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Autism Spectrum Disorders in Survivors of Extreme Prematurity

Department of Neurology and Neurosurgery, School of Physical and Occupational Therapy, McGill University, 2300 Tupper Street, Montreal, Quebec, H3H 1P3, Canada.
Clinics in perinatology (Impact Factor: 2.13). 12/2009; 36(4):791-805, vi. DOI: 10.1016/j.clp.2009.07.010
Source: PubMed

ABSTRACT Recent studies in survivors of extreme prematurity point to an increased prevalence of a previously underrecognized atypical social-behavioral profile strongly suggestive of an autism spectrum disorder. Prospective studies that incorporate early autism screening and autism diagnostic testing are needed to better delineate the sensitivity and specificity of early signs of autism in ex-premature children. Advances in neonatal MRI techniques capable of quantitative structural and functional measurements will also provide important insights into the effects of prematurity itself, and prematurity-related brain injury on the genesis of autism spectrum disorders in this population. Available evidence linking prematurity and autism spectrum disorders is reviewed in this article.

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    • "Of great concern is the fact that these children are also at substantially elevated risk of screening positive for (Kuban et al., 2009; Limperopoulos et al., 2008; Moore, Johnson, Hennessy, & Marlow, 2012), and being diagnosed with (Johnson et al., 2010; Pinto-Martin et al., 2011), an autism spectrum disorder (ASD). The 'autistic phenotype' of preterm children, however , is thought to represent a milder form of the disorder than that seen in full-term children (Indredavik, Vik, Skranes, & Brubakk, 2008), and to arise from a different causative pathway – one that is nongenetic and stems from brain injuries and altered neurodevelopment associated with very premature birth (Johnson & Marlow, 2011; Limperopoulos, 2009). It is important for researchers, clinicians, and educators to understand the core deficits that underlie the social difficulties, and other 'autistic-like' symptoms, displayed by certain preterm children. "
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    ABSTRACT: Research has shown that children born very prematurely are at substantially elevated risk for social and behavioral difficulties similar to those seen in full-term children with autism spectrum disorders (ASDs; e.g., Johnson et al., The Journal of Pediatrics,, 156, 519). To gain insight into core deficits that may underlie these difficulties, in this study, we assessed the social perceptual skills of 8- to 11-year-old children born at very low birthweight (VLBW) (<1,500 g) and age-matched, full-term controls, using the Child and Adolescent Social Perception Measure (Magill-Evans et al., Journal of Nonverbal Behaviour, , 19, 151). We also assessed social and behavioral outcomes with two parent-report measures used in ASD screening. Children in the preterm group had normal range estimated verbal IQ. However, we found that they were impaired in their ability to use nonverbal cues from moving faces and bodies, and situational cues, to correctly identify the emotions of characters depicted in videotaped social interactions. Their performance on this task was related to the number of 'autistic-like' traits they displayed. This research highlights links between social perceptual deficits and poor social and behavioral outcomes in children born very prematurely. The results also suggest that even those who have escaped major intellectual/language problems are at risk for social and behavioral problems that can be of clinical concern.
    Journal of Child Psychology and Psychiatry 02/2014; 55(9). DOI:10.1111/jcpp.12210 · 5.67 Impact Factor
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    • "The majority of such studies have focused on infants with very low (<1,500 g) and extremely low (<1,000 g) birth weight (most often involving preterm births) (Indredavik et al., 2004; Skranes et al,. 2007; Schendel & Bhasin, 2008; Hack et al., 2009; Kuban et al., 2009; Limperpoulos, 2009); however, associations between ASD and less extreme values of low birth weight (<2,500 g) have been detected (Bryson et al., 1988; Burd et al., 1999; Maimburg & Vaeth, 2006; Kolevzon et al., 2007; Burstyn et al., 2010; Itzchak et al., 2011). "
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    ABSTRACT: Autism spectrum disorder (ASD) is a neurodevelopmental disorder of complex etiology. Although strong evidence supports the causal role of genetic factors, environmental risk factors have also been implicated. This study used a co-twin-control design to investigate low birth weight as a risk factor for ASD. We studied a population-based sample of 3715 same-sex twin pairs participating in the Child and Adolescent Twin Study of Sweden (CATSS). ASD was assessed using a structured parent interview for screening of ASD and related developmental disorders, based on DSM-IV criteria. Birth weight was obtained from medical birth records maintained by the Swedish Medical Birth Registry. Twins lower in birth weight in ASD-discordant twin pairs (n=34) were more than three times more likely to meet criteria for ASD than heavier twins [odds ratio (OR) 3.25]. Analyses of birth weight as a continuous risk factor showed a 13% reduction in risk of ASD for every 100 g increase in birth weight (n=78). Analysis of the effect of birth weight on ASD symptoms in the entire population (most of whom did not have ASD) showed a modest association. That is, for every 100 g increase in birth weight, a 2% decrease in severity of ASD indexed by scores on the Autism - Tics, attention-deficit hyperactivity disorder (AD/HD), and other Comorbidities (A-TAC) inventory would be expected in the sample as a whole. The data were consistent with the hypothesis that low birth weight confers risk to ASD. Thus, although genetic effects are of major importance, a non-genetic influence associated with birth weight may contribute to the development of ASD.
    Psychological Medicine 12/2011; 42(5):1091-102. DOI:10.1017/S0033291711002339 · 5.43 Impact Factor
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    • ") in autistic children using in vivo neuroimaging studies. Recently, Limperopoulos (2009) using neuroimaging studies demonstrated that cerebellar injury and impaired cerebellar growth in premature infants were independently associated with higher (abnormal) Modified Checklist for Autism in Toddlers (M-CHAT) scores. Furthermore , recent evidence from neuroimaging and electrophysiological studies suggest that cerebellum is not only important for motor function but is also actively involved in sensory function and cognitive task (Bower 1997; Kern 2002, 2003; Pierce and Courchesne 2001). "
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    ABSTRACT: Using guidelines of the Meta-analysis of Observational Studies in Epidemiology Group, we systematically reviewed the literature on neonatal jaundice (unconjugated hyperbilirubinemia) and Autism Spectrum Disorder (ASD) in term and preterm infants. Thirteen studies were included in a meta-analysis. Most used retrospective matched case-control designs. There was significant heterogeneity (Q = 31, p = 0.002) and no evidence of publication bias (p = 0.12). Overall, jaundice, assessed by total serum bilirubin (TSB), was associated with ASD (OR, 1.43, 95% CI 1.22-1.67, random effect model). This association was not found in preterms (OR 0.7, 95% CI 0.38-1.02) but deserves further investigation since other measures of bilirubin such as unbound unconjugated bilirubin may be better predictors of neurotoxicity than TSB in preterms.
    Journal of Autism and Developmental Disorders 11/2011; 41(11):1455-63. DOI:10.1007/s10803-010-1169-6 · 3.06 Impact Factor
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