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Screening for autism in preterm children: diagnostic utility of the Social Communication Questionnaire
  1. Samantha Johnson1,
  2. Chris Hollis2,
  3. Enid Hennessy3,
  4. Puja Kochhar2,
  5. Dieter Wolke4,
  6. Neil Marlow1
  1. 1Research Department of Academic Neonatology, Institute for Women's Health, University College London, London, UK
  2. 2Division of Psychiatry, School of Community Health Sciences, University of Nottingham, Nottingham, UK
  3. 3Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
  4. 4Department of Psychology and Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
  1. Correspondence to Dr Samantha Johnson, Institute for Women's Health, UCL, 86–96 Chenies Mews, London WC1E 6HX, UK; sam.johnson{at}


Objective Preterm survivors are at high risk for autism spectrum disorders (ASD). The diagnostic utility of the Social Communication Questionnaire (SCQ) in screening for ASD was assessed in extremely preterm children at 11 years of age.

Design All babies born at <26 weeks gestation in UK and Ireland from March through December 1995 were recruited to the EPICure Study. Of 307 survivors, 219 (71%) were assessed at 11 years. Parents of 173 children completed the SCQ to screen for autistic features and the Development and Well Being Assessment (DAWBA) psychiatric interview. A consensus diagnosis of ASD was assigned by two child psychiatrists following review of the DAWBA parental interview and corresponding DAWBA teacher questionnaire.

Setting Community-based follow-up.

Results Using the established SCQ cut-off (scores ≥15), 28 (16%) extremely preterm children screened positive for ASD. Eleven (6%) were assigned a diagnosis of ASD. Using this cut-off, the SCQ had 82% sensitivity and 88% specificity for identifying ASD in this population. Using a receiver operating characteristic curve, SCQ scores ≥14 had optimal diagnostic utility (area under curve: 0.94; sensitivity: 91%; specificity: 86%). Positive predictive value was relatively low (31%) resulting in numerous over-referrals. However, children with false positive screens had significantly worse neuro-developmental, cognitive and behavioural outcomes than those with true negative screens.

Conclusion The SCQ has good diagnostic utility for identifying ASD in extremely preterm children and is a useful screening tool in this population. Children with false positive screens represent a high-risk group in whom further diagnostic assessment would be beneficial.

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  • Funding This study was funded by the Medical Research Council (MRC), UK. Neil Marlow receives a proportion of funding from the Department of Health's NIHR Biomedical Research Centres funding scheme at UCLH/UCL.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Southampton and South West Hampshire Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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