OBJECTIVES Recent evidence suggests higher prevalence of autism spectrum disorder (ASD) in NICU graduates. This aim of this study was to identify retrospectively early behaviors found more frequently in NICU infants who went on to develop ASD. METHODS Twenty-eight NICU graduates who later received a diagnosis of ASD were compared with 2169 other NICU graduates recruited from 1994 to 2005. They differed in gender, gestational age, and birth cohort. These characteristics were used to draw a matched control sample (n = 112) to determine which, if any, early behaviors discriminated subsequent ASD diagnosis. Behavioral testing at targeted ages (adjusted for gestation) included the Rapid Neonatal Neurobehavioral Assessment (hospital discharge, 1 month), Arousal-Modulated Attention (hospital discharge, 1 and 4 months), and Bayley Scales of Infant Development (multiple times, 4–25 months). RESULTS At 1 month, children with ASD but not control children had persistent neurobehavioral abnormalities and higher incidences of asymmetric visual tracking and arm tone deficits. At 4 months, children with ASD had continued visual preference for higher amounts of stimulation than did control children, behaving more like newborns. Unlike control children, children with ASD had declining mental and motor performance by 7 to 10 months, resembling infants with severe central nervous system involvement. CONCLUSIONS Differences in specific behavior domains between NICU graduates who later receive a diagnosis of ASD and matched NICU control children may be identified in early infancy. Studies with this cohort may provide insights to help understand and detect early disabilities, including ASD.

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Neonatal assessments should provide valid estimates of behavior and neurological status, reflect recovery from acute effects, predict subsequent outcome, and point to specific intervention strategies for any problems noted. The authors report relations among measures designed to evaluate early behavioral capabilities and dysfunctions in areas frequently disrupted by central nervous system (CNS) injury that involve arousal‐modulated attention and elicited and spontaneous movements, to each other and to the Bayley Scales of Infant Development over the first 2 years. Infants were classified into four CNS injury groups based on auditory brainstem responses and cranial ultrasonography. CNS injury was associated with all behavioral measures in neonates, but the strength of the relationships changed for each over time, as did the degree and time‐course for performance recovery. CNS findings alone were insufficient to predict later outcome. Early behavioral evaluations were better predictors into the second year and indicated that: (1) high‐risk infants who performed normally as neonates had normal development; (2) those with early transient abnormalities appeared to normalize by 4 months but started to decline by 13–16 months; and (3) consistently abnormal early behavior predicted the worst outcome. Use of multiple measures in the neonatal period and repeated assessments across early infancy provide a useful and accurate approach for evaluating recovery from CNS injury, predicting later mental and motor performance and helping to design early intervention strategies.