Published online July 1, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. 222 (doi:10.1542/peds.2008-1044)

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LETTER TO THE EDITOR

Positive Screening Results for Autism in Ex-preterm Infants

Marit S. Indredavik, MD, PhD
Department of Neuroscience
Norwegian University of Science and Technology
NO-7489 Trondheim, Norway
Department of Child and Adolescent Psychiatry
St Olav's University Hospital
NO-7433 Trondheim, Norway

Torstein Vik, MD, PhD
Department of Public Health and General Practice
Norwegian University of Science and Technology
NO-7489 Trondheim, Norway

Jon Skranes, MD, PhD
Ann-Mari Brubakk, MD, PhD
Department of Laboratory Medicine
Children's and Women's Health
Norwegian University of Science and Technology
NO-7489 Trondheim, Norway
Children's Clinic
St Olav's University Hospital
NO-7433 Trondheim, Norway

To the Editor.—

Limperopoulos et al presented very interesting results in their article "Positive Screening for Autism in Ex-preterm Infants: Prevalence and Risk Factors."¹ The researchers reported a high prevalence of autism spectrum features in ex-preterm infants and associations between autistic traits and several perinatal factors, as well as abnormal MRI findings. Their results help to disentangle the pattern of psychosocial difficulties in ex-preterm children.

However, the authors' statements that "[t]o our knowledge, this is the first description of this phenomenon" and "[n]o previous reports of autism screening testing in ex-preterm infants are available for comparison" require a comment.

We would like to draw attention to articles we have published in the Archives of Disease in Childhood (fetal and neonatal edition) in 2004,² Pediatric Neurology in 2005,³ and Brain in 2007.⁴ We found increased scores on the Autism Spectrum Screening Questionnaire (ASSQ) and increased prevalence of Asperger-syndrome–like symptoms (assessed by interview) in a cohort of very low birth weight (VLBW) adolescents at the age of 14 years.² The 4 VLBW adolescents with symptoms of Asperger disorder all had white matter reduction and ventricular dilatation on MRI scan.³ High ASSQ scores were correlated with reduced fractional anisotropy values on diffusion tensor imaging in the external capsule and superior fascicle on the left side in VLBW adolescents.⁴

We have been careful in our conclusions on increased prevalence of autism spectrum disorders, because our sample was limited. Furthermore, in our research on ex-preterm adolescents, we have found the present diagnostic categories to be inadequate within the spectrum of autistic traits and attention deficit. Hence, we see a need for more differentiated and precise diagnostic criteria. Still, the findings of autistic features may be helpful in understanding the social problems often reported in ex-preterm adolescents. We speculate that VLBW children may exhibit a considerably milder form of the autistic spectrum of social skills deficits. They may struggle with encoding and interpreting subtle cues of social relations, which may involve both cognitive mechanisms and emotional components and be attributable to impaired brain connectivity. Certainly, additional research is needed to elucidate the prevalence, mechanisms, and neural basis of autism spectrum features in ex-preterm children. We look forward to new research performed by Limperopoulos et al and others on this matter, and we will focus on autistic traits in our present follow-up of young adults born with VLBW.

REFERENCES

1. Limperopoulos C, Bassan H, Sullivan NR, et al. Positive screening for autism in ex-preterm infants: prevalence and risk factors. Pediatrics.2008; 121 (4):758 –765[Abstract/Free Full Text]
2. Indredavik MS, Vik T, Heyerdahl S, Kulseng S, Fayers P, Brubakk AM. Psychiatric symptoms and disorders in adolescents with low birth weight. Arch Dis Child Fetal Neonatal Ed.2004; 89 :F445 –F450[Abstract/Free Full Text]
3. Indredavik MS, Skranes JS, Vik T, et al. Low-birth-weight adolescents: psychiatric symptoms and cerebral MRI abnormalities. Pediatr Neurol.2005; 33 (4):259 –266[CrossRef][Web of Science][Medline]
4. Skranes J, Vangberg TR, Kulseng S, et al. Clinical findings and white matter abnormalities seen on diffusion tensor imaging in adolescents with very low birth weight. Brain.2007; 130 (pt 3):654 –666[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Indredavik, M. S. Articles by Brubakk, A.-M. Search for Related Content PubMed PubMed Citation Articles by Indredavik, M. S. Articles by Brubakk, A.-M. Related Collections Office Practice Social Bookmarking                         What's this?