Saturday, 27 December 2014

Late/moderately preterm kids at risk for a positive autism screen

If you're sick of the sight of tinsel and/or turkey (delete as appropriate), I promise no more mention of them in this post. Just a brief introduction to the the paper by Alexa Guy and colleagues [1] (open-access) who concluded that: "LMPT [late and moderately preterm] infants are at significantly increased risk for positive autistic screen."
Megamind, incredibly handsome criminal
genius and master of all villainy!

Based on the [final] analysis of data from some 600 LMPT infant and 760 term-born infants taking part in a study initiative here in the UK, researchers looked at M-CHAT (Modified Checklist for Autism in Toddlers) scores derived from parental questioning when the child was 2 years old. They found: "LMPT infants were at significantly increased risk for a positive M-CHAT questionnaire screen compared with term-born infants, and this remained significant after application of the follow-up interview and exclusion of infants with neurosensory impairments." Further that their findings: "provide empirical evidence that screening for ASD is especially confounded in preterm populations" as a function of the the high false-positive rate found compared against the term-born controls.

M-CHAT has cropped up a few times on this blog (see here for example). In recent times, the schedule has undergone a bit of (further) revision, evolving into the M-CHAT-R/F [2] (see here for further details) to further improve on its sensitivity statistics when it comes to assessing risk of an autism spectrum disorder (ASD). Indeed, as per the Guy quote: "An M-CHAT follow-up interview is essential as screening for autism spectrum disorders is especially confounded in preterm populations" one can perhaps see where M-CHAT R/F might be particularly handy for further study of this important group.

These results add to an already sizeable volume of peer-reviewed research literature hinting that the timing of our very earliest introduction into the world might influence risk of neurodevelopmental issues such as autism and/or a positive screen for potential autism. That being said, the various factors linked to time in-utero such as birth weight as potentially impacting on development illustrate how complex an issue this might be. How we screen for autism in among the various complexities of preterm births (and lower birth weight) remains a question on many people's minds, including the possibility of using more than one instrument [3].

Music to close: Norwegian Wood.

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[1] Guy A. et al. Infants Born Late/Moderately Preterm Are at Increased Risk for a Positive
Autism Screen at 2 Years of Age. J Pediatrics. 2014. 5 December.

[2] Robins DL. et al. Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics. 2014 Jan;133(1):37-45.

[3] Dudova I. et al. Comparison of three screening tests for autism in preterm children with birth weights less than 1,500 grams. Neuropsychiatr Dis Treat. 2014 Nov 17;10:2201-2208.

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ResearchBlogging.org Guy, A., Seaton, S., Boyle, E., Draper, E., Field, D., Manktelow, B., Marlow, N., Smith, L., & Johnson, S. (2014). Infants Born Late/Moderately Preterm Are at Increased Risk for a Positive Autism Screen at 2 Years of Age The Journal of Pediatrics DOI: 10.1016/j.jpeds.2014.10.053