Symptoms and antecedents of autism in children born extremely premature: a national population-based study.

This study looked at autism-like symptoms in children who were born extremely early (before 28 weeks). At age 11, these children were much more likely to have social difficulties, repetitive behaviors, and communication problems compared to children born at full term. About 1 in 5 extremely premature children showed high levels of autism symptoms. Children who didn't receive certain medications before birth, had lower IQ scores, or had mental health issues at age 5 were at higher risk.

This Norwegian population-based cohort study examined autism spectrum disorder (ASD) symptoms in 216 extremely preterm (EP) children at 11 years of age, excluding those with intellectual disabilities, non-ambulatory cerebral palsy, blindness, and/or deafness. Using the Autism Spectrum Screening Questionnaire (ASSQ), researchers compared EP children to 1,882 reference children from the general population. EP children showed significantly elevated rates of social difficulties (14.5% vs 4.1%), repetitive behaviors (23.7% vs 4.0%), and communication problems (23.1% vs 4.8%). Approximately one in five EP children scored in the high range for overall ASD symptoms.

Risk factors included absence of prenatal steroids, lower-range IQ (70-84), and mental health problems at age 5.

Extremely preterm children require systematic screening for autism spectrum symptoms, particularly social difficulties, repetitive behaviors, and communication problems. Early identification of risk factors (no prenatal steroids, lower IQ, early mental health problems) can inform targeted intervention strategies and support planning.

Study excluded children with intellectual disabilities and severe impairments, potentially underestimating ASD prevalence. Response rate was 64% for EP children, introducing potential selection bias. Cross-sectional design limits causal inferences about identified risk factors.

The objective of this study is to investigate the prevalence of autism (ASD) symptoms, i.e. , social difficulties, repetitive behaviors, and communicational problems, among children born extremely preterm (EP) compared to a reference group, and to investigate possible antecedents of ASD symptoms among EP children. Method is a national Norwegian cohort of 11 year old EP children, excluding those with intellectual disabilities, non-ambulatory cerebral palsy, blindness, and/or deafness. Parents and teachers reported ASD symptoms using The Autism Spectrum Screening Questionnaire (ASSQ). Social difficulties, repetitive behaviors, communicational problems, and a total ASSQ score were presented.

Combined ratings on the ASSQ was defined as parent and/or teacher scoring the child ≥ 98th percentile of the reference group, which was the population-based Bergen Child Study. Of eligible children, 216 (64%) EP and 1882 (61%) reference children participated. EP children had significantly higher mean scores and combined ratings on social difficulties (14.5% vs. 4.1%, OR: 3.2), repetitive behaviors (23.7% vs. 4.0%, OR: 6.4), communicational problems (23.1% vs. 4.8%, OR: 5.4), and the total ASSQ score (18.3% vs. 3.4%, OR: 5.7) compared to reference children. Only no prenatal steroids, IQ 70-84, and mental health problems at 5 years of age were significantly associated with ASD symptoms at 11 years of age.

EP children were at increased risk of social difficulties, repetitive behaviors, and communicational problems, and approximately one out of five were reported as high scorers of ASD symptoms. No prenatal steroids use, IQ in the lower range, and mental health problems at 5 years of age were associated with ASD symptoms.