Premature babies are at greater risk for developing autism, but a new study suggests that preemies may not show the typical signs of autism early on.
In fact, researchers found that preemies who avoid eye contact in early infancy are actually less likely to show symptoms of autism at age two, compared to preemies who maintain eye contact during early interactions.
“Children with autism typically have challenges with social interaction and may avoid eye contact, but it turned out that children in this study who had characteristics of autism at age two were more likely to maintain eye contact and not avert their gazes in early infancy,” said first author Bobbi Pineda, Ph.D., assistant professor in occupational therapy and pediatrics at Washington University School of Medicine in St. Louis.
For the study, researchers observed behavioral symptoms characteristic of autism in a particularly high-risk group: babies born prematurely. Observing early behaviors allows researchers to understand which signs may be predictive of autism so that babies can receive timely diagnostic testing and interventions to improve their adaptive responses and outcome.
The researchers evaluated 62 premature infants hospitalized in the neonatal intensive care unit (NICU) at St. Louis Children’s Hospital. The babies were all born at least 10 weeks before full term and were evaluated close to the dates they were supposed to have been born.
The study focused on whether the infants made eye contact or averted their gazes; responded to objects or people around them; interacted socially; and calmed themselves when upset. The researchers also observed whether the babies showed a horizontal repetitive eye movement called nystagmus.
Of the 62 preemies, 58 were observed for visual cues; the rest were sleeping when the researchers came to visit. Of those 58 babies, 41 averted their gazes, and 21 showed nystagmus. Nearly all of the infants with nystagmus — 19 — also averted their gazes.
Later, at age two, when the babies in the study were screened for autism with a standard screening checklist, 13 toddlers (21 percent) screened positive. A positive screening indicates a child is at risk and should receive diagnostic testing. The researchers were surprised to find that many of the babies who had averted their gazes and showed signs of nystagmus as infants did not display warning signs of autism at age two.
“Surprisingly, we found that the children who later screened positive for autism were more likely as infants to not avert their gazes during social interaction,” Pineda said. “They were more likely to sustain eye contact.”
Pineda hypothesized that preemies in the NICU may avert their gazes as a coping mechanism to help them deal with the stress of an intense environment during a vulnerable period of development. So absence of gaze aversion, she said, could signal an inability to avoid stressors.
“This could explain why some infants behave differently in social interactions as babies than later, as children,” Pineda said. “Better understanding how autism traits emerge along the developmental pathway is an important area for future research.”
Screening tools for autism spectrum disorder don’t exist for infants, but more research is needed to improve understanding of how autism traits emerge, added Pineda. This information would help pave the way for early interventions aimed at improving life skills and ultimately help those with autism lead more fulfilling lives.
The research is published in The American Journal of Occupational Therapy.