Neonatal brain abnormalities associated with autism spectrum disorder in children born very preterm.
Neonatal MRI already flags higher ASD risk in very-preterm babies—look for cystic white-matter lesions and smaller cerebellar volumes.
01Research in Context
What this study did
Doctors scanned the brains of 119 very-preterm babies on day one of life.
They waited seven years to see which kids got an autism diagnosis.
Then they compared the first-day MRI pictures of the ASD group with the pictures of pre-term kids who did not develop ASD.
What they found
Two neonatal red flags stood out.
Kids who later met ASD criteria had more cystic white-matter lesions.
They also had slightly smaller cerebellar volumes.
These signs were already visible before the babies left the NICU.
How this fits with other research
Storch et al. (2012) seems to disagree. They found 90 % of routine MRIs in older, high-functioning kids with ASD looked normal. The clash disappears when you notice age and risk level: Eussen et al. (2016) studied brand-new, very-preterm brains, while A et al. studied school-age, high-functioning children.
Eussen et al. (2016) also extends the story. A second paper by the same team (M et al., 2016) used DTI in children and teens and showed wide white-matter integrity problems across many tracts. The neonatal cystic lesions may be the first hit that later grows into the broad white-matter issues seen in older youth with ASD.
Cox et al. (2017) supply the how-to. Their prompting plus DRO protocol taught kids with ASD and ID to lie still for scans without sedation. That same shaping could help fragile pre-term babies stay calm for the early MRI that this paper says we should read.
Why it matters
If you work with NICU graduates, ask the medical team for the neonatal MRI report. Note any cystic white-matter lesions or small cerebellar size. Flag these children for close developmental watch and early ABA starts. Early signs plus these brain clues can shorten the wait for diagnosis and give you months of extra teaching time.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Request the NICU MRI report for every pre-term intake and circle any mention of white-matter cysts or cerebellar size.
02At a glance
03Original abstract
Very preterm (VP) survivors are at increased risk of autism spectrum disorder (ASD) compared with term-born children. This study explored whether neonatal magnetic resonance (MR) brain features differed in VP children with and without ASD at 7 years. One hundred and seventy-two VP children (<30 weeks' gestation or <1250 g birth weight) underwent structural brain MR scans at term equivalent age (TEA; 40 weeks' gestation ±2 weeks) and were assessed for ASD at 7 years of age. The presence and severity of white matter, cortical gray matter, deep nuclear gray matter, and cerebellar abnormalities were assessed, and total and regional brain volumes were measured. ASD was diagnosed using a standardized parent report diagnostic interview and confirmed via an independent assessment. Eight VP children (4.7%) were diagnosed with ASD. Children with ASD had more cystic lesions in the cortical white matter at TEA compared with those without ASD (odds ratio [OR] 8.7, 95% confidence interval [CI] 1.5, 51.3, P = 0.02). There was also some evidence for smaller cerebellar volumes in children with ASD compared with those without ASD (OR = 0.82, CI = 0.66, 1.00, P = 0.06). Overall, the results suggest that VP children with ASD have different brain structure in the neonatal period compared with those who do not have ASD. Autism Res 2016, 9: 543-552. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.
Autism research : official journal of the International Society for Autism Research, 2016 · doi:10.1002/aur.1558