BACKGROUND AND OBJECTIVE: It has been well established that children born preterm are at an increased risk of developing Autism Spectrum Disorder (ASD), and that risk increases as gestational age decreases. However, there is limited knowledge on how the ASD phenotype in preterm-born children compares to ASD presentation in children born at term. The objective of this study is to compare ASD core symptoms and characteristics commonly associated with ASD in children born extremely preterm (EP) and children born at term.
METHODS: Extremely preterm (EP) participants (n=59) from the Extremely Low Gestational Age Newborn (ELGAN) Study who met diagnostic criteria for ASD at approximately 10 years of age were matched with term participants (n=59) from the Simons Simplex Collection (SSC) on age, sex, and nonverbal IQ. Differences in core ASD symptomatology were evaluated using the Autism Diagnostic Interview-Revised (ADI-R), an in-depth parent interview, and the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2), a semi-structured clinical observation assessment. Developmental milestones, anthropometrics, seizure disorder, and psychiatric symptoms were also investigated as associated characteristics of ASD. Analyses excluding multiplex EP individuals and their term matches, as well female-only analyses, were also conducted.
RESULTS: On the ADI-R, the EP group had lower scores (decreased symptom severity) on verbal communication, specifically stereotypic language, and restricted and repetitive behaviors (RRBs). However, no between-group differences were observed with direct observation based on the ADOS-2 assessment. The EP group was more likely to have delayed speech milestones, lower height, weight, and head circumference, and lower rates of depression and anxiety symptoms. When 7 multiplex EP participants and their term control matches were eliminated from the sample, there were no differences from the primary analyses. Female-only analyses were similar to primary analyses on core ASD symptomatology findings. Regarding associated characteristics, females only differed on height, head circumference, and anxiety symptoms.
CONCLUSIONS: Accounting for age, sex, nonverbal IQ, and prior ASD diagnosis status, EP children had less severe stereotypic language and RRB symptoms compared to term children based on ADI-R parent report, but exhibited no differences on parent-reported nonverbal communication or reciprocal social interaction symptoms, or with direct observation of social affective and repetitive and restricted ASD symptoms on the ADOS-2. EP children with ASD also showed decreased physical growth and delayed language relative to those born at term, possibly reflecting the developmental effects of being born EP. In sum, the ASD phenotype was generally similar between EP and term born children, with the exception of less severity of retrospectively parent-reported stereotypic behaviors, lower physical growth parameters, and increased delays in language milestones among EP born children with ASD.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/45585 |
| Date | 07 February 2023 |
| Creators | Lai, Emily |
| Contributors | Joseph, Robert M. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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