Behavioral characteristics of autism spectrum disorder in very preterm birth children

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. Electronic supplementary material The online version of this article (10.1186/s13229-019-0282-4) contains supplementary material, which is available to authorized users.

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“…Suspected cases will be referred to pediatric psychologists for further evaluation. In this study, the prevalence of ASD below five years old was 6% (2001–2010), which correlated with other studies [ 30 , 31 ]. Intriguingly, the prevalence of ASD in premature infants after 2010 was decreasing to 0.6%.…”

“…Impairments in social and communication skills and restricted and repetitive behaviors when it comes to interests and activities are two main characteristics of ASD. The prevalence of ASD in the very preterm population studied in Taiwan correlated to the 7% prevalence rate in a meta-analysis study of children born preterm [ 30 , 31 ]. The high prevalence of ASD in the preterm population might be caused by preterm birth and/or by alteration of immature brain growth, as genetic factors may play a role in both preterm birth and ASD [ 31 ].…”

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