Early Detection of Autism Spectrum Symptomatology in Very Preterm Infants

Charlotte Sanderson

Research output: ThesisDoctoral Thesis

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Children born very preterm (VP) are at an increased risk for a wide range of neurodevelopmental impairments, including autism spectrum disorder (ASD) and related symptomatology. The present thesis investigated early behavioural markers for ASD in VP infants. Using a prospective, longitudinal design, three early infancy markers which have been linked to ASD outcomes in other high-risk groups were investigated: the Autism Observation Scale for Infants (Bryson, Zwaigenbaum, Mcdermott, Rombough, & Brian, 2008), a disengagement of visual attention task (Mayada Elsabbagh, Fernandes, et al., 2013) and infant temperament profiles (Putnam, Helbig, Gartstein, Rothbart, & Leerkes, 2014). Existing data from 65 full term and 41 VP infants at 6 and 12 months was collated, audited and examined using a series of bivariate and multivariate analyses. A sub-set of these infants were followed up at 30-34 months to estimate associations with ASD outcomes, as indicated by the Autism Diagnostic Observation Schedule (ADOS II) (Lord et al., 2012). VP infants showed greater impairment on the AOSI, a behavioural assessment of multiple ASD markers, compared to full-term controls at both 6 and 12 months. These impairments appeared to be independent of developmental delays. AOSI scores at 12 months also showed association with ASD outcomes at 30-34 months. VP infants were also rated by their parents as showing more negative affect during the first year of life, though no association with ASD outcomes was observed. These findings are discussed in relation to the wider literature on early detection in ASD. In particular, the likelihood of heterogeneity in early trajectories towards ASD symptoms is discussed. Multiple marker assessments like the AOSI may be particularly useful tools for detecting ASD symptomatology earlier in high-risk infant populations, in order to enable earlier targeted intervention. Future research may consider the longer-term stability of these early profiles in VP infants, and explore specific biological and psychosocial risk factors for emerging ASD symptomatology in this group.
Original languageEnglish
Awarding Institution
  • Royal Holloway, University of London
  • Marlow, Neil, Supervisor, External person
  • Vosper, Jane, Supervisor
  • de Haan, Michelle, Supervisor, External person
Award date1 Nov 2016
Publication statusUnpublished - 2016


  • Preterm
  • Autism
  • ASD
  • autism spectrum disorder
  • infant

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