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Published on: July 31, 2017
Early developmental milestone clusters of autistic children based on electronic health records
Ayelet Ben-Sasson1, Joshua Guedalia1, Keren Ilan1
1University of Haifa, Haifa, Israel.
Insights
Autistic children show distinct early developmental milestone (EDM) patterns, with four clusters identified. These clusters, ranging from mild to global delays, highlight the need for tailored autism screening and interventions based on individual profiles.
Area of Science:
- Developmental Pediatrics
- Neurodevelopmental Disorders
- Child Psychology
Background:
- Autism Spectrum Disorder (ASD) presents with heterogeneous symptoms and developmental trajectories.
- Early developmental milestones (EDMs) are crucial indicators of neurodevelopment in young children.
- Understanding distinct patterns of EDM attainment in autistic children can inform early identification and intervention.
Purpose of the Study:
- To identify and characterize distinct clusters of autistic children based on their early developmental milestone attainment patterns.
- To investigate demographic and clinical differences across identified EDM clusters.
- To inform the development of tailored early screening and intervention strategies for autistic children.
Main Methods:
- K-means cluster analysis was applied to data from 5836 autistic children.
- Milestone attainment data for 43 gross motor, fine motor, language, and social milestones were analyzed from the first three years of life.
- Demographic factors, parental concerns, and provider referrals were examined across clusters.
Main Results:
- Four distinct EDM clusters were identified: mild, moderate, severe, and global developmental delay.
- The global cluster exhibited the most significant delays across domains, particularly early gross motor delays, and higher rates of preterm birth via cesarean section.
- Language development showed the most prominent differences between clusters, with specific patterns observed in the second and third years of life.
- Demographic variations included socioeconomic status, with the mild cluster having higher SES and the global cluster the lowest.
- Parental concerns and referral rates were highest in the global and severe clusters.
Conclusions:
- Autistic children's early language and motor delays can be categorized into distinct profiles based on magnitude and onset.
- These EDM clusters may correlate with specific etiologies (e.g., prematurity, genetics) and inform targeted intervention programs.
- Early autism screening protocols should be individualized to accommodate these diverse developmental profiles.
Abstract:
Autistic children vary in symptoms, co-morbidities, and response to interventions. This study aimed to identify clusters of autistic children with a distinct pattern of attaining early developmental milestones (EDMs). The clustering of 5836 autistic children was based on the attainment of 43 gross motor, fine motor, language, and social developmental milestones during the first 3 years of life as recorded in baby wellness visits. K-means cluster analysis detected four EDM clusters: mild (n = 1686); moderate (n = 1691); severe (n = 2265); and global (n = 194). The most prominent cluster differences were in the language domain. The global cluster showed earlier and greater developmental delay across domains, unique early gross motor delays, and more were born preterm via cesarean section. The severe cluster had poor language development prominently in the second year of life, and later fine motor delays. Moderate cluster had mainly language delays in the third year of life. The mild cluster mostly passed milestones. EDM clusters differed demographically, with higher socioeconomic status in mild cluster and lowest in global cluster. However, the severe cluster had more immigrant and non-Jewish mothers followed by the moderate cluster. The rates of parental concerns and provider developmental referrals were significantly higher in the global, followed by the severe, moderate, and mild EDM clusters. Autistic children's language and motor delay in the first 3 years can be grouped by common magnitude and onset profiles as distinct groups that may link to specific etiologies (like prematurity or genetics) and specific intervention programs. Early autism screening should be tailored to these different developmental profiles.
