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ABSTRACT: Transient hypothyroxinaemia of prematurity (THOP) is associated with increased risk of cerebral palsy and lower IQ in low-birthweight infants. This study explores whether THOP is also associated with increased risk of autism spectrum disorders (ASD).
This secondary analysis uses data from a birth cohort of newborns weighing 500 -2000 g (n = 1105) who were followed to age 21 years, when they were assessed for ASD in the second of a two-stage process. Of the 187 assessed at age 21, 14 had ASD. Neonatal thyroxine results were available for 12/14 and 165/173 participants diagnosed with and without ASD, respectively. THOP was defined as thyroxine z-score <-2.6. Unadjusted relative risks (RR) and confidence intervals (CI) were calculated.
The mean neonatal thyroxine z-score in young adults diagnosed with ASD was 0.5 SD lower [95% CI -0.16, 1.06] than in those without ASD. Participants with THOP were at 2.5-fold greater risk of ASD (RR 2.5 [95% CI 0.7, 8.4]). While neither of these differences was statistically significant, in a secondary subgroup analysis of those whose mothers did not have hypertension during pregnancy, THOP significantly increased the RR for ASD (5.0 [95% CI 1.2, 20.5]).
While the primary relation between THOP and ASD found here is not statistically significant, the magnitude of association and significant relationship observed in the subgroup whose mothers did not have hypertension during pregnancy suggest that it is worthy of further investigation.
Paediatric and Perinatal Epidemiology 03/2013; 27(2):182-7. · 2.31 Impact Factor
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ABSTRACT: OBJECTIVE: To determine the relation of neonatal cranial ultrasound abnormalities to autism spectrum disorders (ASD) in low birth weight (LBW) adult survivors, a population at increased ASD risk. STUDY DESIGN: This is a secondary analysis of a prospectively-followed regional birth cohort of 1105 LBW infants systematically screened for perinatal brain injury with cranial ultrasound in the first week of life and later assessed for ASD using a two-stage process [screening at age 16 years (n = 623) followed by diagnostic assessment at age 21 years of a systematically selected subgroup of those screened (n = 189)]; 14 cases of ASD were identified. For this analysis, cranial ultrasound abnormalities were defined as ventricular enlargement (indicative of diffuse white matter injury), parenchymal lesions (indicative of focal white matter injury), and isolated germinal matrix/intraventricular hemorrhage. RESULTS: Compared with no cranial ultrasound abnormalities, any type of white matter injury (ventricular enlargement and/or parenchymal lesion) tripled the risk for screening positively for ASD [3.0 (2.2, 4.1)]. However, the risk of being diagnosed with ASD depended on type of white matter injury. With ventricular enlargement, the risk of ASD diagnosis was almost seven-fold that of no cranial ultrasound abnormality [6.7 (2.3, 19.7)], and no elevated risk was found for parenchymal lesion without ventricular enlargement [1.8 (0.2, 13.6)]. Isolated germinal matrix/intraventricular hemorrhage did not increase risk for a positive ASD screen or diagnosis. CONCLUSION: In LBW neonates, cranial ultrasound evidence of ventricular enlargement is a strong and significant risk factor for subsequent development of rigorously-diagnosed ASD.
The Journal of pediatrics 02/2013; · 4.02 Impact Factor
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ABSTRACT: To estimate the diagnostic prevalence of autism spectrum disorders (ASDs) in a low birth weight (LBW) cohort.
Participants belonged to a regional birth cohort of infants (N = 1105) born weighing <2000 g between October 1, 1984, and July 3, 1989, and followed up by periodic assessments to 21 years of age. At 16 years (n = 623), adolescents were screened for ASD using a wide net (previous professional diagnosis of an ASD or a score above a liberal cutoff on the Social Communication Questionnaire or the Autism Spectrum Symptoms Questionnaire). At 21 years (n = 189), 60% of screen positives and 24% of screen negatives were assessed for diagnoses of ASD by the Autism Diagnostic Observation Schedule or the Autism Diagnostic Interview-Revised.
Samples retained at ages 16 and 21 years were representative of samples assessed at earlier ages except for lower levels of social risk. Of positive screens, 11 of 70 had ASD; of negative screens, 3 of 119 had ASD. The fractions of the 2 screening groups with ASD (14.3% in screen-positives and 2.5% in screen negatives) were weighted by fractions of screen-positives and screen-negatives among the adolescents (18.8% and 81.2%, respectively). This calculation produced an estimated prevalence rate of ASD in the entire cohort of 5% (31 of 623).
The diagnostic prevalence of ASD in this LBW preterm cohort was higher than that reported by the Centers for Disease Control and Prevention for 8-year-olds in the general US population in 2006.
PEDIATRICS 11/2011; 128(5):883-91. · 4.47 Impact Factor
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ABSTRACT: Infants born prematurely are at risk for a perinatal encephalopathy characterized by white and gray matter injuries that affect subsequent cortical development and neural connectivity and potentially increase risk for later psychiatric disorder.
To determine the relation of perinatal brain injury, as detected by neonatal head ultrasound, to psychiatric disorders in adolescents who were born prematurely.
Prospective cohort.
Community.
Adolescent survivors of a population-based low-birth-weight (<2000 g; 96% preterm; born 1984-1987) cohort (n = 1105) screened as neonates with serial head ultrasounds. Neonatal head ultrasound abnormalities were categorized as either (1) germinal matrix and/or intraventricular hemorrhage or (2) parenchymal lesions and/or ventricular enlargement. Of 862 eligible survivors, 628 (72.9%) were assessed at age 16 years. The sample consisted of 458 nondisabled survivors assessed in person. Main Outcome Measure Adolescent current and lifetime psychiatric disorders assessed with parent report on the Diagnostic Interview Schedule for Children-IV.
Compared with no abnormality, germinal matrix/intraventricular hemorrhage increased risk for current major depressive disorder (odds ratio, 2.7; 95% confidence interval, 1.0-6.8) and obsessive-compulsive disorder (9.5; 3.0-30.1). Parenchymal lesions/ventricular enlargement increased risk for current attention-deficit/hyperactivity disorder-inattentive type (odds ratio, 7.6; 95% confidence interval, 2.0-26.5), tic disorders (8.4; 2.4-29.6), and obsessive-compulsive disorder (7.6; 1.39-42.0). Parenchymal lesions/ventricular enlargement were not related to lifetime attention-deficit/hyperactivity disorder-inattentive type, but all other relations were similar for lifetime disorders. Control for other early risk factors did not alter these relations. Most of these relations persisted with control for concurrent cognitive or motor problems.
In preterm infants, 2 distinct types of perinatal brain injury detectable with neonatal head ultrasound selectively increase risk in adolescence for psychiatric disorders in which dysfunction of subcortical-cortical circuits has been implicated.
Archives of general psychiatry 07/2011; 68(7):742-52. · 12.26 Impact Factor
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Timothy Buie,
Daniel B Campbell,
George J Fuchs,
Glenn T Furuta,
Joseph Levy,
Judy Vandewater, Agnes H Whitaker,
Dan Atkins,
Margaret L Bauman,
Arthur L Beaudet, [......],
Pat Levitt,
Susan E Levy,
Jeffery D Lewis,
Katherine F Murray,
Marvin R Natowicz,
Aderbal Sabra,
Barry K Wershil,
Sharon C Weston,
Lonnie Zeltzer,
Harland Winter
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ABSTRACT: Autism spectrum disorders (ASDs) are common and clinically heterogeneous neurodevelopmental disorders. Gastrointestinal disorders and associated symptoms are commonly reported in individuals with ASDs, but key issues such as the prevalence and best treatment of these conditions are incompletely understood. A central difficulty in recognizing and characterizing gastrointestinal dysfunction with ASDs is the communication difficulties experienced by many affected individuals. A multidisciplinary panel reviewed the medical literature with the aim of generating evidence-based recommendations for diagnostic evaluation and management of gastrointestinal problems in this patient population. The panel concluded that evidence-based recommendations are not yet available. The consensus expert opinion of the panel was that individuals with ASDs deserve the same thoroughness and standard of care in the diagnostic workup and treatment of gastrointestinal concerns as should occur for patients without ASDs. Care providers should be aware that problem behavior in patients with ASDs may be the primary or sole symptom of the underlying medical condition, including some gastrointestinal disorders. For these patients, integration of behavioral and medical care may be most beneficial. Priorities for future research are identified to advance our understanding and management of gastrointestinal disorders in persons with ASDs.
PEDIATRICS 01/2010; 125 Suppl 1:S1-18. · 4.47 Impact Factor
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ABSTRACT: To compare weight concerns and self-reported body mass index (BMI) of low birth weight (LBW) adolescent boys to those of a normative sample and examine relationships among BMI, weight concerns, self-esteem, and depression in the LBW cohort.
LBW boys (n = 260; mean age, 16.0) belong to the Neonatal Brain Hemorrhage Study birth cohort. Normative boys (n = 305; mean age, 16.5) belong to the National Health and Nutrition Examination Survey. Both samples were assessed in 2001-2004 with self-report questionnaires. BMI was calculated from self-reported height and weight. Weight perception and weight dissatisfaction were assessed with the Eating Symptoms Inventory. In LBW boys, self-esteem was measured with the Rosenberg Self-Esteem Scale and depression with the Beck Depression Inventory.
Based on self-reported height and weight, LBW boys were more likely to be healthy weight or underweight and less likely to be overweight than normative boys. Despite having healthier self-reported BMIs, LBW boys reported more weight concerns than the normative sample. A total of 46.9% of LBW boys perceived their weight as abnormal, and 76.5% desired weight change. Weight concerns in LBW boys mostly reflected a perception of being underweight (31.2% of the cohort) and a desire to gain weight (47.5% of the cohort), although only 6.5% were clinically underweight. Weight concerns, but not BMI, were related to clinical depression and lower self-esteem.
LBW adolescent boys are at high risk of experiencing weight concerns. Weight concerns rather than BMI are associated with emotional problems in LBW boys.
Journal of Developmental & Behavioral Pediatrics 07/2008; 29(3):166-72. · 2.13 Impact Factor
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ABSTRACT: Studies of clinically referred patients have implicated low birth weight (LBW) as a possible risk factor for eating disorders. This study examines eating attitudes and weight concerns in nonreferred LBW female adolescents.
274 LBW girls (mean age 15.9) belonging to a prospective regional LBW birth cohort completed the Eating Attitudes Test (EAT-26) and items from the Eating Symptoms Inventory on weight perception and weight dissatisfaction.
Only 2.3% scored above threshold for eating disorder risk on the EAT-26. A total of 25% perceived themselves as overweight and 18.7% perceived themselves as underweight, while 63.4% desired to lose and 17.7% desired to gain weight. Girls who perceived themselves as overweight or desired to lose weight had higher mean EAT scores than those who did not.
Nonreferred adolescent girls born at LBW are not, as a whole, at risk for abnormal eating attitudes and negative perceptions of their weight.
International Journal of Eating Disorders 05/2008; 41(6):573-5. · 2.95 Impact Factor
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ABSTRACT: To describe motor and cognitive outcomes in nondisabled low-birth-weight (LBW) adolescents and to determine the relation of specific prenatal, perinatal, and neonatal risk factors to these outcomes.
A prospective epidemiological study.
An adolescent follow-up of a regional LBW (<2000 g) cohort born in or admitted to 3 hospitals between September 1, 1984, and June 30, 1987 (n = 1105). Of 862 eligible survivors, 628 (72.9%) underwent assessment at a mean age of 16 years; of these, 33 had severe disability that precluded psychometric evaluation. The 474 nondisabled adolescents undergoing assessment at home had slightly less social risk at birth than did all other nondisabled eligible adolescents.
The 474 nondisabled LBW adolescents assessed at home. Main Exposures Basic birth characteristics (social risk, sex, fetal growth ratio, and gestational age), neonatal cranial ultrasound abnormalities, and other early medical complications.
Riley Motor Problems Inventory and Wechsler Abbreviated Scales of Intelligence.
Nondisabled LBW adolescents had an excess of motor problems compared with the normative sample. The IQ scores, although within the normal range, were significantly lower than population norms. Independent predictors of total motor problems included male sex, white matter injury on neonatal ultrasound, and days of ventilation. Independent predictors of lower Full Scale IQ scores included social disadvantage, fetal growth ratio, and white matter injury on neonatal ultrasound.
Specific prenatal, perinatal, and neonatal risk factors influence motor and cognitive performance in nondisabled LBW survivors well into adolescence, even when controlling for social risk. Advances in maternal-fetal and neonatal care can substantially improve these long-term outcomes.
Archives of Pediatrics and Adolescent Medicine 10/2006; 160(10):1040-6. · 4.14 Impact Factor
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ABSTRACT: To examine the association between menstrual functioning and depressive disorder symptoms (DDS), obsessive-compulsive disorder symptoms (OCDS), and eating disorder symptoms (EDS) in high school girls.
Survey data from a county-wide high school population (completion rate 91%) were used. Associations between menstrual indices and scores above clinical cutoff on the Beck Depression Inventory, Leyton Obsessive-Compulsive Inventory-Child Version, and Eating Attitudes Test were examined by using logistic regression ( = 2,547 girls).
Controlling for chronological age and other risk factors, late menarche was associated with DDS (odds ratio [OR] = 2.26, 95% confidence interval [CI] = 1.16-4.18). Gynecological year 1 (GY1) was associated with DDS (OR = 3.13, CI = 1.23-7.33), EDS (OR = 3.11, CI = 1.00-8.09), and OCDS, both number (OR = 5.75, CI = 1.79-15.74) and interference (OR = 12.55, CI = 3.20-41.4). Secondary amenorrhea was associated with DDS (OR = 1.94, CI = 11.30-2.84) and EDS (OR = 2.32, CI = 1.51-3.49); polymenorrhea with EDS (OR = 1.92, CI = 1.27-2.86); and irregular cycles with EDS (OR = 1.70, CI = 1.11-2.54) and DDS (OR = 1.76, CI = 11.21-2.53).
In high school girls, late menarche, GY1, and menstrual cycle abnormalities are associated differentially with DDS, OCDS, and EDS.
Journal of the American Academy of Child & Adolescent Psychiatry 11/2002; 41(10):1197-204. · 6.44 Impact Factor
