Positive Screening on the Modified Checklist for Autism in Toddlers (M-CHAT) in Extremely Low Gestational Age Newborns

Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston University, Boston, MA 02118, USA.
The Journal of pediatrics (Impact Factor: 3.79). 04/2009; 154(4):535-540.e1. DOI: 10.1016/j.jpeds.2008.10.011
Source: PubMed


To test the hypothesis that children born preterm are more likely to screen positive on the M-CHAT for an autism spectrum disorder.
We compared the M-CHAT positive rate of those with cerebral palsy, cognitive impairment, and vision and hearing impairments to those without such deficits.
Relative to children who could walk, the odds for screening positive on the M-CHAT were increased 23-fold for those unable to sit or stand independently and more than 7-fold for those requiring assistance to walk. Compared with children without a diagnosis of cerebral palsy, those with quadriparesis were 13 times more likely to screen positive, and those with hemiparesis were 4 times more likely to screen positive. Children with major vision or hearing impairments were 8 times more likely to screen positive than those without such impairments. Relative to those with a Mental Development Index (MDI) of >70, the odds for screening positive were increased 13-fold for those with an MDI of <55 and more than 4-fold for those with an MDI of 55 to 69.
Major motor, cognitive, visual, and hearing impairments appear to account for more than half of the positive M-CHAT screens in extremely low gestational age newborns. Even after those with such impairments were eliminated, 10% of children--nearly double the expected rate--screened positive.

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    • "Early identification of ASD in VP children is complicated by the fact that neurological, cognitive and sensory sequelae are relatively common [Anderson et al., 2003], and the functional consequences of these impairments often overlap with symptoms of ASD. As a result, false positive classifications on ASD screens are more common in VP compared with term-born cohorts [Johnson & Marlow, 2009; Kuban et al., 2009; Luyster et al., 2011; Moore et al., 2012]. The identification of biomarkers for ASD is therefore particularly warranted in VP populations, to improve the predictive accuracy of behavioral signs and enable earlier detection of the disorder [Walsh, Elsabbagh, Bolton, & Singh, 2011]. "
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    ABSTRACT: Very preterm (VP) survivors are at increased risk of autism spectrum disorder (ASD) compared with term-born children. This study explored whether neonatal magnetic resonance (MR) brain features differed in VP children with and without ASD at 7 years. One hundred and seventy-two VP children (<30 weeks' gestation or <1250 g birth weight) underwent structural brain MR scans at term equivalent age (TEA; 40 weeks' gestation ±2 weeks) and were assessed for ASD at 7 years of age. The presence and severity of white matter, cortical gray matter, deep nuclear gray matter, and cerebellar abnormalities were assessed, and total and regional brain volumes were measured. ASD was diagnosed using a standardized parent report diagnostic interview and confirmed via an independent assessment. Eight VP children (4.7%) were diagnosed with ASD. Children with ASD had more cystic lesions in the cortical white matter at TEA compared with those without ASD (odds ratio [OR] 8.7, 95% confidence interval [CI] 1.5, 51.3, P = 0.02). There was also some evidence for smaller cerebellar volumes in children with ASD compared with those without ASD (OR = 0.82, CI = 0.66, 1.00, P = 0.06). Overall, the results suggest that VP children with ASD have different brain structure in the neonatal period compared with those who do not have ASD. Autism Res 2015. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.
    Autism Research 10/2015; DOI:10.1002/aur.1558 · 4.33 Impact Factor
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    • "Only 13 infants (21%) in the cohort screened positive for ASD. In addition, the primary outcome was a screening measure, the M–CHAT, that has been criticized for overidentifying ASD risk in premature infants (Kuban et al., 2009; Luyster et al., 2011; Moore et al., 2012). Moreover, it is unclear whether the M–CHAT may have been sensitive in identifying developmental delay not specific to ASD. "
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    ABSTRACT: To define neonatal social characteristics related to autism risk. Sixty-two preterm infants underwent neonatal neurobehavioral testing. At age 2 yr, participants were assessed with the Modified Checklist for Autism in Toddlers and Bayley Scales of Infant and Toddler Development, 3rd edition. Positive autism screening was associated with absence of gaze aversion, χ = 5.90, p =.01, odds ratio = 5.05, and absence of endpoint nystagmus, χ = 4.78, p = .02, odds ratio = 8.47. Demonstrating gaze aversion was related to better language outcomes, t(55) = -3.07, p ≤ .003. Displaying endpoint nystagmus was related to better language outcomes, t(61) = -3.06, p = .003, cognitive outcomes, t(63) = -5.04, p < .001, and motor outcomes, t(62) = -2.82, p = .006. Atypical social interactions were not observed among infants who later screened positive for autism. Instead, the presence of gaze aversion and endpoint nystagmus was related to better developmental outcomes. Understanding early behaviors associated with autism may enable early identification and lead to timely therapy activation to improve function. Copyright © 2015 by the American Occupational Therapy Association, Inc.
    07/2015; 69(4):6904220010p1-6904220010p11. DOI:10.5014/ajot.2015.015925
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    • "We expected to find that problems in one or more areas of biological motion perception might be related to the presence of " autistic-like " symptoms in this population. If confirmed, this result would be of interest, given that recent reports suggest that children born prematurely are at heightened risk for screening positive for (Kuban et al., 2009; Limperopoulos et al., 2008; Moore, Johnson, Hennessy, & Marlow, 2012) or being diagnosed with (Johnson et al., 2010) an autism spectrum disorder. Indeed, among children born weighing < 2000 g, the prevalence of autism spectrum disorder is 5%—a value approximately five times higher than that seen in the general population (Pinto- Martin et al., 2011). "
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    ABSTRACT: Biological motion perception can be assessed using a variety of tasks. In the present study, 8- to 11-year-old children born prematurely at very low birth weight (<1500 g) and matched, full-term controls completed tasks that required the extraction of local motion cues, the ability to perceptually group these cues to extract information about body structure, and the ability to carry out higher order processes required for action recognition and person identification. Preterm children exhibited difficulties in all 4 aspects of biological motion perception. However, intercorrelations between test scores were weak in both full-term and preterm children-a finding that supports the view that these processes are relatively independent. Preterm children also displayed more autistic-like traits than full-term peers. In preterm (but not full-term) children, these traits were negatively correlated with performance in the task requiring structure-from-motion processing, r(30) = -.36, p < .05), but positively correlated with the ability to extract identity, r(30) = .45, p < .05). These findings extend previous reports of vulnerability in systems involved in processing dynamic cues in preterm children and suggest that a core deficit in social perception/cognition may contribute to the development of the social and behavioral difficulties even in members of this population who are functioning within the normal range intellectually. The results could inform the development of screening, diagnostic, and intervention tools.
    Child Neuropsychology 08/2014; 21(5):1-26. DOI:10.1080/09297049.2014.945407 · 2.42 Impact Factor
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