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.
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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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    • "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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