To assess the prevalence of positive screens using the Modified Checklist for Autism in Toddlers (M-CHAT) questionnaire and follow-up interview in late and moderately preterm (LMPT; 32-36 weeks) infants and term-born controls.
Study design
Population-based prospective cohort study of 1130 LMPT and 1255 term-born infants. Parents completed the M-CHAT questionnaire at 2-years corrected age. Parents of infants with positive questionnaire screens were followed up with a telephone interview to clarify failed items. The M-CHAT questionnaire was re-scored, and infants were classified as true or false positives. Neurosensory, cognitive, and behavioral outcomes were assessed using parent report.
Results
Parents of 634 (57%) LMPT and 761 (62%) term-born infants completed the M-CHAT questionnaire. LMPT infants had significantly higher risk of a positive questionnaire screen compared with controls (14.5% vs 9.2%; relative risk [RR] 1.58; 95% CI 1.18, 2.11). After follow-up, significantly more LMPT infants than controls had a true positive screen (2.4% vs 0.5%; RR 4.52; 1.51, 13.56). This remained significant after excluding infants with neurosensory impairments (2.0% vs 0.5%; RR 3.67; 1.19, 11.3).
Conclusions
LMPT infants are at significantly increased risk for positive autistic screen. An M-CHAT follow-up interview is essential as screening for autism spectrum disorders is especially confounded in preterm populations. Infants with false positive screens are at risk for cognitive and behavioral problems.
ASD
Autism spectrum disorders
LMPT
Late and moderately preterm
M-CHAT
Modified Checklist for Autism in Toddlers
RR
Relative risk
SES
Socioeconomic score
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Funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research (PGfAR) (RP-PG-0407-10029). The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health. N.M. receives a proportion of funding from the Department of Health's NIHR biomedical research centers funding scheme at UCLH/UCL. The authors declare no conflicts of interest.