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Clinical assessment of autism in high-risk 18-month-olds
1Hospital for Sick Children, University of Toronto, and Bloorview Kids' Rehab, Toronto, Canada. jbrian@sickkids.ca
Insights
Early identification of autism spectrum disorders (ASD) in 18-month-olds is crucial. This study identified key behavioral markers in infant siblings, including social deficits, behavioral reactivity, and motor control, for earlier ASD diagnosis.
Area of Science:
- Developmental Psychology
- Pediatric Neurology
- Autism Spectrum Disorder Research
Background:
- Early intervention significantly improves outcomes for children with autism spectrum disorders (ASDs).
- Current diagnostic tools for ASDs at 18 months lack standardization.
- Infant siblings of children with ASD are at a higher risk for developing the condition.
Purpose of the Study:
- To assess potential behavioral markers for identifying autism spectrum disorders (ASDs) in 18-month-old infant siblings.
- To evaluate the utility of the Autism Diagnostic Observation Schedule (ADOS) and Autism Observation Scale for Infants (AOSI) in early ASD detection.
- To identify specific behavioral indicators that differentiate infants at high risk for ASD.
Main Methods:
- A prospective study involving 155 infant siblings of children with ASD and 73 low-risk controls at 18 months of age.
- Data collection using the Autism Diagnostic Observation Schedule (ADOS) and Autism Observation Scale for Infants (AOSI).
- Infants were diagnosed using a blind best-estimate diagnosis at age 3, categorizing them into ASD siblings, non-ASD siblings, and controls.
Main Results:
- Discriminant function analyses indicated that social and behavioral domains of the ADOS provided the most informative items for ASD identification.
- AOSI items related to behavioral reactivity and motor control offered additional valuable information.
- Key behavioral markers identified included social-communication deficits, state regulation, and motor control issues.
Conclusions:
- The findings underscore the importance of considering a broader range of behavioral markers beyond social-communication deficits for early ASD identification.
- Temperament dimensions, such as state regulation and motor control, are crucial factors in assessing toddlers for suspected ASD.
- Integrating ADOS and AOSI assessments can enhance the accuracy of early ASD detection in high-risk infants.
Abstract:
Earlier intervention improves outcomes for children with autism spectrum disorders (ASDs), but existing identification tools are at the limits of standardization with 18-month-olds. We assessed potential behavioural markers of ASD at 18 months in a high-risk cohort of infant siblings of children with ASD. Prospective data were collected using the Autism Diagnostic Observation Schedule (ADOS) and Autism Observation Scale for Infants (AOSI) on 155 infant siblings and 73 low-risk controls at 18 months. Infants were classified into three groups (ASD sibs, non-ASD sibs, controls) based on blind best-estimate diagnosis at age 3. Fisher's exact tests, followed by discriminant function analyses, revealed that the majority of informative ADOS items came from the social and behavioural domains, and AOSI items measuring behavioural reactivity and motor control contributed additional information. Findings highlight the importance of considering not only social-communication deficits, but also basic dimensions of temperament including state regulation and motor control when assessing toddlers with suspected ASD.
