Screening for Autism in Preterm Children: A Systematic Review.

Premature babies have higher rates of autism than other children, but current autism screening tools don't work as well for them. This study looked at how accurate different screening questionnaires are for preterm children. The tools varied widely in their ability to correctly identify autism, with some missing many cases. The overlap between premature birth effects and autism signs makes screening more difficult.

Better screening tools are needed for preterm children to ensure early autism detection and support.

This systematic review and meta-analysis examined the diagnostic accuracy of autism spectrum disorder (ASD) screening tools in preterm children, who have higher ASD rates than the general population. Analyzing nine studies, researchers found that screening tool sensitivity ranged from 0-100% and specificity from 38-98%. Meta-analysis of pooled data showed the Modified Checklist for Autism in Toddlers had 55% sensitivity and 85% specificity, while the Social Communication Questionnaire had 53% sensitivity and 90% specificity. Significant study heterogeneity limited data pooling.

The findings highlight challenges in ASD screening for preterm children due to overlapping behavioral characteristics and emphasize the need for refined screening approaches in this vulnerable population.

Current ASD screening tools show poor sensitivity in preterm children, potentially missing many cases. Clinicians should interpret screening results cautiously in this population and consider additional assessment approaches. There is urgent need for validated screening tools specifically designed for preterm children's unique neurodevelopmental profile.

Only nine studies met inclusion criteria with significant heterogeneity limiting meta-analysis to four studies. The wide variation in diagnostic accuracy measures and study methodologies restricts the generalizability of findings and confidence in pooled estimates.

Preterm children exhibit a higher prevalence of autism spectrum disorder (ASD) than the general population. The unique neurodevelopmental characteristics of preterm children present challenges in screening for and diagnosing ASD. To date, a systematic review of screening tools for ASD in this population has not been completed. This systematic review and meta-analysis evaluates the diagnostic performance of currently used ASD screening tools in the preterm population.

The database search was conducted by using MEDLINE, PsycINFO, PubMed, Embase, and CINAHL in July 2024. Articles that quantified the diagnostic accuracy of ASD screening tools in the preterm population were included. Nine studies were included in this review, and only 4 studies in the meta-analyses. All studies were assessed for risk of bias, applicability, and certainty.

Sensitivity of screening tools for ASD in preterm children ranged from 0% to 100%, whereas specificity ranged from 38% to 98%. Pooled data were available for the Modified Checklist for Autism in Toddlers (2 studies) and Social Communication Questionnaire. (2 studies), with pooled sensitivities of 55% and 53% and specificities 85% and 90%, respectively. There was significant study heterogeneity, limiting the number of studies from which to pool diagnostic accuracy data. Screening tools vary in their ability to identify ASD in the preterm population, underscoring how overlapping behavioral phenotypes may confound early identification.

There is a critical need to refine and assess ASD screening tools in preterm children, facilitating timely interventions in this cohort.