School-age outcomes of infants at risk for autism spectrum disorder
Meghan Miller1, Ana-Maria Iosif2, Gregory S Young1
1MIND Institute, University of California, Davis.
Insights
Children with a family history of autism spectrum disorder (ASD) show higher rates of clinical concerns, including ADHD and language difficulties, into school age. Continued monitoring is recommended for these high-risk children.
Area of Science:
- Developmental Psychology
- Clinical Psychology
- Genetics
Background:
- Autism spectrum disorder (ASD) research often focuses on affected individuals, with less attention to long-term outcomes in at-risk siblings.
- Understanding the developmental trajectories of siblings of children with ASD is crucial for identifying non-ASD related clinical concerns.
Purpose of the Study:
- To conduct a longer-term follow-up of high-risk siblings (younger siblings of children with ASD) and low-risk siblings.
- To evaluate differences in clinical outcomes, psychopathology, autism symptoms, language, and cognitive abilities at school age (5.5-9 years).
Main Methods:
- Follow-up study of infants initially recruited as high-risk (n=79) or low-risk (n=60) for ASD.
- Utilized examiner ratings, parent reports, and standardized assessments to evaluate clinical concerns, psychopathology, autism symptoms, language, and nonverbal cognition.
- Excluded children diagnosed with ASD to focus on non-ASD outcomes in high-risk siblings.
Main Results:
- High-risk siblings showed significantly increased odds of clinically elevated/impaired scores across measures (43% vs. 12%) and examiner-rated Clinical Concerns (CC) (38% vs. 13%) compared to low-risk siblings.
- High-risk siblings with CC outcomes had higher parent-reported psychopathology and autism symptoms, and lower language skills than low-risk and high-risk siblings without CC.
- No differences in nonverbal cognitive skills were observed between groups.
Conclusions:
- A significant subgroup of school-age children with a family history of ASD exhibits persistent or emerging clinical concerns beyond autism.
- These findings highlight the continued vulnerability in high-risk siblings and underscore the need for ongoing screening and monitoring into the school-age years.
- The study emphasizes the importance of assessing a broad range of developmental and behavioral outcomes in children with a familial risk for ASD.
Abstract:
Studies of infants at risk for autism spectrum disorder (ASD) have proliferated, but few of these samples have been followed longer-term. We conducted a follow-up study, at age 5.5-9 years, of younger siblings of children with ASD (high-risk group, n = 79) or typical development (low-risk group, n = 60), originally recruited as infants. Children with ASD were excluded because of the focus on understanding the range of non-ASD outcomes among high-risk siblings. Using examiner ratings, parent ratings, and standardized assessments, we evaluated differences in clinical outcomes, psychopathology symptoms, autism symptoms, language skills, and nonverbal cognitive abilities. After adjusting for covariates, the high-risk group had increased odds of any clinically elevated/impaired score across measures relative to the low-risk group (43% vs. 12%, respectively). The high-risk group also had increased odds of examiner-rated Clinical Concerns (CC) outcomes (e.g., ADHD concerns, broader autism phenotype, speech-language difficulties, anxiety/mood problems, learning problems) relative to the low-risk group (38% vs. 13%, respectively). The high-risk group with CC outcomes had higher parent-reported psychopathology and autism symptoms, and lower directly-assessed language skills, than the Low-Risk Typically Developing (TD) and High-Risk TD groups, which did not differ. There were no differences in nonverbal cognitive skills. For some in the high-risk group, clinical concerns persisted from early childhood, whereas for others clinical concerns were first evident at school-age. Results suggest continued vulnerability in at least a subgroup of school-age children with a family history of ASD and suggest that this population may benefit from continued screening and monitoring into the school-age years. Autism Res 2016, 9: 632-642. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.
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