Autism-like behaviours and diagnostic discordance in preschool children born very preterm

Abstract To characterise preterm children testing positive in the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), but negative in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a cross-sectional analysis of a prospectively followed cohort was performed. Seventy-four children born before 32 weeks’ gestation were assessed at 4–6 years of age and classified as Concordant (DSM-5+/ADOS-2+), Discordant (DSM-5−/ADOS-2+), or Negative (DSM-5−/ADOS-2−). Neurodevelopmental and behavioural profiles were compared between groups. Concordant, Dscordant, and Negative cases accounted for 26%, 59%, and 15%, respectively. Perinatal backgrounds and developmental quotients showed no between-group differences. Parent-reported socio-emotional and behavioural difficulties were generally highest in the Concordant group, with the Discordant group showing intermediate profiles. After adjustment for sex and gestational age and correction for multiple comparisons, Social Responsiveness Scale (SRS) Social Communication and Interaction and Restricted and Repetitive Behaviour and Strengths and Difficulties Questionnaire (SDQ) emotional symptoms and conduct problems were associated with Concordant rather than Discordant classification. On cluster analysis, DSM-5 aligned more closely with SRS/SDQ than ADOS-2. Discordant children showed meaningful socio-emotional and behavioural difficulties, warranting clinical attention and assessment of individual developmental and behavioural needs irrespective of whether full DSM-5 criteria for ASD are met.i