极早产与青年期自闭症特质：EPICure 研究。
Extremely preterm birth and autistic traits in young adulthood: the EPICure study.
机构信息
Institute for Women's Health, University College London, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK. h.o'
School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland. h.o'
出版信息
Mol Autism. 2021 May 6;12(1):30. doi: 10.1186/s13229-021-00414-0.
BACKGROUND
A high prevalence of autism spectrum disorder is reported in children born extremely preterm (EP), but an even larger proportion of survivors are affected by subclinical difficulties than meet diagnostic criteria. The aims of this study were to investigate autistic traits associated with the broader autism phenotype in a cohort of young adults born EP, and explore how these traits relate to emotion recognition, empathy and autism symptom presentation in childhood. The prevalence of autism diagnoses was also investigated.
METHODS
One hundred and twenty-nine young adults born before 26 weeks of gestation and 65 term-born controls participated in the 19-year follow-up phase of the EPICure studies. In addition to a clinical interview, participants completed the Broader Autism Phenotype Questionnaire (BAPQ), the Empathy Quotient questionnaire, and the Frankfurt Test and Training of Facial Affect Recognition. The Social Communication Questionnaire (SCQ) was completed by the participants' parents at age 11 years.
RESULTS
EP born young adults scored significantly higher on the BAPQ in comparison with their term-born peers, indicating greater autistic traits. Among EP participants, BAPQ scores were correlated with SCQ scores in childhood (r = 0.484, p < 0.001). EP young adults had significantly lower scores in emotion recognition and empathy in comparison with controls; however, this effect was mediated by IQ. At 19 years, a diagnosis of autism was reported by 10% of EP participants versus 1.6% of controls, whereas 31% of EP participants scored above the cut-off for the broader autism phenotype in comparison with 8.5% of term-born controls.
LIMITATIONS
The high attrition of EP participants from lower socio-economic backgrounds and with lower cognitive functioning may have led to an underrepresentation of those presenting with difficulties associated with autism.
CONCLUSIONS
A larger proportion of EP survivors are affected by difficulties associated with autism than have confirmed diagnoses, with a moderate correlation between autism symptom scores in childhood and autistic traits in young adulthood. EP young adults had significantly higher autism symptom scores and a larger proportion had a diagnosis of autism than controls. Screening for autistic traits at set points throughout childhood will help identify those EP individuals at risk of social difficulties who may benefit from intervention.
背景
极早产儿（EP）所生儿童自闭症谱系障碍的发病率较高，但亚临床困难的幸存者比例甚至大于符合诊断标准的比例。本研究的目的是调查 EP 新生儿队列中与广泛自闭症表型相关的自闭症特征，并探讨这些特征如何与儿童时期的情绪识别、同理心和自闭症症状表现相关。还调查了自闭症诊断的患病率。
方法
129 名出生于 26 周前的早产儿和 65 名足月出生的对照组参加了 EPICure 研究的 19 年随访阶段。除了临床访谈外，参与者还完成了广泛自闭症表型问卷（BAPQ）、同理心商数问卷、法兰克福面部表情识别测试和训练以及社交沟通问卷（SCQ）。参与者的父母在 11 岁时完成了 SCQ。
结果
与足月出生的同龄人相比，EP 出生的年轻人在 BAPQ 上的得分明显更高，表明自闭症特征更明显。在 EP 参与者中，BAPQ 得分与童年时期的 SCQ 得分呈正相关（r=0.484，p<0.001）。与对照组相比，EP 年轻人在情绪识别和同理心方面的得分明显较低；然而，这种影响被智商所介导。19 岁时，10%的 EP 参与者报告了自闭症诊断，而对照组为 1.6%，而 31%的 EP 参与者的广泛自闭症表型得分高于临界值，而对照组为 8.5%。
局限性
来自社会经济背景较低和认知功能较低的 EP 参与者的大量流失可能导致与自闭症相关的困难人群代表性不足。
结论
与已确诊的自闭症相比，更多的 EP 幸存者受到与自闭症相关的困难的影响，童年时期的自闭症症状评分与成年早期的自闭症特征之间存在中度相关性。EP 年轻人的自闭症症状评分显著更高，且有自闭症诊断的比例高于对照组。在整个儿童时期的特定时间点对自闭症特征进行筛查，将有助于识别那些有社交困难风险的 EP 个体，他们可能受益于干预。
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