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Screening for Autism Spectrum Disorders in Extremely Preterm Infants

Stephens, Bonnie E. MD*; Bann, Carla M. PhD; Watson, Victoria E. MS, CAS*; Sheinkopf, Stephen J. PhD; Peralta-Carcelen, Myriam MD, MPH§; Bodnar, Anna MD; Yolton, Kimberly PhD; Goldstein, Ricki F. MD**; Dusick, Anna M. MD††; Wilson-Costello, Deanne E. MD‡‡; Acarregui, Michael J. MD§§; Pappas, Athina MD¶¶; Adams-Chapman, Ira MD‖‖; McGowan, Elisabeth C. MD***; Heyne, Roy J. MD†††; Hintz, Susan R. MD, MS, Epi‡‡‡; Ehrenkranz, Richard A. MD§§§; Fuller, Janell MD¶¶¶; Das, Abhik PhD‖‖‖; Higgins, Rosemary D. MD****; Vohr, Betty R. MD*for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

Journal of Developmental & Behavioral Pediatrics: September 2012 - Volume 33 - Issue 7 - p 535–541
doi: 10.1097/DBP.0b013e31825fd0af
Original Article

Background: Extremely preterm (EP) infants screen positive for autism spectrum disorders (ASD) at high rates. However, it is not clear whether this is because of high rates of ASD in EPs or to high rates of false-positive screens for ASD in children with a high rate of underlying neurodevelopmental impairments. Combining a parent questionnaire designed to distinguish developmental delay from ASD with direct observation of infant behavior may more accurately screen for ASD in EPs.

Objectives: To determine rates of positive screen for ASD at 18 to 22 months(m) in EPs using 3 screens; to determine factors associated with a positive screen.

Methods: Five hundred fifty-four infants born <27 weeks were screened at 18 to 22 m using the Pervasive Developmental Disorders Screening test, second edition Stage 2, and the response to name and response to joint attention items from the Autism Diagnostic Observation Schedule. Infants with severe cerebral palsy, deafness, and blindness were excluded. Associations between positive screen and neonatal/ infant characteristics were determined.

Results: Of 554 infants, 113 (20%) had ≥ 1 positive screen. 10% had a positive Pervasive Developmental Disorders Screening test, second edition, 6% response to name, 9% response to joint attention; in only 1 % all 3 screens were positive. Positive screen was associated with male gender, more hospital days, white race, lower maternal education, abnormal behavioral scores, and cognitive/ language delay.

Conclusions: The use of 3 screens for ASD in EPs results in higher screen positive rates than use of 1 screen alone. Diagnostic confirmation is needed before true rates of ASD in EPs are known.

Supplemental Digital Content is Available in the Text.

*Department of Pediatrics, Women & Infants' Hospital, Brown University, Providence, RI

Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC

Department of Psychiatry & Human Behavior, Center for the Study of Children at Risk, Brown Alpert Medical School, Women & Infants Hospital, Providence, RI

§Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL

Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT

Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH

**Department of Pediatrics, Duke University, Durham, NC

††Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN

‡‡Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH

§§Department of Pediatrics, University of Iowa, Iowa City, IA

¶¶Department of Pediatrics, Wayne State University, Detroit, MI

‖‖Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA

***Department of Pediatrics, Division of Newborn Medicine, Floating Hospital for Children, Tufts Medical Center, Boston, MA

†††Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX

‡‡‡Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA

§§§Department of Pediatrics, Yale University School of Medicine, New Haven, CT

¶¶¶University of New Mexico Health Sciences Center, Albuquerque, NM

‖‖‖Statistics and Epidemiology Unit, RTI International, Rockville, MD

****Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.

Disclosure: The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions this article on the journal’s Web site (

Address for reprints: Bonnie E. Stephens, MD, Department of Pediatrics, Women & Infants' Hospital, 101 Dudley Street , Providence, RI 02905; email:

Received January , 2012

Accepted May , 2012

© 2012 Lippincott Williams & Wilkins, Inc.