Comparing autism phenotypes in children born extremely preterm and born at term.
Robert M Joseph, Emily R Lai, Somer Bishop and 8 others
PMID 36595641WHAT IT FOUND
Children born extremely preterm with autism showed similar core symptoms to term-born children when observed directly.
However, parents of preterm children reported fewer repetitive behaviors and stereotyped speech, a difference likely driven by lower rates of prior autism diagnosis in the preterm group.
Key findings
01There were no group differences on ADOS-2 social affect or repetitive and restricted domain scores or calibrated severity scores.
02Parents of extremely preterm participants reported significantly lower scores on the ADI-R for restricted and repetitive behaviors and stereotyped speech compared to parents of term participants.
03The lower parent-reported repetitive behaviors in the extremely preterm group were associated with a lack of prior clinical autism diagnosis, as parents of children without a diagnosis reported fewer symptoms.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The extremely preterm group had a lower rate of prior clinical ASD diagnosis (36% undiagnosed) compared to the term group (100% diagnosed or referred), which may have biased parent-reported symptoms on the ADI-R. The groups were not matched on maternal education, marital status, or race, which differed between cohorts. Different measures were used to assess associated characteristics like psychiatric symptoms and motor milestones between the two cohorts, limiting direct comparability. Half of the extremely preterm participants had nonverbal IQs in the impaired range, limiting generalizability to higher-functioning preterm children. The sample size was relatively small, which may have reduced power to detect differences in secondary outcomes.
Declared interests
The study was supported by the National Institute of Child Health and Human Development (NICHD) and the Simons Foundation. No other conflicts of interest were declared.
The easy way to misread this
Do not conclude that extremely preterm children have fewer repetitive behaviors. The difference was only seen in parent reports, not direct observation, and was likely influenced by the fact that many preterm children in the study had not previously been diagnosed with autism, which may have altered how parents identified and reported these symptoms.