Clinical Correlates and Prevalence of Food Selectivity in Children with Autism Spectrum Disorder.

OBJECTIVE: To examine clinical correlates and prevalence of food selectivity (FS) - ie, self-restricted diet, reluctance to try new foods - in children with autism spectrum disorder (ASD) ascertained from a general outpatient autism clinic. STUDY DESIGN: A multidisciplinary team (pediatric nurse practitioner, psychologist and dietitian) assessed medical and psychosocial histories and dietary habits in 103 children with ASD (mean age = 5.8 ± 2.2 years; range 2-10). Parents rated child mealtime behavior on the Brief Autism Mealtime Behavior Inventory (BAMBI) and disruptive behavior on the Aberrant Behavior Checklist (ABC). Height and weight measurements were collected. Children were classified as FS or no FS based on parent reported intake and mealtime behavior. A 24-hour dietary recall was used to record intake percentages < 80%. Logistic regression and multivariable modeling were used to evaluate clinical correlates with FS. RESULTS: Of 103 children, 45.6% (n = 47) were classified as FS; 54.4% (n = 56) no FS. After adjusting for potential confounders, the odds of FS increased by 1.91 (95% CI: 1.38, 2.64, P < .001) for every half-SD increase in BAMBI total score and by 1.35 (95% CI: 1.05, 1.74, P = .020) for every half-SD increase in ABC Hyperactivity/Noncompliance. No group differences in anthropometrics or nutritional intake were identified. CONCLUSIONS: Food selectivity (FS) in children with ASD was strongly associated with greater severity of disruptive mealtime and hyperactivity/noncompliance behaviors. FS was not associated with anthropometrics or nutritional intake.

Probability of an Autism Diagnosis by Gestational Age.

Early preterm infants (EPT) (<33 6/7 weeks) are at increased risk for autism spectrum disorders (ASDs) but prevalence estimates vary widely across studies. Furthermore, there are very few studies addressing the association between late preterm (LPT) births (34-36 6/7 weeks) and ASDs. To address the question of whether LPT infants carry the same risk for ASDs as full-term infants, this study aimed to estimate the relative probability of an ASD diagnosis using Bayes rule. A retrospective cohort analysis of 406 children was undertaken to look at gestational age, ASDs, and birth history. The application of Bayes rule was used, given that there is not sufficient information about the joint probabilities related to prematurity and autism. Using the estimated gestational age proportions within ASD diagnosis, plus national estimates of ASDs, probabilities for ASDs within a given gestational age were calculated. Among these 406 children with ASDs, 6.7% were EPT and 10.6% were LPT. In comparison to full term, EPT children are at 1.9 multiplicative increase in risk (95% CI [1.3, 2.5]). While the probability of ASDs for LPT children was higher than that for term, the estimated relative risk of the LPT infants was not statistically significant (95% CI [0.9, 1.5]). EPT infants were significantly more likely to be diagnosed with ASDs compared to their term peers. While the relative probability of ASD diagnosis among children born LPT was not statistically significant in this limited sample, the results indicate a possible elevated risk. A larger cohort is needed to adequately estimate this risk.

Maternal and Neonatal Birth Factors Affecting the Age of ASD Diagnosis.

Early diagnosis of autism spectrum disorders (ASD) enables early intervention that improves long term functioning of children with ASD but is often delayed until age of school entry. Few studies have identified factors that affect timely diagnosis. This study addressed how maternal education, race, age, marital status as well as neonatal birth factors affect the age at which a child is diagnosed with ASD. This study involved a retrospective analysis of 664 records of children treated at one of the largest autism treatment centers in the United States from March 1, 2009 to December 30, 2010. Logistic regression and Cox proportional hazards regression were used to identify maternal and neonatal factors associated with age of diagnosis. Infant gender, maternal race, marital status, and maternal age were identified as significant factors for predicting the age of ASD diagnosis. In the Cox proportional hazards regression model, only maternal race and marital status were included. Median survival age till diagnosis of children born to married mothers was 53.4 months compared to 57.8 months and 63.7 months of children born to single and divorced or widowed mothers respectively. Median survival age till diagnosis for children of African American mothers was 53.8 months compared to 57.2 months for children of Caucasian mothers. No statistically significant difference of timing of ASD diagnosis was found for children of varying gestational age. Children born to older or married mothers and mothers of minority races were more likely to have an earlier ASD diagnosis. No statistically significant differences in timing of ASD diagnosis were found for children born at varying gestational ages. Identification of these factors has the potential to inform public health outreach aimed at promoting timely ASD diagnosis. This work could enhance clinical practice for timelier diagnoses of ASD by supporting parents and clinicians around the world in identifying risk factors beyond gender and SES and developing strategies to recognize earlier signs of ASD and contribute to improved development outcomes in children with ASD.

Autism spectrum disorders and prematurity: a review across gestational age subgroups.

Autism spectrum disorders (ASDs) are increasingly recognized as a public health problem. According to the Centers for Disease Control and Prevention, the prevalence for ASD is now 1 in 88. The prevalence of ASDs in children has increased over the past 2 decades, nearly doubling the prevalence since the Centers for Disease Control and Prevention began tracking these numbers. Infants are defined as premature when birth takes place before 37 weeks' gestation (259 days from the first day of the mother's last menstrual period). More than 4 million live births occur in the United States each year. Preterm births account for approximately half a million of those births. The rate of premature birth has increased by more than 20% between 1990 and 2006. Cognitive impairment and atypical brain development are thought to be sequelae of preterm delivery. Low birth weight and preterm birth place these infants at higher risk for disturbances in social interaction, communication, and other psychoaffective disorders in adulthood. Major advances in the field of early autism detection include validated screening tools to facilitate early screening for children with ASD as well as those considered to be at high risk for the disorder. Given the significant maternal and neonatal morbidities that are often coupled with prematurity, understanding the prevalence and risk factors that are implicated in changes in the fetal brain may provide researchers with vital links to autism in this population.