we will unravel how an ASD-specific social skills training with concomitant oxytocin administration can modulate behavior through neurobiological pathways. For the first time, we will characterize long-term effects of a social skills training combined with oxytocin treatment on behavioral and neurobiological phenotypes. Also acute effects of oxytocin will be investigated to delineate general and specific effects of additional oxytocin treatment in order to develop biologically plausible models for symptoms and successful therapeutic interventions in ASD. Finally, in the health economics cluster, we will assess service utilization and ASD-related costs in order to identify potential needs and cost savings specifically tailored to Germany. The ASD-Net has been established as part of the German Research Network for Mental Disorders, funded by the BMBF (German Federal Ministry of Education and Research). DISCUSSION The highly integrated structure of the ASD-Net guarantees sustained collaboration of clinicians and researchers to alleviate individual distress, harm, and social disability of patients with ASD and reduce costs to the German health care system. TRIAL REGISTRATION Both clinical trials of the ASD-Net are registered in the German Clinical Trials Register: DRKS00008952 (registered on August 4, 2015) and DRKS00010053 (registered on April 8, 2016).
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Affiliation(s)
- Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Clinic, Philipps-University Marburg, Marburg, Germany
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | | | - Stefan Ehrlich
- Department of Child & Adolescent Psychiatry, Medical Faculty of the Technical University Dresden, Dresden, Germany
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Philipp Kanske
- Department of Social Neuroscience, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Peter Kirsch
- Department of Clinical Psychology Central Institute of Mental Health, Mannheim, Germany
| | - Sören Krach
- Department for Psychiatry and Psychotherapy, University Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Frieder Michel Paulus
- Department for Psychiatry and Psychotherapy, University Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Mannheim, Germany
| | - Stefan Roepke
- Department of Psychiatry, Campus Benjamin Franklin, Charité - Medical Faculty Berlin, Berlin, Germany
| | - Veit Roessner
- Department of Child & Adolescent Psychiatry, Medical Faculty of the Technical University Dresden, Dresden, Germany
| | - Tanja Schad-Hansjosten
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Tania Singer
- Department of Social Neuroscience, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Sanna Stroth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Clinic, Philipps-University Marburg, Marburg, Germany
| | - Stephanie Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Mannheim, Germany
| | - Anne-Kathrin Wermter
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Clinic, Philipps-University Marburg, Marburg, Germany
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Fezer GF, Matos MBD, Nau AL, Zeigelboim BS, Marques JM, Liberalesso PBN. CARACTERÍSTICAS PERINATAIS DE CRIANÇAS COM TRANSTORNO DO ESPECTRO AUTISTA. REVISTA PAULISTA DE PEDIATRIA 2017; 35:130-135. [PMID: 28977330 PMCID: PMC5496724 DOI: 10.1590/1984-0462/;2017;35;2;00003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/17/2016] [Indexed: 11/22/2022]
Abstract
Objective: To analyze perinatal features of children with autism spectrum disorder (ASD). Methods: Retrospective review of the medical records of 75 children with ASD, between January 2008 and January 2015. Inclusion criteria were diagnosis of ASD based on DSM-5 criteria, and the informed consent form signed by the person who is legally responsible. The exclusion criterion was missing on the medical record. The variables analyzed were maternal age, prematurity (gestational age under 37 weeks), low birth weight (<2,500 g), and perinatal asphyxia (5th minute Apgar score <7). Data were analyzed using the difference between proportions test, being significant p<0.05. Results: Seventy-five patients were included. Maternal age ranged from 21.4 to 38.6 years (29.8±4.1 years). Premature birth occurred in 14 (18.7%) patients, perinatal asphyxia in 6 (8.0%), and low birth weight in 32 (42.6%) patients. The prevalence of prematurity, low birth weight, and perinatal asphyxia among the children in our study was higher than the general prevalence of these conditions among all live births in our country, region, and state, which are, respectively, 11.5, 2.3, and 8.5% in Brazil; 11.0, 2.2, and 8.5% in Southern Brazil; and 10.5, 2.0, and 8.4% in the state of Paraná. Conclusions: Our findings show a higher prevalence of prematurity, low birth weight, and perinatal asphyxia among children with ASD. Some limitations are the retrospective study design, and the small sample size. Large prospective studies are needed to clarify the possible association between perinatal complications and ASD.
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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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30
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Johnson S, Marlow N. Early and long-term outcome of infants born extremely preterm. Arch Dis Child 2017; 102:97-102. [PMID: 27512082 DOI: 10.1136/archdischild-2015-309581] [Citation(s) in RCA: 177] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/12/2016] [Indexed: 01/26/2023]
Abstract
There is no question that birth at extremely low gestational ages presents a significant threat to an infant's survival, health and development. Growing evidence suggests that gestational age may be conceptualised as a continuum in which births before 28 weeks of gestation (extremely preterm: EP) represent the severe end of a spectrum of health and developmental adversity. Although comprising just 1%-2% of all births, EP deliveries pose the greatest challenge to neonatal medicine and to health, education and social services for the provision of ongoing support for survivors with additional needs. Studying the outcomes of these infants remains critical for evaluating and enhancing clinical care, planning long-term support and for advancing our understanding of the life-course consequences of immaturity at birth. Here we review literature relating to early and long-term neurodevelopmental, cognitive, behavioural and educational outcomes following EP birth focusing on key themes and considering implications for intervention.
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Affiliation(s)
- Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neil Marlow
- Institute for Women's Health, University College London, London, UK
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31
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Altimier L, Phillips R. The Neonatal Integrative Developmental Care Model: Advanced Clinical Applications of the Seven Core Measures for Neuroprotective Family-centered Developmental Care. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.nainr.2016.09.030] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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32
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Darcy-Mahoney A, Minter B, Higgins M, Guo Y, Williams B, Head Zauche LM, Birth K. Probability of an Autism Diagnosis by Gestational Age . NEWBORN AND INFANT NURSING REVIEWS : NAINR 2016; 16:322-326. [PMID: 28989329 PMCID: PMC5627777 DOI: 10.1053/j.nainr.2016.09.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Early preterm infants (EPT) (<33 6/7 weeks) are at increased risk for autism spectrum disorders (ASDs) but prevalence estimates vary widely across studies. Furthermore, there are very few studies addressing the association between late preterm (LPT) births (34-36 6/7 weeks) and ASDs. To address the question of whether LPT infants carry the same risk for ASDs as full-term infants, this study aimed to estimate the relative probability of an ASD diagnosis using Bayes rule. A retrospective cohort analysis of 406 children was undertaken to look at gestational age, ASDs, and birth history. The application of Bayes rule was used, given that there is not sufficient information about the joint probabilities related to prematurity and autism. Using the estimated gestational age proportions within ASD diagnosis, plus national estimates of ASDs, probabilities for ASDs within a given gestational age were calculated. Among these 406 children with ASDs, 6.7% were EPT and 10.6% were LPT. In comparison to full term, EPT children are at 1.9 multiplicative increase in risk (95% CI [1.3, 2.5]). While the probability of ASDs for LPT children was higher than that for term, the estimated relative risk of the LPT infants was not statistically significant (95% CI [0.9, 1.5]). EPT infants were significantly more likely to be diagnosed with ASDs compared to their term peers. While the relative probability of ASD diagnosis among children born LPT was not statistically significant in this limited sample, the results indicate a possible elevated risk. A larger cohort is needed to adequately estimate this risk.
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Affiliation(s)
- Ashley Darcy-Mahoney
- George Washington University School of Nursing, 2030 M St NW Suite 300, Washington, DC 20052
- George Washington University, Autism and Neurodevelopmental Institute, 2121 Eye Street NW Suite 601, Washington, DC 20052
| | - Bonnie Minter
- Marcus Autism Center, Children’s Healthcare of Atlanta, 1920 Briarcliff Road, Atlanta, GA 30329, United States
| | - Melinda Higgins
- Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd., Atlanta, GA 30322, United States
| | - Ying Guo
- Emory University Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA 30322, United States
| | - Bryan Williams
- Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd., Atlanta, GA 30322, United States
| | - Lauren M. Head Zauche
- Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd., Atlanta, GA 30322, United States
| | - Katie Birth
- Children’s Healthcare of Atlanta, 1405 Clifton Rd., Atlanta, GA 30329, United States
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33
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Roldán-Tapia MD, Moreno-Ríos S, Cánovas-López R. Thinking about social and nonsocial alternative possibilities in premature preschoolers. J Clin Exp Neuropsychol 2016; 39:725-737. [DOI: 10.1080/13803395.2016.1257703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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34
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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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35
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Duerden EG, Lee M, Chow S, Sato J, Mak-Fan K, Taylor MJ. Neural Correlates of Reward Processing in Typical and Atypical Development. Child Neurol Open 2016; 3:2329048X16667350. [PMID: 28503615 PMCID: PMC5417348 DOI: 10.1177/2329048x16667350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/19/2016] [Accepted: 07/29/2016] [Indexed: 12/22/2022] Open
Abstract
Atypically developing children including those born preterm or who have autism spectrum disorder can display difficulties with evaluating rewarding stimuli, which may result from impaired maturation of reward and cognitive control brain regions. During functional magnetic resonance imaging, 58 typically and atypically developing children (6-12 years) participated in a set-shifting task that included the presentation of monetary reward stimuli. In typically developing children, reward stimuli were associated with age-related increases in activation in cognitive control centers, with weaker changes in reward regions. In atypically developing children, no age-related changes were evident. Maturational disturbances in the frontostriatal regions during atypical development may underlie task-based differences in activation.
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Affiliation(s)
- Emma G Duerden
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Neurology, University of Toronto, Toronto, Ontario, Canada.,Neurosciences & Mental Health, Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Minha Lee
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Chow
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Julie Sato
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Mak-Fan
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Margot J Taylor
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Neurology, University of Toronto, Toronto, Ontario, Canada.,Neurosciences & Mental Health, Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
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36
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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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38
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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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39
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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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40
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Pineda R, Melchior K, Oberle S, Inder T, Rogers C. Assessment of Autism Symptoms During the Neonatal Period: Is There Early Evidence of Autism Risk? Am J Occup Ther 2015; 69:6904220010p1-11. [PMID: 26114457 DOI: 10.5014/ajot.2015.015925] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To define neonatal social characteristics related to autism risk. METHOD Sixty-two preterm infants underwent neonatal neurobehavioral testing. At age 2 yr, participants were assessed with the Modified Checklist for Autism in Toddlers and Bayley Scales of Infant and Toddler Development, 3rd edition. RESULTS Positive autism screening was associated with absence of gaze aversion, χ=5.90, p=01, odds ratio=5.05, and absence of endpoint nystagmus, χ=4.78, p=.02, odds ratio=8.47. Demonstrating gaze aversion was related to better language outcomes, t(55)=-3.07, p≤.003. Displaying endpoint nystagmus was related to better language outcomes, t(61)=-3.06, p=.003, cognitive outcomes, t(63)=-5.04, p<.001, and motor outcomes, t(62)=-2.82, p=.006. CONCLUSION Atypical social interactions were not observed among infants who later screened positive for autism. Instead, the presence of gaze aversion and endpoint nystagmus was related to better developmental outcomes. Understanding early behaviors associated with autism may enable early identification and lead to timely therapy activation to improve function.
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Affiliation(s)
- Roberta Pineda
- Roberta Pineda, PhD, OTR/L, is Assistant Professor, Program in Occupational Therapy, Department of Pediatrics, School of Medicine, Washington University, St. Louis, MO;
| | - Kelsey Melchior
- Kelsey Melchior, MSOT, is Occupational Therapy Student, Program in Occupational Therapy, School of Medicine, Washington University, St. Louis, MO
| | - Sarah Oberle
- Sarah Oberle, OTD, OTR/L, is Occupational Therapist, Program in Occupational Therapy, School of Medicine, Washington University, St. Louis, MO
| | - Terrie Inder
- Terrie Inder, MD, is Mary Ellen Avery Professor in Pediatrics in the Field of Newborn Medicine, Harvard Medical School, Boston, MA, and Professor in Pediatrics, Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA
| | - Cynthia Rogers
- Cynthia Rogers, MD, is Assistant Professor, Departments of Psychiatry and Pediatrics, School of Medicine, Washington University, St. Louis, MO
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41
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Pineda RG, Reynolds LC, Seefeldt K, Hilton CL, Rogers CL, Inder TE. Head Lag in Infancy: What Is It Telling Us? Am J Occup Ther 2015; 70:7001220010p1-8. [PMID: 26709421 DOI: 10.5014/ajot.2016.017558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate changes in head lag across postmenstrual age and define associations between head lag and (1) perinatal exposures and (2) neurodevelopment. METHOD Sixty-four infants born ≤ 30 wk gestation had head lag assessed before and at term-equivalent age. Neurobehavior was assessed at term age. At 2 yr, neurodevelopmental testing was conducted. RESULTS Head lag decreased with advancing postmenstrual age, but 58% (n = 37) of infants continued to demonstrate head lag at term. Head lag was associated with longer stay in the neonatal intensive care unit (p = .009), inotrope use (p = .04), sepsis (p = .02), longer endotracheal intubation (p = .01), and cerebral injury (p = .006). Head lag was related to alterations in early neurobehavior (p < .03), but no associations with neurodevelopment were found at 2 yr. CONCLUSION Head lag was related to medical factors and early neurobehavior, but it may not be a good predictor of outcome when used in isolation.
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Affiliation(s)
- Roberta G Pineda
- Roberta G. Pineda, PhD, OTR/L, is Assistant Professor, Program in Occupational Therapy and Department of Pediatrics, Washington University School of Medicine, St. Louis, MO;
| | - Lauren C Reynolds
- Lauren C. Reynolds, OTD, OTR/L, is Research Coordinator, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Kristin Seefeldt
- Kristin Seefeldt, OTR/L, is Occupational Therapist, The Lighthouse Neurological Rehabilitation Center, Kingsley, MI
| | - Claudia L Hilton
- Claudia L. Hilton, PhD, OTR, is Assistant Professor, Department of Occupational Therapy and Department of Rehabilitation Sciences, University of Texas Medical Branch, Galveston
| | - Cynthia L Rogers
- Cynthia L. Rogers, MD, is Assistant Professor, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Terrie E Inder
- Terrie E. Inder, MD, PhD, is Chair, Department of Pediatric Newborn Medicine, Brigham and Women's Infant Hospital, Boston, MA
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42
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Ure AM, Treyvaud K, Thompson DK, Pascoe L, Roberts G, Lee KJ, Seal ML, Northam E, Cheong JL, Hunt RW, Inder T, Doyle LW, Anderson PJ. Neonatal brain abnormalities associated with autism spectrum disorder in children born very preterm. Autism Res 2015; 9:543-52. [PMID: 26442616 DOI: 10.1002/aur.1558] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/08/2015] [Accepted: 08/15/2015] [Indexed: 11/11/2022]
Abstract
Very preterm (VP) survivors are at increased risk of autism spectrum disorder (ASD) compared with term-born children. This study explored whether neonatal magnetic resonance (MR) brain features differed in VP children with and without ASD at 7 years. One hundred and seventy-two VP children (<30 weeks' gestation or <1250 g birth weight) underwent structural brain MR scans at term equivalent age (TEA; 40 weeks' gestation ±2 weeks) and were assessed for ASD at 7 years of age. The presence and severity of white matter, cortical gray matter, deep nuclear gray matter, and cerebellar abnormalities were assessed, and total and regional brain volumes were measured. ASD was diagnosed using a standardized parent report diagnostic interview and confirmed via an independent assessment. Eight VP children (4.7%) were diagnosed with ASD. Children with ASD had more cystic lesions in the cortical white matter at TEA compared with those without ASD (odds ratio [OR] 8.7, 95% confidence interval [CI] 1.5, 51.3, P = 0.02). There was also some evidence for smaller cerebellar volumes in children with ASD compared with those without ASD (OR = 0.82, CI = 0.66, 1.00, P = 0.06). Overall, the results suggest that VP children with ASD have different brain structure in the neonatal period compared with those who do not have ASD. Autism Res 2016, 9: 543-552. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Alexandra M Ure
- Murdoch Childrens Research Institute, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia
| | - Karli Treyvaud
- Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Deanne K Thompson
- Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Leona Pascoe
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - Gehan Roberts
- Murdoch Childrens Research Institute, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Katherine J Lee
- Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Marc L Seal
- Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Elisabeth Northam
- Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Jeanie L Cheong
- Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,The Royal Women's Hospital, Melbourne, Australia
| | - Rod W Hunt
- Murdoch Childrens Research Institute, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Terrie Inder
- Brigham and Women's Hospital, Boston, United States of America
| | - Lex W Doyle
- University of Melbourne, Melbourne, Australia.,The Royal Women's Hospital, Melbourne, Australia
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43
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Early detection of autism spectrum disorders: From retrospective home video studies to prospective ‘high risk’ sibling studies. Neurosci Biobehav Rev 2015; 55:627-35. [DOI: 10.1016/j.neubiorev.2015.06.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/23/2015] [Accepted: 06/03/2015] [Indexed: 11/23/2022]
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44
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Rahkonen P, Lano A, Pesonen AK, Heinonen K, Räikkönen K, Vanhatalo S, Autti T, Valanne L, Andersson S, Metsäranta M. Atypical sensory processing is common in extremely low gestational age children. Acta Paediatr 2015; 104:522-8. [PMID: 25620288 DOI: 10.1111/apa.12911] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 11/21/2014] [Accepted: 12/17/2014] [Indexed: 12/14/2022]
Abstract
AIM Atypical sensory processing is common in children born extremely prematurely. We investigated sensory processing abilities in extremely low gestational age (ELGA) children and analysed associated neonatal risk factors, neuroanatomical findings and neurodevelopmental outcome. METHODS We carried out a prospective study of 44 ELGA children, including 42 who had undergone brain magnetic resonance imaging (MRI) at term-equivalent age, when they were 2 years of corrected age. Their sensory processing abilities were assessed with the Infant/Toddler Sensory Profile questionnaire and their neurodevelopmental with a structured Hempel neurological examination, Griffiths Mental Developmental Scales and Bayley Scales of Infant and Toddler Development Third Edition. RESULTS Sensory profiles were definitely or probably atypical (<-1 SD) in half of the ELGA children, and the most common behavioural pattern was low registration (23%). Sensation seeking was associated with abnormalities in grey and/or white matter in the brain MRI (p < 0.01). Atypical oral sensory processing was associated with surgical closure of the patent ductus arteriosus (p = 0.02, adjusted p < 0.01). CONCLUSION Atypical sensory processing in ELGA children was common, and children with neonatal neuroanatomical lesions tended to present specific behavioural responses to sensory stimuli. Surgical closure of the patent ductus arteriosus may predispose infants to feeding problems due to atypical oral sensory processing.
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Affiliation(s)
- Petri Rahkonen
- Department of Pediatrics; Children's Hospital; University of Helsinki; Helsinki Finland
| | - Aulikki Lano
- Department of Child Neurology; Children's Hospital; University of Helsinki; Helsinki Finland
| | | | - Kati Heinonen
- Institute of Behavioral Sciences; University of Helsinki; Helsinki Finland
| | - Katri Räikkönen
- Institute of Behavioral Sciences; University of Helsinki; Helsinki Finland
| | - Sampsa Vanhatalo
- Department of Clinical Neurophysiology; Children's Hospital; University of Helsinki; Helsinki Finland
| | - Taina Autti
- Medical Imaging Center; University of Helsinki; Helsinki Finland
| | - Leena Valanne
- Medical Imaging Center; University of Helsinki; Helsinki Finland
| | - Sture Andersson
- Department of Pediatrics; Children's Hospital; University of Helsinki; Helsinki Finland
| | - Marjo Metsäranta
- Department of Pediatrics; Children's Hospital; University of Helsinki; Helsinki Finland
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Gray PH, Edwards DM, O'Callaghan MJ, Gibbons K. Screening for autism spectrum disorder in very preterm infants during early childhood. Early Hum Dev 2015; 91:271-6. [PMID: 25766314 DOI: 10.1016/j.earlhumdev.2015.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/13/2015] [Accepted: 02/20/2015] [Indexed: 11/28/2022]
Abstract
AIM The aim of the study was to screen very preterm infants for autism spectrum disorder (ASD) with comparisons to a group of term controls. The study also aimed to identify maternal and neonatal risk factors, development and behaviour associated with a positive screen in the preterm group. METHOD Preterm infants born ≤ 30 weeks gestation and term infants were recruited at two years of age. The mothers were posted the questionnaires and completed the Modified Checklist for Autism in Toddlers (M-CHAT), the Child Behaviour Checklist (CBCL) and the Depression, Anxiety and Stress Scales (DASS). Previously collected data from the mothers at 12 months--the Edinburgh Postnatal Depression Scales (EPDS) were analysed. The children had neurodevelopmental assessment including the Bayley-III. Infants positive on M-CHAT screen had an M-CHAT follow-up interview by phone and then were assessed by a developmental paediatrician as indicated with a diagnosis of autism being made on clinical judgement. RESULTS 13 (13.4%) of the 97 preterm infants screened positive on the M-CHAT compared to three (3.9%) of the 77 term infants (p = 0.036). On follow-up interview, three of the preterm infants remained positive (one was diagnosed with autism) compared to none of the term infants. The preterm infants who screened positive were born to younger, non-Caucasian mothers and were of lower birth weight and had a higher incidence of being small for gestational age (SGA). The infants had lower composite scores on Bayley-III and had more internalising and externalising behaviours on the CBCL. The mothers had more emotional problems on the DASS and higher scores on the EPDS. On multivariate analysis, SGA, greater internalising behaviours and higher EPDS scores remained statistically significant. CONCLUSIONS A positive screen on the M-CHAT occurs more commonly in very preterm infants than those born at term. Internalising behaviours and maternal mental health are associated with a positive screen in the preterm cohort.
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Affiliation(s)
- Peter H Gray
- Growth and Development Unit, Mater Mothers' Hospital, South Brisbane, Queensland, Australia; Mater Research Institute, The University of Queensland, Mater Health Services, South Brisbane, Queensland, Australia.
| | - Dawn M Edwards
- Growth and Development Unit, Mater Mothers' Hospital, South Brisbane, Queensland, Australia; Dept. of Social Work, Mater Children's Hospital, South Brisbane, Queensland, Australia.
| | - Michael J O'Callaghan
- Growth and Development Unit, Mater Mothers' Hospital, South Brisbane, Queensland, Australia; Dept. of Paediatrics and Child Health, University of Queensland, Mater Children's Hospital, South Brisbane, Queensland, Australia.
| | - Kristen Gibbons
- Mater Research Institute, The University of Queensland, Mater Health Services, South Brisbane, Queensland, Australia.
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Neurodevelopmental outcome after extreme prematurity: a review of the literature. Pediatr Neurol 2015; 52:143-52. [PMID: 25497122 DOI: 10.1016/j.pediatrneurol.2014.10.027] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 10/28/2014] [Accepted: 10/28/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Advances in obstetric and neonatal medical care and assisted reproductive technology have increased the rates of preterm birth, decreased preterm mortality rates, and lowered the limit of viability. However, morbidity in survivors, including neurodevelopmental disabilities, has increased, especially in extremely preterm infants born at ≤25 weeks' gestation. A better understanding of the prevalence and patterns of adverse neurodevelopmental outcomes in extremely preterm infants is important for patient care, counseling of families, and research. METHODS The PubMed and Ovid Medline databases were searched for full text articles published between 1999 and 2013 in English that reported neurodevelopmental outcomes after extreme prematurity, and a review of identified relevant cohort studies was performed. RESULTS Extreme prematurity of 22 to 25 weeks' gestation is associated with an overall high mortality of ≥50%. High rates (17% to 59%) of severe neurodevelopmental disabilities occur among survivors on short-term follow-up. The rates of surviving unimpaired or minimally impaired are 6% to 20% for live-born infants at ≤25 weeks' gestation and <5% for infants born at 22 and 23 weeks' gestation. Long-term adverse outcomes after extreme prematurity include intellectual disability (5% to 36%), cerebral palsy (9% to 18%), blindness (0.7% to 9%), and deafness (2% to 4%). Milder degrees of disability involving cognition, behavior, and learning are increasingly recognized among older preterm children, teens, and young adults. CONCLUSIONS Infants who are born at ≤25 weeks' gestation, especially those born at 22 and 23 weeks' gestation, have a very low likelihood of surviving little or no impairment. Nearly half of surviving extremely premature infants have significant neurodevelopmental disabilities on short- and long-term follow-up. Instituting early intervention programs, providing family support, and establishing special educational school programs can pay high dividends and lead to brighter futures and, hence, help improve neurodevelopmental outcome of preterm infants.
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Guy A, Seaton SE, Boyle EM, Draper ES, Field DJ, Manktelow BN, Marlow N, Smith LK, Johnson S. Infants born late/moderately preterm are at increased risk for a positive autism screen at 2 years of age. J Pediatr 2015; 166:269-75.e3. [PMID: 25477165 DOI: 10.1016/j.jpeds.2014.10.053] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/24/2014] [Accepted: 10/22/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To assess the prevalence of positive screens using the Modified Checklist for Autism in Toddlers (M-CHAT) questionnaire and follow-up interview in late and moderately preterm (LMPT; 32-36 weeks) infants and term-born controls. STUDY DESIGN Population-based prospective cohort study of 1130 LMPT and 1255 term-born infants. Parents completed the M-CHAT questionnaire at 2-years corrected age. Parents of infants with positive questionnaire screens were followed up with a telephone interview to clarify failed items. The M-CHAT questionnaire was re-scored, and infants were classified as true or false positives. Neurosensory, cognitive, and behavioral outcomes were assessed using parent report. RESULTS Parents of 634 (57%) LMPT and 761 (62%) term-born infants completed the M-CHAT questionnaire. LMPT infants had significantly higher risk of a positive questionnaire screen compared with controls (14.5% vs 9.2%; relative risk [RR] 1.58; 95% CI 1.18, 2.11). After follow-up, significantly more LMPT infants than controls had a true positive screen (2.4% vs 0.5%; RR 4.52; 1.51, 13.56). This remained significant after excluding infants with neurosensory impairments (2.0% vs 0.5%; RR 3.67; 1.19, 11.3). CONCLUSIONS LMPT infants are at significantly increased risk for positive autistic screen. An M-CHAT follow-up interview is essential as screening for autism spectrum disorders is especially confounded in preterm populations. Infants with false positive screens are at risk for cognitive and behavioral problems.
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Affiliation(s)
- Alexa Guy
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom; School of Psychology, University of Warwick, Coventry, United Kingdom
| | - Sarah E Seaton
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Elaine M Boyle
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - David J Field
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Bradley N Manktelow
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Neil Marlow
- Department of Academic Neonatology, Institute for Women's Health, University College London, London, United Kingdom
| | - Lucy K Smith
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
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Reynolds LC, Inder TE, Neil JJ, Pineda RG, Rogers CE. Maternal obesity and increased risk for autism and developmental delay among very preterm infants. J Perinatol 2014; 34:688-92. [PMID: 24811227 PMCID: PMC4152391 DOI: 10.1038/jp.2014.80] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/10/2014] [Accepted: 03/12/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Thirty-five percent of women of child-bearing age are obese, and there is evidence that maternal obesity may increase the risk for adverse neurodevelopmental outcome. However, research regarding obesity and neurodevelopment among children born preterm is limited. This study aimed to determine associations between maternal obesity and neurodevelopment in very preterm children at age 2 years. STUDY DESIGN Maternal/infant dyads (n=62) born ⩽30 weeks gestation were enrolled in a prospective cohort study at a level-III neonatal intensive care unit. Mothers were classified as obese or non-obese based on pre-pregnancy body mass index. Infants underwent magnetic resonance imaging at term equivalent and developmental testing at age 2. Maternal obesity was investigated for associations with neurodevelopment. RESULT Maternal obesity was associated with positive screen for autism (odds ratio=9.88, P=0.002) and lower composite language scores (β=-9.36, (confidence interval=-15.11, -3.61), P=0.002). CONCLUSION Maternal obesity was associated with adverse neurodevelopmental outcome at age 2 in this cohort of very preterm children. This study requires replication, but may support targeted surveillance of infants born to women with maternal obesity.
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Affiliation(s)
- Lauren C. Reynolds
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Terrie E. Inder
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, United States
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Jeffrey J. Neil
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, United States
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Roberta G. Pineda
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Cynthia E. Rogers
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States
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Williamson KE, Jakobson LS. Social perception in children born at very low birthweight and its relationship with social/behavioral outcomes. J Child Psychol Psychiatry 2014; 55:990-8. [PMID: 24552579 PMCID: PMC4263237 DOI: 10.1111/jcpp.12210] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND Research has shown that children born very prematurely are at substantially elevated risk for social and behavioral difficulties similar to those seen in full-term children with autism spectrum disorders (ASDs). METHODS To gain insight into core deficits that may underlie these difficulties, in this study, we assessed the social perceptual skills of 8- to 11-year-old children born at very low birthweight (VLBW) (<1,500 g) and age-matched, full-term controls, using the Child and Adolescent Social Perception Measure. We also assessed social and behavioral outcomes with two parent-report measures used in ASD screening. RESULTS Children in the preterm group had normal range estimated verbal IQ. However, we found that they were impaired in their ability to use nonverbal cues from moving faces and bodies, and situational cues, to correctly identify the emotions of characters depicted in videotaped social interactions. Their performance on this task was related to the number of 'autistic-like' traits they displayed. CONCLUSIONS This research highlights links between social perceptual deficits and poor social and behavioral outcomes in children born very prematurely. The results also suggest that even those who have escaped major intellectual/language problems are at risk for social and behavioral problems that can be of clinical concern.
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50
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Williamson KE, Jakobson LS, Saunders DR, Troje NF. Local and global aspects of biological motion perception in children born at very low birth weight. Child Neuropsychol 2014; 21:603-28. [PMID: 25103588 PMCID: PMC4566871 DOI: 10.1080/09297049.2014.945407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 07/11/2014] [Indexed: 12/03/2022]
Abstract
Biological motion perception can be assessed using a variety of tasks. In the present study, 8- to 11-year-old children born prematurely at very low birth weight (<1500 g) and matched, full-term controls completed tasks that required the extraction of local motion cues, the ability to perceptually group these cues to extract information about body structure, and the ability to carry out higher order processes required for action recognition and person identification. Preterm children exhibited difficulties in all 4 aspects of biological motion perception. However, intercorrelations between test scores were weak in both full-term and preterm children--a finding that supports the view that these processes are relatively independent. Preterm children also displayed more autistic-like traits than full-term peers. In preterm (but not full-term) children, these traits were negatively correlated with performance in the task requiring structure-from-motion processing, r(30) = -.36, p < .05), but positively correlated with the ability to extract identity, r(30) = .45, p < .05). These findings extend previous reports of vulnerability in systems involved in processing dynamic cues in preterm children and suggest that a core deficit in social perception/cognition may contribute to the development of the social and behavioral difficulties even in members of this population who are functioning within the normal range intellectually. The results could inform the development of screening, diagnostic, and intervention tools.
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Affiliation(s)
- K. E. Williamson
- Department of Psychology, University of Manitoba, WinnipegMB, Canada
| | - L. S. Jakobson
- Department of Psychology, University of Manitoba, WinnipegMB, Canada
| | - D. R. Saunders
- Department of Psychology, Queen’s University, KingstonON, Canada
| | - N. F. Troje
- Department of Psychology, Queen’s University, KingstonON, Canada
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