Symptoms and antecedents of autism in children born extremely premature: a national population-based study.

Silje Katrine Fevang Elgen,Madland Ada Røiseland,Elgen Irene Bircow,Maria Vollsæter,Mari Hysing

doi:10.1007/s00787-022-01953-4

Abstract

The objective of this study is to investigate the prevalence of autism (ASD) symptoms, i.e. , social difficulties, repetitive behaviors, and communicational problems, among children born extremely preterm (EP) compared to a reference group, and to investigate possible antecedents of ASD symptoms among EP children. Method is a national Norwegian cohort of 11year old EP children, excluding those with intellectual disabilities, non-ambulatory cerebral palsy, blindness, and/or deafness. Parents and teachers reported ASD symptoms using The Autism Spectrum Screening Questionnaire (ASSQ). Social difficulties, repetitive behaviors, communicational problems, and a total ASSQ score were presented. Combined ratings on the ASSQ was defined as parent and/or teacher scoring the child ≥ 98th percentile of the reference group, which was the population-based Bergen Child Study. Of eligible children, 216 (64%) EP and 1882 (61%) reference children participated. EP children had significantly higher mean scores and combined ratings on social difficulties (14.5% vs. 4.1%, OR: 3.2), repetitive behaviors (23.7% vs. 4.0%, OR: 6.4), communicational problems (23.1% vs. 4.8%, OR: 5.4), and the total ASSQ score (18.3% vs. 3.4%, OR: 5.7) compared to reference children. Only no prenatal steroids, IQ 70-84, and mental health problems at 5years of age were significantly associated with ASD symptoms at 11years of age. EP children were at increased risk of social difficulties, repetitive behaviors, and communicational problems, and approximately one out of five were reported as high scorers of ASD symptoms. No prenatal steroids use, IQ in the lower range, and mental health problems at 5years of age were associated with ASD symptoms.

Highlights

Social difficulties, repetitive behaviors, and communication deficits are the three main symptom domains of Autism Spectrum Disorder (ASD) [1]
The present study found children born extremely preterm (EP) without nonambulatory cerebral palsy (CP), intellectual disabilities, deafness, or blindness to be at a twofold to more than tenfold increased risk of exhibiting autism symptoms compared to reference children
This may be the case for the EP group, since the attending children had a higher proportion of mothers with higher education, which is associated with less-frequent mental health problems for their children [19]

Summary

Introduction

Repetitive behaviors, and communication deficits are the three main symptom domains of Autism Spectrum Disorder (ASD) [1]. The prevalence of ASD among children born extremely preterm (EP), defined as gestational age < 28 weeks or birth weight < 1000 g, has been estimated to 7–8% [2, 3], which is significantly higher than the expected prevalence rate of 0.7% in the general population [4]. EP born children without a diagnosis of ASD have a higher load of ASD symptoms compared to term born children [5]. Children suffering from severe neurodevelopmental disabilities (NDD), i.e., non-ambulatory cerebral palsy (CP), intellectual disabilities (ID), blindness, and. European Child & Adolescent Psychiatry deafness, are at increased risk of ASD [6, 7]. EP children are at increased risk of severe NDD [8]. Even after excluding those with severe NDD [9] and IQ < 85 [10], EP children are still at risk of ASD symptoms compared to controls

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