1. Children with an increased risk of SED
Social-Emotional Outcomes in High-Risk Infants
Authors: Mittal S., Poon J.,Ruddy A, Ebling M., Katikaneni L.
Department of Pediatrics, Medical University of South Carolina, Charleston SC
Background
Results
Conclusions
Social emotional difficulties (SED) have been well described in very preterm infants and VLBW infants.
In our study, we find that high risk infants failed the ASQ-SE 56% of the time.
Specifically, children who are born SGA or neurologically compromised (either with IVH or HIE) are at an increased risk for SED at an early age. These children have been associated to have an increased risk of academic difficulties later on.
In our high risk clinic, adjusted age is used until 2 years of age. Children were more likely to screen positive as they got older on subsequent screens.
1 in 36 neonates seen in NICU graduate clinic who scored “at risk” for SED were diagnosed with ASD.
Out of 11 children with autism, all failed the ASQ-SE at one visit or more. More research is needed to determine if the ASQ-SE can identify children with ASD.
Per ASQ-SE’s data of 133 children with ASD receiving an ASQ-SE between months, 83.5% scored “ at risk” on ASQ-SE.
Risk of ASD increased 9 times if a child failed ASQ-SE two or more times. Pediatricians should consider evaluating further for these neurobehavioral conditions if a child scores “at risk” ASQ-SE, in particular, if failed more than once.
Children with social-emotional difficulties (SED) are at an increased risk for academic underachievement, delinquency, strained peer relationships, and behavioral problems
The American Academy of Pediatrics (AAP) recommends that pediatricians screen for social-emotional problems in all children.
The Ages and Stages Questionnaire – Social Emotional (ASQ:SE) is a level 1 screening tool used to identify social-emotional difficulties in early childhood.
Data examining the efficacy of screening in children who screen positive on the ASQ:SE screening is limited, and even more so in high risk infants.
Our primary objective was to identify risk factors and outcomes for neonates seen in a NICU Graduate Clinic who score at risk for SED on ASQ-SE.
Our secondary aim was to identify how many children diagnosed with ASD and ADHD in the NICU Graduate clinic had previously failed an ASQ-SE
This study was a retrospective review of 701 children meeting inclusion criteria: infants seen at our hospital’s NICU Graduate Clinic from January 1, 2008 to January 1, 2015.
Data was obtained from the Perinatal Information Systems (PINS), an established database used to collect and extract medical information for all infants discharged from MUSC Children’s Hospital.
Patients received the ASQ-SE (1) since the NICU Graduate clinic implemented ASQ:SE2 in October of 2015.
Data were analyzed using SAS v 9.4
Data were analyzed using chi- square test or Fischer’s exact test. A logistic regression model was used to show associations with the dependent outcome. 
Univariable analysis showed no association with the following risk factors: low birth weight, twin gestation/multiples, ethnicity, maternal education, gender congenital heart disease, prolonged mechanical ventilation, low Apgar scores, ROP stage 3 or 4.
DBP OUTCOMES
701 high risk infants were seen between the ages of 0-5 with a total of 1780 patient encounters
56% (392) scored at risk on ASQ-SE at one visit or more.
Children with an increased risk of SED
Odds Ratio
Grade 3 & 4 IVH
2.5 [1.1 – 5.53]
High Frequency Oscillator Ventilation => 7 days (76%)
2.16 [ ]
SGA/IUGR (57%)
1.75 [ ]
Hypoxic Ischemic Encephalopathy IE/abnormal neurological examination at birth (74%)
2.15 [ ]
Objectives
Of the 392 children scoring at risk on ASQ-SE, 9% (36) were later diagnosed with ADHD and 2.8% (11) were later diagnosed with an autism spectrum disorder (ASD).
100% of children with ASD (11) and 97% of children with ADHD (36) scored “at risk” on the ASQ-SE at one visit or more
18% of children who failed were referred to developmental-behavioral pediatrics for follow-up.
DESIGN/METHODS
72% of children 0-3 who failed ASQ-SE were receiving early intervention services.
Children with Autism Spectrum Disorder: MCHAT, ASQ-SE, and ASQ-Personal-Social Scores
REFERENCES
Age (months)
ASQ-SE
MCHAT
ASQ-PS
30 m F
2. 24/28 m P m
4. 26 M
5. < 18 M
No mchat
6. 32 M M ?
8. 24 M M M M
Hardy S, Haisley L, Manning C, Fein D. Can Screening With the Ages and Stages Questionnaire Detect Autism? Journal of developmentalandbehavioralpediatrics : JDBP 2015; 36(7): doi: /DBP
Saylor, C.F., Boyce, G.C. & Price, C. Child Psychiatry Hum Dev (2003) 33:
Social-Emotional Screening for Infants and Toddlers in Primary Care. Rahil D. Briggs, Erin M. Stettler, Ellen Johnson Silver, Rebecca D. A. Schrag, Meghna Nayak, Susan Chinitz, Andrew D. Racine Pediatrics Feb 2012, 129 (2) e377-e384; DOI:  /peds
Children were more likely to screen “at risk” on the ASQ-SE as age increased (p<.001).