New research in the American Journal of Occupational Therapy examines relationships among neonatal visual and auditory responses, social behaviors, and autism risk.
Research conducted by a team of occupational therapists and physicians at Washington University in St. Louis aims to help detect signs of autism and altered development earlier in life, so that services can be offered sooner to improve children’s adaptive skills and outcome.
The team evaluated and observed 62 pre-term infants initially hospitalized at St. Louis Children’s Hospital. Early neonatal neurobehavioral testing was conducted at the infant’s due date (the time when the infant would have been born if not born early and typically the age that the infant is discharged from the neonatal intensive care unit). This included observations about social interaction, visual and auditory responses. Participants were assessed again when they were two years old with the Modified Checklist for Autism in Toddlers, and they also underwent standardized developmental testing with the Bayley Scales of Infant and Toddler Development, 3rd Edition. Children identified in this study were not diagnosed with autism, but a screening tool indicated they were at higher risk for autism.
“We expected to see avoidance of social interaction among infants who later screened positive for autism risk, as avoidance of social interaction and failure to make eye contact are often seen in children with autism,” says Roberta Pineda, PhD, OTR/L, assistant professor of the Program in Occupational Therapy, Department of Pediatrics, School of Medicine at Washington University in St. Louis. “Instead, our findings did not support our hypothesis, and positive screening for autism risk was associated with absence of gaze aversion in the neonatal period. In fact, infants who avoided visual interaction through gaze aversion in the neonatal period were five times more likely to have good outcome at age two years. While this was an unexpected finding, pre-term infants in the NICU may avert their gaze to protect themselves from stimuli that is too intense, and infants who later went on to screen positive for autism risk did not demonstrate this same gaze aversion response as their peers. This is, however, a different pattern from what is observed later when children with autism are more likely to avoid social interaction.”
The team identified that infants with later autism risk as well as poor developmental outcome were less likely to demonstrate gaze aversion and less likely to demonstrate end-point nystagmus in the neonatal period.
