Extremely Preterm Born Children at Very High Risk for Developing Autism Spectrum Disorder.

This study aimed to provide a more comprehensive picture of the prevalence of autism spectrum disorder (ASD) in a geographic cohort of extremely preterm born adolescents by using established diagnostic instruments in addition to screening instruments. 53 participants passed a screening procedure with two screening instruments and a diagnostic evaluation with a semi-structured assessment and a parent interview. 28 % of the adolescents had a community based clinical diagnosis of ASD. When research diagnoses were also taken into account, this rate increased to 40 %. Intellectual disability, language impairment and behavioural difficulties are characteristic for these children with ASD. This study is to our knowledge the first to use ASD-specific diagnostic instruments to confirm ASD diagnoses in extremely preterm born children in early adolescence. The study expands findings of previous research and raises the need for follow-up into late childhood and early adolescence.

Gaze aversion during social interaction in preterm infants: a function of attention skills?

Preterm infants avert their gaze more often and for longer periods in early social interactions compared to full term infants. In previous studies this finding is interpreted as being a function of the higher degree of parental stimulation that is often found in parents of preterm children. The current study explores an additional hypothesis. Since the development of general visual attention abilities is found to be less optimal in preterm children, it is possible that less optimal maturation of attention abilities partially explains the elevated gaze aversion in a social context. Therefore, the current study investigated the association between gaze aversion in a social context and the ability to disengage and shift visual attention in a non-social context in 20 preterm and 42 full term infants aged 4 and 6 months. Results confirm that preterm infants are slower to shift their attention in a non-social context and that they avert their gaze more often in a social context compared to full term children. Furthermore, more frequent gaze aversion during social interaction at 6 months was related to longer disengagement and the shifting of attention at 4 and 6 months, but only within the preterm group. The results suggest that attention maturation is less optimal in preterm children; this can be observed in a non-social as well as a social context. Less attention maturation in preterm children can negatively influence the amount of time they can stay actively involved in social interaction.

Preverbal skills as mediators for language outcome in preterm and full term children.

Language delay is a well documented problem that occurs on a higher rate in preterm children compared to full term children. Preverbal social skills, such as the ability to share attention to an object with another person (i.e., triadic interaction), are suggested to reflect part of the processes through which children learn language. This longitudinal study examined preverbal and verbal skills in 25 preterm and 35 full term children in order to investigate if birth status affects language development through the proposed mediating processes of preverbal dyadic and triadic skills. Dyadic initiatives during the still-face episode were assessed at 6 months. Triadic responsiveness (gaze following) was examined at 9 and 14 months. Triadic initiatives (joint attention and behavioral request) were also assessed at 14 months. At 30 months, receptive and expressive language was examined. The data showed group differences in 6-month dyadic initiatives, 9-month triadic responsiveness, 14-month triadic behavioral request initiatives and 30-month receptive and expressive language skills at the expense of the preterm children, confirming their risk for a less favorable preverbal and verbal development. Multiple mediation analyses confirmed the hypothesis that birth status affects language development partially through preverbal skills, which is important for clinical practice.

Dyadic and triadic skills in preterm and full term infants: a longitudinal study in the first year.

This longitudinal study examined dyadic and triadic skills in 26 preterm and 31 full term infants at 3, 6 and 9 months of age. In dyadic interaction, infants engaged with a stranger in face-to-face play interrupted by a still-face episode. In triadic interaction, infants interacted with the adult stranger as she coordinated gaze between the infant and object. Both groups were sensitive for non-contingency in both dyadic and triadic interactions. There were significant group and developmental differences for dyadic and triadic competencies. Compared to full term infants, preterms made less positive elicits during the still-face at 6 months and followed gaze less at 9 months of age. Six-month dyadic skills and 9-month triadic competencies were positively related in preterm and full term infants.

Expressive and receptive language characteristics in three-year-old preterm children with extremely low birth weight.

OBJECTIVE: The purpose of this study was to analyze the language characteristics of a group of extremely low birth weight (ELBW) children at 3 years of age and to compare these language results with a sample of full-term children with normal birth weight (FBW). METHODS: All children were judged to be free of any major physical, sensorial and neurological impairments and had a mental developmental index of >55 on the Bayley Scales of Infant Development. The Language was tested using the Reynell Developmental Language scales. RESULTS: There was a significant difference between the ELBW group and the FBW group regarding the receptive and all the expressive language characteristics. There was a significant correlation between the mental developmental index and the language scores in the ELBW as well as in the FBW group. CONCLUSION: According to the analysis of the language characteristics, the logopedic approach to 3-year-old children born with ELBW must be focused on receptive (comprehension of 'wh'-questions, passive sentences, inferencing skills and spatial prepositions) and expressive (defining words, expressing semantic relations) morphosyntactic abilities and linguistic conceptualization. These communication disorders appear unrelated to neurological or sensorial impairments, but can be partly explained by a decreased general mental functioning.

Outcome at 3 years of age in a population-based cohort of extremely preterm infants.

OBJECTIVE: To assess health and neurodevelopmental outcome at 3 years of age in neonatal intensive care unit (NICU)-surviving children who were born at 26 or fewer weeks of gestation in a geographically defined region of Belgium from 1999 through 2000. METHODS: The study included a clinical examination and a standardized neurologic and developmental assessment. Disabilities were defined by international criteria. In 97% (92 of 95) of the children, accurate information on the presence of overall disability could be collected. RESULTS: Thirty-six percent (95% confidence interval [CI] 25-47%) of the formally assessed children (28 of 77) had deficient neuromotor development, with 5% of them showing severe sensory-communicative impairment. Mean (+/-standard deviation) scores on the Mental Developmental Index and Psychomotor Developmental Index were 81.2 (18.8) and 73.2 (17.8), respectively. Seventy percent (95% CI 60-80%) had a mental (Mental Developmental Index) or psychomotor (Psychomotor Developmental Index) impairment or both, assessed to be more than 1 standard deviation below the population mean. Mental and psychomotor outcome did not differ significantly when compared according to either gestational age, gender, or multiple birth (all P>.05). When either minor central dysfunction or cerebral palsy was not taken into account, normal mental development was recorded in 62% of the subjects. The cumulative of poor outcome (ie, disability- or prematurity-related death) among the 95 infants discharged alive was estimated to be 58% (95% CI 48-68%), representing 25 (26%) mildly-to-moderately disabled and 28 (29%) severely disabled toddlers, including two infants whose postdischarge deaths were directly related to prematurity. CONCLUSION: The average developmental outcome is poor in children born as extremely preterm infants. Finding early predictors of adverse outcome is a major challenge.

Gaze following as a function of affective expression in 3-, 6- and 9-month-old infants.

The influence of affective expression on gaze following was investigated in 3-, 6- and 9-month-old infants. Gaze following became more robust at the older ages. There was no strong evidence that infants' gaze following activity was differentially influenced by the adult's affective expression, but rather for a developmental difference in emotion processing.

Temporal coordination of joint attention behavior in preschoolers with autism spectrum disorder.

The current study investigated initiating and following declarative joint attention, and initiating requesting joint attention in a group of preschool children with autism spectrum disorder (ASD) and an age-matched control group. Different forms of joint attention were elicited while children interacted with their mothers. Temporal coordination of the children's joint attention behavior was examined using three levels of coding. Children with ASD showed less but similar requesting abilities and slower point following combined with an abnormal behavioral pattern of looking at the other person's pointing finger instead of the object pointed at. Initiating declarative behavior was qualitatively and quantitatively different, characterized by isolated instances of communication instead of a fluent shift of attention between object and person.

Early social communicative behaviours of preschoolers with autism spectrum disorder during interaction with their mothers.

The present study examined spontaneous symbolic play, declarative joint attention, social referencing and imitation of symbolic play in 3- to 6-year-old children with an autism spectrum disorder (ASD; n = 20) during interaction with their mothers. Compared to a control group (n = 20) matched on age and IQ, the children with ASD initiated less joint attention with their mothers when confronted with a pleasant event and they showed a tendency to play less symbolically and more non-functionally. Contrary to expectations, children with ASD showed no social referencing or imitation deficits. Interestingly, two clusters of intercorrelating behaviours were found in the ASD group: one suggesting symbolic or metarepresentational abilities, the other comprising interpersonal behaviours. The findings support the hypothesis that early social communicative abilities may follow a different developmental pathway in ASD, and stress the importance of a contextual factor, namely the presence of the mother.