Elsevier

The Journal of Pediatrics

Volume 154, Issue 4, April 2009, Pages 535-540.e1
The Journal of Pediatrics

Original article
Positive Screening on the Modified Checklist for Autism in Toddlers (M-CHAT) in Extremely Low Gestational Age Newborns

https://doi.org/10.1016/j.jpeds.2008.10.011Get rights and content

Objective

To test the hypothesis that children born preterm are more likely to screen positive on the M-CHAT for an autism spectrum disorder.

Study design

We compared the M-CHAT positive rate of those with cerebral palsy, cognitive impairment, and vision and hearing impairments to those without such deficits.

Results

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.

Conclusions

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.

Section snippets

The ELGAN Study

The ELGAN Study was designed to identify characteristics and exposures that increase the risk of structural and functional neurologic disorders in ELGANs. During the years 2002 to 2004, women delivering before 28 weeks gestation at 1 of 14 participating institutions in 11 cities in 5 states were invited to enroll in the study. The enrollment and consent processes were approved by the individual institutional review boards.

Mothers were approached for consent either on antenatal admission or

Results

More than 21% (212/988) of all children screened positive for ASD on the M-CHAT (Table I). Among the children without motor, vision, hearing, or cognitive impairments, 10% screened positive (Table II). Because 2/3 of children with ASD also have cognitive impairment,5 excluding children from the referent group on the basis of cognitive limitations eliminates some who are at high risk for ASD. Consequently, we created a second referent group that excluded children with motor, vision, and hearing

Discussion

In ELGAN children, those with motor, vision, or hearing impairments are much more likely than others to screen positive on the M-CHAT. Because we have yet to assess these children for an ASD at an older age, we do not know whether those children with motor, vision, or hearing impairments really are at increased risk for ASD or whether their visual, hearing, and motor deficits are equated with characteristics commonly seen in autism, such as visual avoidance, inconsistent response to voice, and

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  • Cited by (0)

    All of the authors are members of the ELGAN Study Group.

    Supported by the National Institute of Neurological Disorders and Stroke (cooperative agreement 1 U01 NS 40069-01A2). The authors declare no conflicts of interest.

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