Autism Screening Positivity Remained Stable During COVID-19 Pandemic

Autism screening positivity among young children was not affected by the COVID-19 pandemic, according to study results published in JAMA Network Open.

Although prenatal exposure to infections has been linked to autism spectrum disorder (ASD) risk, it is unknown whether exposure to the SARS-CoV-2 virus or the environment of the COVID-19 pandemic was associated with changes in autism screening rates.

To this aim, researchers conducted a cohort study using data from the COVID-19 Mother Baby Outcomes (COMBO) Initiative which collected data from 2 hospitals in New York City. Children (N=2044) who underwent ASD screening with the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) at 16 to 30 months of age between January 2018 and September 2021 or at 18 months of age for children born between February 2020 and September 2021 were included in this analysis. The researchers compared autism screening positivity between children born before (n=516) and during (n=1533) the COVID-19 pandemic and between children who were exposed to SARS-CoV-2 during gestation (n=331) and those unexposed (n=1098). Data sourced from electronic health records (EHR) and the COMBO research cohort were analyzed separately.

The children in the pooled EHR (n=1664) and research (n=385) study populations comprised 52.88% and 57.66% boys and 12.26% and 9.87% were born before 37 weeks’ gestation, respectively. The mothers of the EHR and research cohorts had a median (interquartile range [IQR]) maternal age of 30 (16-56) and 32 (18-46) years at delivery, 24.04% and 40.78% of were White, and 59.56% and 43.64% were Hispanic, respectively. In the EHR data, children born before the pandemic had a significantly lower gestational age (P =.02), more were boys (P =.01), and their mothers were older (P =.002) compared with those born during the pandemic.

The researchers found that, the rate of M-CHAT-R positivity ranged between 13.5% and 23.2% and did not differ on the basis of timing of birth in relation to the pandemic in either the EHR (c², 0.03; P =.87) or research (c², 0.32; P =.57) cohorts.

For children exposed to SARS-CoV-2 during gestation, the rate of M-CHAT-R positivity ranged between 12.3% and 24.0%. Overall, children exposed to SARS-CoV-2 had a lower positivity rate than those who were not exposed in the EHR analysis (c², 8.28; P =.004) but not in the research cohort (c², 0.32; P =.57).

In only the EHR cohort, the risk for autism screening positivity was inversely related with exposure to SARS-CoV-2 during gestation (adjusted odds ratio [aOR], 0.43; 95% CI, 0.22-0.81; P =.01). This relationship was significant in subgroup analyses among children born at full-term (aOR, 0.45; 95% CI, 0.24-0.79; P =.01), girls (aOR, 0.30; 95% CI, 0.10-0.71; P =.01), boys (aOR, 0.48; 95% CI, 0.23-0.93; P =.04), Hispanic children (aOR, 0.44; 95% CI, 0.23-0.77; P =.01), and children with Medicaid insurance (aOR, 0.39; 95% CI, 0.21-0.68; P =.002).

“Our findings suggest that neither prenatal exposure to maternal SARS-CoV-2 infection nor prenatal exposure to the pandemic milieu is associated with likelihood of positive screening results for autism,” the researchers concluded. “Continued monitoring of this generation is important to develop targeted and appropriate policies in education and welfare.”

These study findings may be limited, as the researchers relied solely on M-CHART-R screening positivity and did not follow-up for evidence of an ASD diagnosis.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor