Purpose <p>Autism is more common among children born preterm than children born at term. This study determined the prevalence of positive autism screening among children born preterm and evaluated sociodemographic, clinical, and neurodevelopmental factors associated with positive screens.</p> Methods <p>Secondary analyses of data from Lucile Packard Children’s Hospital High Risk Infant Follow-up clinic. Infants born &lt; 32 weeks gestation between 2016 and 2020, who attended the clinic at 18–30 months, were classified into two groups based on results of Modified Checklist for Autism in Toddlers-Revised with Follow-Up (M-CHAT-R/F): positive-screen (score &gt; 2) and negative-screen (≤ 2). We compared sociodemographics, clinical factors, and language development across groups.</p> Results <p>The prevalence of positive screens was 12.2%. Children in the positive-screen group had lower gestational age, birthweight, and longer hospital stays than children in the negative-screen group (all <i>p</i> &lt;.05). However, in multivariate analysis, gestational age was the only factor significantly associated with positive screens (<i>p</i> =.04). We found no group differences in sociodemographics or medical complications. The positive-screen group had lower mean language scores than the negative-screen group (<i>p</i> &lt;.001). However, 36.6% of children in the negative-screen group also had a language developmental quotient ≤ 85.</p> Conclusion <p>The high prevalence of positive screens reinforces the importance of early screening for autism in preterm children. Gestational age at birth was the primary factor associated with positive screens. Language difficulties were not specific to children with positive screens, highlighting the need for autism screening and routine developmental assessments for preterm children.</p>