Neurobehavioral and Medical Correlates of Autism Screening: 2-Year Outcomes for Infants Born Very Preterm.

OBJECTIVES: To identify neonatal characteristics and 2-year neurodevelopmental outcomes associated with positive screening for risk of autism.

STUDY DESIGN: Nine university-affiliated neonatal intensive care units (NICUs) enrolled infants born at <30 weeks of gestation. Infants underwent the NICU Network Neurobehavioral Scale (NNNS) examination before discharge and the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), the Child Behavior Checklist (CBCL), and the Modified Checklist for Autism in Toddlers, revised with follow-up (M-CHAT-R/F) at two years corrected age. Generalized estimating equations examined associations between M-CHAT-R/F, neurobehavioral test results, and neonatal medical morbidities.

RESULTS: At two years corrected age, data were available for 466/744 enrolled infants without cerebral palsy. Infants with hypo-aroused NNNS profiles were more likely to screen M-CHAT-R/F positive (OR=2.76, 95% CI: 1.38, 5.54).). Infants with ≥ 2 medical morbidities also were more likely to screen positive (OR=2.65, 95% CI: 1.27, 5.54).). Children with positive M-CHAT-R/F scores had lower Bayley-III Cognitive (t (451)=5.43, p < .001, d=0.82), Language (t (53.49)= 7.82, p < .001, d=1.18), and Motor (t (451)=7.98, p < .001, d=1.21) composite scores and significantly higher CBCL Internalizing (t (457) -6.19, p < .001, d=-0.93) and Externalizing (t (57.87)=-5.62, p < .001, d=-0.84) scores.

CONCLUSIONS: Positive M-CHAT-R/F screens at 2 years corrected age were associated with neonatal medical morbidities and neurobehavioral examinations as well as toddler developmental and behavioral outcomes. These findings demonstrate the potential utility of the M-CHAT-R/F as a global developmental screener in infants born very preterm, regardless of whether there is a later autism diagnosis.