dyslimbic
04-10-2008, 05:26 AM
http://www.medscape.com/viewarticle/572735
April 9, 2008 — In a recent study of 91 toddlers who had been born prematurely and weighed from 1 to 3.28 pounds (460-1490 g) at birth, 25% screened positive for early signs of autistic features.
This study is the first to document a high prevalence of early autistic features in survivors of extreme prematurity, the group, led by Catherine Limperopoulos, PhD, at McGill University, in Montreal, Quebec, Canada, writes. The toddlers were screened at a mean age of 21.9 ± 4.7 months with use of the Modified Checklist for Autism in Toddlers.
The findings suggest "routine, systematic screening of very-low-birth-weight infants for early signs of autism is important," Dr. Limperopoulos told Medscape Psychiatry. "It's [also] important to perform formal diagnostic autism testing in those who test positive, in order to confirm whether this initial positive screening does in fact translate into autism spectrum disorders," she said, noting that the team is currently performing these definitive follow-up tests for autism in this cohort.
The study looked at an extremely high-risk subgroup of premature infants with a gestational age range of 23 to 30 weeks (and did not include premature infants having a gestational age of 31 to 37 weeks), she added.
The study is published in the April issue of Pediatrics.
Advances in neonatal intensive care have dramatically increased the survival of preterm infants, but there is an increasing population of very-low-birth-weight children that experience significant disabilities in socialization, communication, and behavior, the group writes.
The study was prompted in part because the team had clinically observed that some very-preterm infants displayed unusual social behaviors at follow-up visits. In addition, validated screening tests to detect early signs of autism have now become available.
Recent studies have demonstrated benefits from intense early interventions, and the American Academy of Pediatrics is endorsing autism screening for all children by age 2 years, Dr. Limperopoulos noted.
The team aimed to perform autism screening tests on toddlers who had been born prematurely and had a very low birth weight and to identify risk factors associated with a positive screening result.
They studied 91 consecutive preterm infants with a birth weight of less than 3.3 pounds (1500 g). When the infants were between 18 and 24 months old, adjusted for prematurity, they were tested with the Modified Checklist for Autism in Toddlers (a 23-item "yes/no" parent report checklist to detect early signs of autism at 16 - 30 months).
The children were also tested with the Child Behavior Checklist for ages 1.5 to 5 years (a caregiver questionnaire about behavior and emotional problems in young children) and the Vineland Adaptive Behavior Scale (a measure of a child's functional status in a wide range of skills).
One Quarter Screened Positive
Of the 91 infants, 23 (25%) had a positive score on the Modified Checklist for Autism in Toddlers screening test. Having abnormal scores on this test correlated highly with having internalizing behavioral problems according to the Child Behavior Checklist and having socialization deficits according to the Vineland Adaptive Behavior Scale.
The infants were more likely to screen positive for early signs of autism if they had the following risk factors: male sex, abnormal results on magnetic resonance imaging (MRI) studies, lower birth weight, younger gestational age, maternal infection, maternal acute intrapartum hemorrhage, and more severe illness at birth.
What Does this Mean?
"Early autistic behaviors seem to be an underrecognized feature of very low birth weight infants," the group concludes. "The results from this study suggest that early screening for signs of autism may be warranted in this high-risk population followed by definitive autism testing in those with positive screening results."
Larger, prospective studies are needed to corroborate these findings and to determine to what extent this initial positive screening test result is a transient or emerging finding during a time of critical development, Dr. Limperopoulos added.
This study was supported by grants from the National Institutes of Health, the LifeBridge Fund, the Caroline Levine Foundation, the Trust Family Foundation, and the Canada Research Chairs Program. The study authors have disclosed no relevant financial relationships.
Pediatrics. 2008;121:758-765.
*
Clinical Context
There is strong evidence of neurodevelopmental impairment among infants with a history of preterm delivery. A study by Hack and colleagues, which was published in the January 17, 2002, issue of the New England Journal of Medicine, observed a cohort of 242 very-low-birth-weight infants into adulthood to assess outcomes. Compared with infants delivered with a normal birth weight, fewer subjects with a history of very-low birth weight had graduated from high school or were enrolled in college. Very-low-birth-weight participants demonstrated lower academic achievement and intelligence scores, and they also experienced higher rates of neurosensory impairments and subnormal height. At the same time, the very-low-birth-weight group reported less alcohol and drug use and had lower rates of pregnancy than normal-birth-weight controls.
A history of prematurity and low birth weight has also been associated with an increased risk for autism spectrum disorders. The current study examines the prevalence of a positive screening for autism disorders among infants with a history of prematurity as well as factors associated with a positive screening result.
April 9, 2008 — In a recent study of 91 toddlers who had been born prematurely and weighed from 1 to 3.28 pounds (460-1490 g) at birth, 25% screened positive for early signs of autistic features.
This study is the first to document a high prevalence of early autistic features in survivors of extreme prematurity, the group, led by Catherine Limperopoulos, PhD, at McGill University, in Montreal, Quebec, Canada, writes. The toddlers were screened at a mean age of 21.9 ± 4.7 months with use of the Modified Checklist for Autism in Toddlers.
The findings suggest "routine, systematic screening of very-low-birth-weight infants for early signs of autism is important," Dr. Limperopoulos told Medscape Psychiatry. "It's [also] important to perform formal diagnostic autism testing in those who test positive, in order to confirm whether this initial positive screening does in fact translate into autism spectrum disorders," she said, noting that the team is currently performing these definitive follow-up tests for autism in this cohort.
The study looked at an extremely high-risk subgroup of premature infants with a gestational age range of 23 to 30 weeks (and did not include premature infants having a gestational age of 31 to 37 weeks), she added.
The study is published in the April issue of Pediatrics.
Advances in neonatal intensive care have dramatically increased the survival of preterm infants, but there is an increasing population of very-low-birth-weight children that experience significant disabilities in socialization, communication, and behavior, the group writes.
The study was prompted in part because the team had clinically observed that some very-preterm infants displayed unusual social behaviors at follow-up visits. In addition, validated screening tests to detect early signs of autism have now become available.
Recent studies have demonstrated benefits from intense early interventions, and the American Academy of Pediatrics is endorsing autism screening for all children by age 2 years, Dr. Limperopoulos noted.
The team aimed to perform autism screening tests on toddlers who had been born prematurely and had a very low birth weight and to identify risk factors associated with a positive screening result.
They studied 91 consecutive preterm infants with a birth weight of less than 3.3 pounds (1500 g). When the infants were between 18 and 24 months old, adjusted for prematurity, they were tested with the Modified Checklist for Autism in Toddlers (a 23-item "yes/no" parent report checklist to detect early signs of autism at 16 - 30 months).
The children were also tested with the Child Behavior Checklist for ages 1.5 to 5 years (a caregiver questionnaire about behavior and emotional problems in young children) and the Vineland Adaptive Behavior Scale (a measure of a child's functional status in a wide range of skills).
One Quarter Screened Positive
Of the 91 infants, 23 (25%) had a positive score on the Modified Checklist for Autism in Toddlers screening test. Having abnormal scores on this test correlated highly with having internalizing behavioral problems according to the Child Behavior Checklist and having socialization deficits according to the Vineland Adaptive Behavior Scale.
The infants were more likely to screen positive for early signs of autism if they had the following risk factors: male sex, abnormal results on magnetic resonance imaging (MRI) studies, lower birth weight, younger gestational age, maternal infection, maternal acute intrapartum hemorrhage, and more severe illness at birth.
What Does this Mean?
"Early autistic behaviors seem to be an underrecognized feature of very low birth weight infants," the group concludes. "The results from this study suggest that early screening for signs of autism may be warranted in this high-risk population followed by definitive autism testing in those with positive screening results."
Larger, prospective studies are needed to corroborate these findings and to determine to what extent this initial positive screening test result is a transient or emerging finding during a time of critical development, Dr. Limperopoulos added.
This study was supported by grants from the National Institutes of Health, the LifeBridge Fund, the Caroline Levine Foundation, the Trust Family Foundation, and the Canada Research Chairs Program. The study authors have disclosed no relevant financial relationships.
Pediatrics. 2008;121:758-765.
*
Clinical Context
There is strong evidence of neurodevelopmental impairment among infants with a history of preterm delivery. A study by Hack and colleagues, which was published in the January 17, 2002, issue of the New England Journal of Medicine, observed a cohort of 242 very-low-birth-weight infants into adulthood to assess outcomes. Compared with infants delivered with a normal birth weight, fewer subjects with a history of very-low birth weight had graduated from high school or were enrolled in college. Very-low-birth-weight participants demonstrated lower academic achievement and intelligence scores, and they also experienced higher rates of neurosensory impairments and subnormal height. At the same time, the very-low-birth-weight group reported less alcohol and drug use and had lower rates of pregnancy than normal-birth-weight controls.
A history of prematurity and low birth weight has also been associated with an increased risk for autism spectrum disorders. The current study examines the prevalence of a positive screening for autism disorders among infants with a history of prematurity as well as factors associated with a positive screening result.