466 - Autism Spectrum Disorder among Children born Preterm – Prevalence, Symptom Severity, and Treatment

Publication Number: 4457.466

Jonathan S. Litt, Stanford University School of Medicine, Palo Alto, CA, United States; Rubi Quinto, Stanford University School of Medicine, Stanford, CA, United States; Paige T. Church, Beth Israel Deaconess Medical Center, Boston, MA, United States

Background: Children born preterm ( < 37 weeks' gestation) are at higher risk for neurodevelopmental impairments compared to term-born peers. While increased rates of autism spectrum disorder (ASD) have been reported in single-centers or cohorts, the population prevalence of ASD among children born preterm is unknown. Further, differences in diagnosis timing, symptom severity, and therapeutic intervention utilization in this population are ill-defined.

Objective: We aimed to quantify the relationship between preterm birth and prevalence and timing of ASD diagnosis, severity of symptoms, and receipt of behavioral therapy in a national sample of US children.

Design/Methods: We used data from the 2023 National Survey of Children's Health, an annual, nationally representative study representing non-institutionalized children ages 0-17 with over-representation of children with special health care needs. The primary predictor was birth < 37 weeks. Outcomes included 1) ASD diagnosis, 2) age of ASD diagnosis ( < 3 years, 3-5 years, >5 years), 3) severity of ASD symptoms (mild, moderate/severe), and 4) receipt of behavioral therapy for ASD. Covariates included child sex, age, and race; parent education, marriage and poverty status, nativity, and language; and health insurance and medical home status. We described the sample using means and proportions and built separate adjusted logistic regression models for each outcome. All analyses used survey sampling weights.

Results: There were 55,162 children in the sample representing 71,288,057 children nationally. Eleven percent were born preterm (Table 1). There were 3.5% with ASD, 25% receiving a diagnosis < 3 years. There were 51% with moderate/severe symptoms and 65% who received behavioral ASD therapy. Children born preterm were twice as likely to have a diagnosis of ASD compared to term-born peers (aOR 2.17, 95% CI 2.13, 2.18) (Table 2). They were less likely to receive a diagnosis before age 3 (aOR 0.51, 95% CI 0.51, 0.52). Despite lower odds of having moderate/severe symptoms (aOR 0.58, 95% CI 0.57, 0.58), they were more likely to receive behavioral therapy (aOR 1.71, 95% CI 1.70, 1.72).

Conclusion(s): Children born preterm are more likely to have ASD diagnoses and receive behavioral therapy compared to term-born peers, though diagnosis is later and symptoms milder. It is not clear if this represents the true prevalence of ASD in this population or a lack of specificity in screening and diagnostic measures for this vulnerable population. Further work is needed to address differences in diagnosis timing and therapeutic intervention by preterm birth status.

Table 1. Sample Characteristics


Table 2. Preterm Birth and Odds of Autism Spectrum Disorder Diagnosis, Severe Symptoms, and Treatment Receipt