Autism prodrome 41 of 89
well as ADHD and anxiety) in the ELBW group (Hack et al., 2009). Limperopoulos
et al. (2008) further underscore the risks conferred by preterm birth. In this study of
91 extremely preterm infants, 26% fell above the cutoff score on the M-CHAT at the
age of 18 months. Positive identification on the M-CHAT was associated with
internalizing behavioral problems on the Child Behavior Checklist (CBCL;
Achenbach, 2002) and with socialization and communication deficits on the Vineland
Scales. Lower birth weight and gestational age, male gender, chorioamnionitis, acute
intrapartum hemorrhage, illness severity on admission, and abnormal MRI also were
all significantly associated with receiving an above cutoff score on the M-CHAT. The
authors suggest that early markers for ASD might be an under recognized
characteristic of very low birth weight infants. Kuban et al. (2009) replicated these
finding and reported that in their sample 21% (212/998) of the infants born before
28th week of gestation screened positive for ASD on the M-CHAT. Major motor,
cognitive, visual, and hearing impairments were more prevalent in the group which
scored positive on the M-CHAT, suggesting that neuro-cognitive impairments might
confound the M-CHAT scoring and interpretation. For example, the parent of a child
with severe motor impairment may mark as abnormal such items on the M-CHAT
screen as “does not point to indicate interest” or “does not bring objects to you”, 2 of
the critical items on the M-CHAT, even though the child may demonstrate no
language or social impairment. Yet, in children without such impairments, the rate of
positive screening was still 16%, nearly 3 times higher than expected in unselected
populations. It may also be the case that ASD are actually associated with neuro-
cognitive impairments and/or more general neurodevelopmental problems. This
suggestion is supported by Hack et al. (2009) who followed up a sample of 219
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