Neurobehavioral and Medical Correlates of Autism Screening: 2-Year Outcomes for Infants Born Very Preterm

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. (J Pediatr 2023;260:113536).

Automated summary

This study aimed to identify neonatal characteristics and 2-year neurodevelopmental outcomes associated with positive screening for risk of autism. The study found that infants with hypoaroused profiles and multiple medical morbidities were more likely to have a positive screening result. These positive screening results were associated with developmental and behavioral issues in the toddlers.