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- Title
Two-Year Autism Risk Screening and 3-Year Developmental Outcomes in Very Preterm Infants.
- Authors
Shuster, Coral L.; Sheinkopf, Stephen J.; McGowan, Elisabeth C.; Hofheimer, Julie A.; O'Shea, T. Michael; Carter, Brian S.; Helderman, Jennifer B.; Check, Jennifer; Neal, Charles R.; Pastyrnak, Steven L.; Smith, Lynne M.; Loncar, Cynthia; Dansereau, Lynne M.; DellaGrotta, Sheri A.; Marsit, Carmen J.; Lester, Barry M.
- Abstract
This cohort study investigates if use of a 2-stage parent-report autism risk screening tool at 2 years of age is associated with 3-year developmental and behavioral outcomes among infants born very preterm. Key Points: Question: How are screening examinations using a 2-stage parent-report autism risk screening tool at 2 years of age associated with 3-year developmental and behavioral outcomes among infants born very preterm? Findings: In this longitudinal cohort study of 467 infants born less than 30 weeks' gestation, children who screened positive on the 2-stage parent-report autism risk screening tool at age 2 years were significantly more likely to have cognitive, language, and motor delay as well as internalizing, externalizing, and autism-related behavior problems at age 3 years. Meaning: Study results suggest use of the 2-stage parent-report autism risk screening tool for behavior problems and overall developmental delays for infants born very preterm, regardless of future autism diagnosis. Importance: Use of the Modified Checklist for Autism in Toddlers, Revised With Follow-Up, a 2-stage parent-report autism risk screening tool, has been questioned due to reports of poor sensitivity and specificity. How this measure captures developmental delays for very preterm infants may provide support for continued use in pediatric care settings. Objective: To determine whether autism risk screening with the 2-stage parent-report autism risk screening tool at age 2 years is associated with behavioral and developmental outcomes at age 3 in very preterm infants. Design, Setting, and Participants: Neonatal Neurobehavior and Outcomes for Very Preterm Infants was a longitudinal, multisite cohort study. Enrollment occurred April 2014 to June 2016, and analyses were conducted from November 2022 to May 2023. Data were collected across 9 university-affiliated neonatal intensive care units (NICUs). Inclusion criteria were infants born less than 30 weeks' gestational age, a parent who could read and speak English and/or Spanish, and residence within 3 hours of the NICU and follow-up clinic. Exposures: Prematurity and use of the 2-stage parent-report autism risk screening tool at age 2 years. Main Outcomes and Measures: Outcomes include cognitive, language, motor composites on Bayley Scales for Infant and Toddler Development, third edition (Bayley-III) and internalizing, externalizing, total problems, and pervasive developmental disorder (PDD) subscale on the Child Behavior Checklist (CBCL) at age 3 years. Generalized estimating equations tested associations between the 2-stage parent-report autism risk screening tool and outcomes, adjusting for covariates. Results: A total of 467 children (mean [SD] gestational age, 27.1 [1.8] weeks; 243 male [52%]) were screened with the 2-stage parent-report autism risk screening tool at age 2 years, and outcome data at age 3 years were included in analyses. Mean (SD) maternal age at birth was 29 (6) years. A total of 51 children (10.9%) screened positive on the 2-stage parent-report autism risk screening tool at age 2 years. Children with positive screening results were more likely to have Bayley-III composites of 84 or less on cognitive (adjusted odds ratio [aOR], 4.03; 95% CI, 1.65-9.81), language (aOR, 5.38; 95% CI, 2.43-11.93), and motor (aOR, 4.74; 95% CI, 2.19-10.25) composites and more likely to have CBCL scores of 64 or higher on internalizing (aOR, 4.83; 95% CI, 1.88-12.44), externalizing (aOR, 2.69; 95% CI, 1.09-6.61), and PDD (aOR, 3.77; 95% CI, 1.72-8.28) scales. Conclusions and Relevance: Results suggest that the 2-stage parent-report autism risk screening tool administered at age 2 years was a meaningful screen for developmental delays in very preterm infants, with serious delays detected at age 3 years.
- Subjects
AUTISM risk factors; CHILD development; GENETIC testing; HEALTH outcome assessment; RISK assessment; CHILD Behavior Checklist; LONGITUDINAL method; CHILDREN
- Publication
JAMA Pediatrics, 2024, Vol 178, Issue 2, p168
- ISSN
2168-6203
- Publication type
Article
- DOI
10.1001/jamapediatrics.2023.5727