Free
Research Platform
Issue Date: July 01, 2015
Published Online: February 09, 2016
Updated: January 01, 2020
Assessment of Autism Symptoms During the Neonatal Period: Is There Early Evidence of Autism?
Author Affiliations
  • Washington University in St. Louis
Article Information
Autism/Autism Spectrum Disorder / Pediatric Evaluation and Intervention / Basic Research
Research Platform   |   July 01, 2015
Assessment of Autism Symptoms During the Neonatal Period: Is There Early Evidence of Autism?
American Journal of Occupational Therapy, July 2015, Vol. 69, 6911505200. https://doi.org/10.5014/ajot.2015.69S1-RP304C
American Journal of Occupational Therapy, July 2015, Vol. 69, 6911505200. https://doi.org/10.5014/ajot.2015.69S1-RP304C
Abstract

Date Presented 4/18/2015

Defining typical and atypical neonatal behavior can improve the pathway to early autism spectrum disorder (ASD) diagnosis and therapy activation for improved function. In the current study, we explore early social behavior in preterm infants with longitudinal associations with ASD risk at age 2 yr.

SIGNIFICANCE: One in 68 children has an autism spectrum disorder (ASD), so early ASD detection is vital. Preterm infants are useful for studying ASD risk; they fail early ASD screens more often than full-term infants, so logically they should display more ASD-related behaviors. However, one study found clear orienting to faces in infants later diagnosed with ASD, suggesting that ASD social behaviors may not manifest so early. Studying ASD-related social behaviors of preterm infants at term equivalent age (TEA) and linking them to ASD outcome at age 2 yr will help determine infantile risk factors.
INNOVATION: Despite emerging evidence of ASD signs in the first year of life, most studies are limited by retrospective analyses of home videos, and only one study has investigated a neonatal population. The current study is extremely innovative, as we explore the novel area of early social behavior in preterm infants at TEA and longitudinal associations with ASD risk at age 2 yr.
APPROACH: Defining typical and atypical neonatal behavior can improve the pathway to early ASD diagnosis and therapy activation for improved function. Our objective was to investigate the relationship between neonatal social behavior and a positive ASD screen. We hypothesized that infants who screen positive for ASD at age 2 yr will demonstrate ASD-related social behaviors at TEA.
METHOD: Sixty-two infants born at 30 wk estimated gestational age (EGA) with no known congenital anomaly were enrolled by the third day of life. The NICU (Neonatal Intensive Care Unit) Network Neurobehavioral Scale (NNNS; cuddling, gaze aversion, visual locking, tight blinking, roving eye movements, end-point nystagmus [EPN], sustained nystagmus, obligatory following, hyperalertness, visual and auditory animate [human face], and inanimate [red ball] orientation) and the Dubowitz Neurological Examination (irritability, consolability, crying) were administered at TEA (37 to 41 wk EGA) in the infant’s crib in a NICU. Follow-up testing occurred at age 2 yr with the Modified Checklist for Autism in Toddlers (MCHAT; parent-report form; categorized at risk for ASD or not), the Infant Toddler Social–Emotional Assessment (ITSEA; parent-report form; social relatedness and atypical behavior scores), and the Bayley Scales of Infant and Toddler Development—Third Edition (Bayley–III; developmental delay in cognitive, language, or motor scores). Associations between early social interaction and ASD screening were analyzed with independent-samples t tests, chi-square analyses, and regression models.
RESULTS: Positive autism screen was linked to lack of gaze aversion (c2 = 5.90, p = .01, odds ratio [OR] = 5.05) and lack of EPN (c2 = 4.78, p = .02, OR = 8.47). Higher motor scores were associated with having EPN (t = −2.64, p = .006); lower motor scores were associated with better inanimate auditory orientation (β = −0.32, p = .023) and poorer self-regulation (β = −0.29, p = .04). Higher cognitive scores were associated with preference for animate objects (t = −2.24, p = .03) and having EPN (t = −5.011, p < .001). Higher language scores were associated with having EPN (t = −2.88, p = .003) and gaze aversion (t = −2.87, p = .004) and better animate orientation (β = 3.79, p = .02).
CONCLUSION: Many core ASD-related social behaviors observed at TEA were not related to ASD risk. Exhibiting gaze aversion at TEA may be a protective response for the developing brain that infants at risk for ASD do not have. Limitations include small sample size and lack of an ASD diagnostic test.