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Social Responsiveness Scale Assessment of the Preterm Behavioral Phenotype in 10-Year-Olds Born Extremely Preterm

Korzeniewski, Steven J. PhD*,†; Joseph, Robert M. PhD; Kim, So Hyun PhD§; Allred, Elizabeth N. MS; O'Shea, T. Michael MD; Leviton, Alan MD; Kuban, Karl C. K. MD**for the ELGAN Study Investigators

Journal of Developmental & Behavioral Pediatrics: November/December 2017 - Volume 38 - Issue 9 - p 697–705
doi: 10.1097/DBP.0000000000000485
Original Articles

Objective: To evaluate the correlates of a clinically significant high score on the Social Responsiveness Scale (SRS) in 10-year-old children who were born extremely preterm and who did not meet criteria for autism spectrum disorder (ASD).

Methods: After excluding 61 participants diagnosed with ASD, we grouped children by IQ < or ≥85 and then compared the prevalence of neurocognitive and other deficits between those who had SRS total and component scores ≥65 and their peers who had lower scores.

Results: Among children who had IQ ≥ 85, the prevalence of SRS total scores ≥65 was 16% (n = 103/628), and among children who had IQ < 85, it was 27% (n = 40/148), higher than the 4% prevalence expected based on normative population data. Among children who had IQ ≥ 85, those who had high SRS scores more often than their peers had deficits in attention and executive function, and language and communication, and they were more often rated by their parents and teachers as having behavioral (e.g., attention-deficit hyperactivity disorder [ADHD]) and emotional (e.g., anxiety and depression) problems.

Conclusion: Social Responsiveness Scale–defined social impairment was much more common in our cohort of 10-year-old children born extremely preterm than was expected based on general population norms. High SRS scores were characteristic of children who had intellectual, neurocognitive, language, and communication limitations, as well as deficits in behavior and emotion regulation.

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*Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI;

Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI;

Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA;

§Department of Psychiatry, Weill Cornell Medical College, New York, NY;

Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA;

Department of Pediatrics, University of North Carolina, Raleigh, NC;

**Department of Pediatrics, Boston Medical Center, Boston University, Boston, MA.

Address for reprints: Steven J. Korzeniewski, PhD, Wayne State University School of Medicine/Perinatology Research Branch [NICHD/NIH], Hutzel Women's Hospital, 4 Brush—Office 4817, 3990 John R, Detroit, MI 48201; e-mail:

Supported by the National Institute of Neurological Disorders and Stroke (5U01NS040069-05; 2R01NS040069-06A2), the National Institute of Child Health and Human Development (5P30HD018655-28), and the Wayne State University Perinatal Initiative. The funders were not involved in study design, data collection, data analysis, manuscript preparation, and/or publication decisions.

Disclosure: The authors declare no conflict of interest.

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Received February , 2017

Accepted June , 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.