title: Neonatal brainstem function and 4-month arousal-modulated attention are jointly associated with autism.
abstract: The authors evaluated the contribution of initially abnormal neonatal auditory brainstem responses (ABRs) and 4-month arousal-modulated attention visual preference to later autism spectrum disorder (ASD) behaviors in neonatal intensive care unit (NICU) graduates. A longitudinal study design was used to compare NICU graduates with normal ABRs (n = 28) to those with initially abnormal ABRs (n = 46) that later resolved. At 4 months postterm age, visual preference (measured after feeding) for a random check pattern flashing at 1, 3, or 8 Hz and gestational age (GA) served as additional predictors. Outcome measures were PDD Behavior Inventory (PDDBI) scores at 3.4 years (standard deviation = 1.2), and developmental quotients (DQ) obtained around the same age with the Griffiths Mental Development Scales (GMDS). Preferences for higher rates of stimulation at 4 months were highly correlated with PDDBI scores (all P-values < 0.01) and the GMDS Hearing and Speech DQ, but only in those with initially abnormal ABRs. Effects were strongest for a PDDBI social competence measure most associated with a diagnosis of autism. For those with abnormal ABRs, increases in preference for higher rates of stimulation as infants were linked to nonlinear increases in severity of ASD at 3 years and to an ASD diagnosis. Abnormal ABRs were associated with later reports of repetitive and ritualistic behaviors irrespective of 4-month preference for stimulation. The joint occurrence of initially abnormal neonatal ABRs and preference for more stimulation at 4 months, both indices of early brainstem dysfunction, may be a marker for the development of autism in this cohort.
authors.affiliation: Department of Psychology, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY 10314, USA. ira.cohen@opwdd.ny.gov
authors.forename: Ira L
authors.initials: IL
authors.lastname: Cohen
authors.forename: Judith M
authors.initials: JM
authors.lastname: Gardner
authors.forename: Bernard Z
authors.initials: BZ
authors.lastname: Karmel
authors.forename: Ha T T
authors.initials: HT
authors.lastname: Phan
authors.forename: Phyllis
authors.initials: P
authors.lastname: Kittler
authors.forename: Tina Rovito
authors.initials: TR
authors.lastname: Gomez
authors.forename: Maripaz G
authors.initials: MG
authors.lastname: Gonzalez
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Lennon
authors.forename: Santosh
authors.initials: S
authors.lastname: Parab
authors.forename: Anthony
authors.initials: A
authors.lastname: Barone
mesh_terms: D001143:Arousal; D001288:Attention; D001321:Autistic Disorder / Q000503:physiopathology*; D001933:Brain Stem / Q000503:physiopathology*; D002657:Child Development; D002675:Child, Preschool; D016057:Evoked Potentials, Auditory, Brain Stem; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D018730:Infant Behavior; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008137:Longitudinal Studies; D010775:Photic Stimulation / Q000379:methods; D012720:Severity of Illness Index