Autism Spectrum Disorders in Extremely Preterm Children

Johnson, Samantha; Hollis, Chris; Kochhar, Puja; Hennessy, Enid; Wolke, Dieter; Marlow, Neil

doi:10.1016/j.jpeds.2009.10.041

Cited by 322 publications

(259 citation statements)

References 34 publications

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“…In a recent whole-population study, we reported that 8% of 219 children born at not more than 25 completed weeks of gestation met the diagnostic criteria for ASD in middle childhood. 1,2 This is markedly higher than the 0.2 to 0.7% prevalence reported in the general population. 3,4 As early diagnosis and behavioural intervention for ASD significantly improves outcome, 5,6 screening may be particularly important in high-risk groups such as extremely preterm children.…”

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confidence: 63%

“…Furthermore, children with ASDs in the general population are significantly more likely to have increased cerebral volumes, independent of non-verbal IQ, 17 whereas ASD symptoms have been associated with smaller head circumferences in extremely preterm children. 1 Temporal periventricular leukomalacia in extremely preterm children has been linked to abnormal visual processing of bodily motion -a process thought to be deficient in individuals with difficulties in social interaction. 18 It has, therefore, been suggested that the associates and risk factors for a diagnosis of ASD are indicative of a different aetiological mechanism for autism in extremely preterm children than in the general population, and one that is associated with altered brain development.…”

Section: Discussionmentioning

confidence: 99%

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Screening for autism in extremely preterm infants: problems in interpretation

Moore

Johnson

Hennessy

et al. 2012

Develop Med Child Neuro

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AIM The aim of this article was to report the prevalence of, and risk factors for, positive autism screens using the Modified Checklist for Autism in Toddlers (M-CHAT) in children born extremely preterm in England.METHOD All children born at not more than 26 weeks' gestational age in England during 2006 were recruited to the EPICure-2 study. At 2 years of age, postal questionnaires incorporating the M-CHAT and additional developmental questions were sent to the parents of each survivor (n=1031; 499 male, 532 female), of which 523 (266 male, 257 female; 51%) were returned completed. RESULTSThe prevalence of positive M-CHAT screens in this extremely preterm population was 41% (216 ⁄ 523; 130 male; 86 female). Severe bronchopulmonary dysplasia, administration of postnatal steroids, late-onset bacteraemia, and being male were statistically significantly associated with a positive screen. Coexisting disabilities were present in 320 (62%) children. Of 200 children without disability, 16.5% screened positive. In contrast, 63 (95.5%) of those with severe motor impairment (odds ratio 42; 95% confidence interval [CI] 12.9-135) and 175 (55.9%) of those with cognitive impairment (odds ratio 5.3; CI 3.5-8) screened positive. All children with a significant vision or hearing impairment screened positive. INTERPRETATIONThe prevalence of positive M-CHAT screens in extremely preterm children is high, especially in children with neurodevelopmental impairment. Positive screens should be interpreted in the light of other neurodevelopmental sequelae in clinical practice to avoid falsepositive referrals.Preterm birth is an established risk factor for psychiatric disorders including autism spectrum disorders (ASDs). In a recent whole-population study, we reported that 8% of 219 children born at not more than 25 completed weeks of gestation met the diagnostic criteria for ASD in middle childhood. 1,2 This is markedly higher than the 0.2 to 0.7% prevalence reported in the general population. 3,4 As early diagnosis and behavioural intervention for ASD significantly improves outcome, 5,6 screening may be particularly important in high-risk groups such as extremely preterm children. The advent of autism screening tools, such as the Modified Checklist for Autism in Toddlers (M-CHAT), 7 has facilitated screening in infancy, and the use of this parentreport questionnaire is increasing in both clinical and research outcome evaluations. A high prevalence of positive autism screens in extremely preterm infants has been reported in selected American cohorts, 8,9 but concerns have been raised regarding the interpretation of such results in light of the high prevalence of other neurodevelopmental impairments. 8,10 In order to advance our understanding of screening for early symptoms of autism in extremely preterm children, we used the M-CHAT in a postal questionnaire format as part of a national population-based study of extremely preterm infants born in England. We investigated the prevalence of and neurodevelopmental associations with positiv...

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confidence: 63%

Section: Discussionmentioning

confidence: 99%

Screening for autism in extremely preterm infants: problems in interpretation

Moore

Johnson

Hennessy

et al. 2012

Develop Med Child Neuro

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“…We performed the same analysis on one additional gene named oxytocin receptor (OXTR) whose mRNA and protein expression has been shown to be markedly upregulated in association with labor in primary human amnion epithelial cells [18]. studies have demonstrated that the methylation status of the promoter region of this gene is associated with tissue-speci�c OXTR expression [28] and the development of autism [19], a disorder linked to PTB [20,21,33,34]. ese �ndings intrigued us to investigate whether DNA methylation could represent one mechanism regulating the labor-associated activity of OXTR in the amnion.…”

Section: Bi��l�t� S��n�in� �Bs� Anal��i� Of Di��r�ntial M�th�la-tionmentioning

confidence: 99%

Genome-Wide Analysis of DNA Methylation in Human Amnion

Kim¹,

Pitlick²,

Christine³

et al. 2013

Epigenetics and Pathology

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e amnion is a speciali�ed tissue in contact with the amniotic �uid, which is in a constantly changing state. To investigate the importance of epigenetic events in this tissue in the physiology and pathophysiology of pregnancy, we performed genome-wide DNA methylation pro�ling of human amnion from term (with and without labor) and preterm deliveries. �sing the Illumina In�nium HumanMethylation27 BeadChip, we identi�ed genes exhibiting differential methylation associated with normal labor and preterm birth. Functional analysis of the differentially methylated genes revealed biologically relevant enriched gene sets. Bisul�te se�uencing analysis of the promoter region of the oxytocin receptor (OXTR) gene detected two CpG dinucleotides showing signi�cant methylation differences among the three groups of samples. Hypermethylation of the CpG island of the solute carrier family 30 member 3 (SLC30A3) gene in preterm amnion was con�rmed by methylation-speci�c PCR. is work provides preliminary evidence that DNA methylation changes in the amnion may be at least partially involved in the physiological process of labor and the etiology of preterm birth and suggests that DNA methylation pro�les, in combination with other biological data, may provide valuable insight into the mechanisms underlying normal and pathological pregnancies.

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“…This less optimal development shows deficit persistence up to childhood (Rose, Feldman, & Jankowski, 2009), and early attention processes in preterm infants are related to parent-reported symptoms of attention deficit hyperactivity disorder later in life (Lawson & Ruff, 2004), which is diagnosed in a higher proportion of children born preterm compared to full term (Johnson et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Gaze aversion during social interaction in preterm infants: A function of attention skills?

Schuymer

Groote

Desoete

et al. 2012

Infant Behavior and Development

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Preterm infants avert their gaze more often and for longer periods in early social interactions compared to full term infants. In previous studies this finding is interpreted as being a function of the higher degree of parental stimulation that is often found in parents of preterm children. The current study explores an additional hypothesis. Since the development of general visual attention abilities is found to be less optimal in preterm children, it is possible that less optimal maturation of attention abilities partially explains the elevated gaze aversion in a social context. Therefore, the current study investigated the association between gaze aversion in a social context and the ability to disengage and shift visual attention in a non-social context in 20 preterm and 42 full term infants aged 4 and 6 months. Results confirm that preterm infants are slower to shift their attention in a non-social context and that they avert their gaze more often in a social context compared to full term children.Furthermore, more frequent gaze aversion during social interaction at 6 months was related to longer disengagement and the shifting of attention at 4 and 6 months, but only within the preterm group. The results suggest that attention maturation is less optimal in preterm children; this can be observed in a non-social as well as a social context. Less attention maturation in preterm children can negatively influence the amount of time they can stay actively involved in social interaction.

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Autism Spectrum Disorders in Extremely Preterm Children

Cited by 322 publications

References 34 publications

Screening for autism in extremely preterm infants: problems in interpretation

Screening for autism in extremely preterm infants: problems in interpretation

Genome-Wide Analysis of DNA Methylation in Human Amnion

Gaze aversion during social interaction in preterm infants: A function of attention skills?

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