Autism-like behaviours and diagnostic discordance in preschool children born very preterm

To characterise preterm children testing positive in the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), but negative in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a cross-sectional analysis of a prospectively followed cohort was performed. Seventy-four children born before 32 weeks’ gestation were assessed at 4–6 years of age and classified as Concordant (DSM-5+/ADOS-2+), Discordant (DSM-5−/ADOS-2+), or Negative (DSM-5−/ADOS-2−). Neurodevelopmental and behavioural profiles were compared between groups.

Concordant, Dscordant, and Negative cases accounted for 26%, 59%, and 15%, respectively. Perinatal backgrounds and developmental quotients showed no between-group differences. Parent-reported socio-emotional and behavioural difficulties were generally highest in the Concordant group, with the Discordant group showing intermediate profiles.

After adjustment for sex and gestational age and correction for multiple comparisons, Social Responsiveness Scale (SRS) Social Communication and Interaction and Restricted and Repetitive Behaviour and Strengths and Difficulties Questionnaire (SDQ) emotional symptoms and conduct problems were associated with Concordant rather than Discordant classification. On cluster analysis, DSM-5 aligned more closely with SRS/SDQ than ADOS-2. Discordant children showed meaningful socio-emotional and behavioural difficulties, warranting clinical attention and assessment of individual developmental and behavioural needs irrespective of whether full DSM-5 criteria for ASD are met.i The authors would like to thank the children who participated in the study, their families, and the nursing staff at the Neonatal Intensive Care Unit of the Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital.

This study was funded by the Japan Science and Technology Agency (FOREST Program, JPMJFR200I) and the Japanese Ministry of Education, Culture, Sports, Science and Technology (Grant-in-Aid for Scientific Research, 24K02709 and 25K14015). Department of Pediatrics and Neonatology, Center for Human Development and Family Science, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho, Nagoya, Aichi, 467-8601, Japan Sachiko Iwata, Yuko Mizutani, Shinji Saitoh & Osuke Iwata Department of Pediatrics, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan Yuko Mizutani, Kayo Nomura & Yukiko Nagai Faculty of Education, Gifu Shotoku Gakuen University, Gifu, Japan Department of Neurodevelopmental Disorders, Nagoya City University Graduate School of Medical Sciences, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan The authors declare no competing interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Iwata, S., Mizutani, Y., Nomura, K. et al.