The relationship between parents’ first concerns and symptoms of autism spectrum disorders

Objective: To examine the relationship between parents’ first concerns and early Autism Spectrum Disorder (ASD) symptoms.

Methods: Symptoms of ASD were compared in 1393 toddlers with and without a diagnosis of an ASD, based on the area of parents’ first concerns. Communication and behaviour problems were examined in the current study, as they are the most frequently reported first concerns in the literature. A series of one-way, between-subjects ANOVAs were conducted on each sub-scale of the BISCUIT Part-1.

Results: Symptoms of Autism Spectrum Disorders (ASD) significant differences were found between most groups on all sub-scales. On the Socialization/Non-verbal Communication and Repetitive Behaviour/Restricted Interest sub-scales, those with ASD and behaviour concerns had the highest scores. On the Communication sub-scale, those with ASD and communication concerns had the highest scores.

Conclusions: A significant relationship exists between early ASD symptoms and area of first concern. The implications of these results are discussed.     

Social and communication behaviours in infants and toddlers with autism and pervasive developmental disorder-not otherwise specified

Purpose: Autism Spectrum Disorders (ASD) are a group of conditions characterized by symptoms that onset in early childhood. Deficits in social skills and communication are two of the core features of ASD and, if not remediated, can lead to poor long-term outcomes. Few researchers have examined characteristics of social skills and communication in infants with ASD.

Method: The social skills and communicative ability of 886 infants and toddlers 17–37 months of age with autism, PDD-NOS or ‘at risk’ for other developmental delays were evaluated using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). A Kruskal-Wallis test with follow-up Mann-Whitney tests were used to test for significance.

Results: Infants and toddlers with autism, followed by PDD-NOS, had greater social and communication deficits than children ‘at risk’ for developmental delays. Items which distinguished between these diagnostic groups were determined.

Conclusions: Outcomes suggest that social and communication deficits can be identified at early ages in a population of developmentally delayed toddlers. Implications are that pinpointing emerging social and communicative autistic traits earlier will allow for more accurate assessment and diagnosis in infants with ASD. This translates into earlier intervention and more effective treatment practices.     

Longitudinal development of communication in children with cerebral palsy between 24 and 53 months: Predicting speech outcomes

ABSTRACT

Objective: To determine whether communication at 2 years predicted communication at 4 years in children with cerebral palsy (CP); and whether the age a child first produces words imitatively predicts change in speech production. Method: 30 children (15 males) with CP participated and were seen 5 times at 6-month intervals between 24 and 53 months (mean age at time 1 = 26.9 months (SD 1.9)). Variables were communication classification at 24 and 53 months, age that children were first able to produce words imitatively, single-word intelligibility, and longest utterance produced. Results: Communication at 24 months was highly predictive of abilities at 53 months. Speaking earlier led to faster gains in intelligibility and length of utterance and better outcomes at 53 months than speaking later. Conclusion: Inability to speak at 24 months indicates greater speech and language difficulty at 53 months and a strong need for early communication intervention.     

Atypical preference for infant-directed speech as an early marker of autism spectrum disorders? A literature review and directions for further research

Autism spectrum disorders (ASD) refer to a complex group of neurodevelopmental disorders causing difficulties with communication and interpersonal relationships, as well as restricted and repetitive behaviours and interests. As early identification, diagnosis, and intervention provide better long-term outcomes, early markers of ASD have gained increased research attention. This review examines evidence that auditory processing enhanced by social interest, in particular auditory preference of speech directed towards infants and young children (i.e. infant-directed speech – IDS), may be an early marker of risk for ASD. Although this review provides evidence for IDS preference as, indeed, a potential early marker of ASD, the explanation for differences in IDS processing among children with ASD versus other children remains unclear, as are the implications of these impairments for later social-communicative development. Therefore, it is crucial to explore atypicalities in IDS processing early on development and to understand whether preferential listening to specific types of speech sounds in the first years of life may help to predict the impairments in social and language development.     

Autism severity as a predictor of inattention and impulsivity in toddlers

Abstract

Objective: Evaluate how severity of autism spectrum disorder (ASD) symptoms predicts attention-deficit/hyperactivity disorder (ADHD) symptoms in atypically developing toddlers.

Method: Parents/caregivers of 2300 atypically developing toddlers’ ages 18–37 months were assessed about their children’s behaviours using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) Part 1 and the inattention/impulsivity subscale of the BISCUIT-Part 2.

Results: ASD symptom severity was positively and significantly correlated with inattention/impulsivity, indicating that children with more severe symptoms of ASD tended to have higher scores on the measure of inattention/impulsivity, R²?=?0.49, F (1, 2298)?=?2234.72, p?<?0.001. Additionally, ASD symptom severity significantly predicted inattention/impulsivity, β?=?0.70, t (2298)?=?47.27, p?<?0.001.

Conclusions: ASD symptom severity predicts rates of ADHD symptoms in atypically developing toddlers. The implications of these findings are discussed in the context of other research.     

Differences in Developmental Concerns of Young Children with Autism Spectrum Disorder Across Racial/Ethnic Groups

Purpose: Parents/caregivers of children with autism spectrum disorder (ASD) have varying types of initial concerns regarding their child’s development, which may be culturally bound to parents’ perceptions of their child’s development. This study investigated differences in the types of initial developmental concerns reported by parents or caregivers of different racial/ethnic groups with children in an early intervention program.

Method: This study examined the frequency of endorsement of different types of concerns in African American, Caucasian, and Hispanic families.

Results: No significant differences between racial/ethnic groups were found in the endorsement of concerns related to communication, language/speech, motor, problem behavior, sensory, feeding, prematurity, attention, adaptive functioning, and medical conditions. Racial/ethnic groups differed significantly in their endorsement for social concerns.

Conclusion: Racial/ethnic group differences were confirmed regarding initial developmental concerns related to social behavior, which may be due to cultural beliefs. The implications of these findings on early identification are discussed.     

The effects of inattention/impulsivity and ASD symptom severity on social skills in toddlers

Objective: The aim of the current study was to examine the effects of symptom severity of ASD and symptom severity of inattention and impulsivity in toddlers to determine the potential impact on social skills.

Methods: A total of 240 toddlers diagnosed with ASD, ranging in age from 17–36 months, were included in this study. Parents or legal guardians were administered measures assessing for symptoms of ASD, symptoms of psychopathology and social skills.

Results: A significant interaction was found, indicating that toddlers with less severe symptoms of ASD and of inattention/impulsivity had better social skills. In contrast, toddlers with more severe symptoms of ASD and inattention/impulsivity had the most deficits in social skills.

Conclusion: These results further confirm that a multidimensional approach to assessment is needed and that comorbid psychopathology symptoms and social skills targets should be a focus of assessment and intervention.     

Preschool predictors of school-age academic achievement in autism spectrum disorder

Abstract

Objective: Characterization of academic functioning in children with autism spectrum disorder (ASD), particularly predictors of achievement, may have important implications for intervention. The current study aimed to characterize achievement profiles, confirm associations between academic ability and concurrent intellectual and social skills, and explore preschool predictors of school-age academic achievement in a sample of children with ASD. Method: Children with ASD (n = 26) were evaluated at the approximate ages of two, four, and ten. Multiple regression was used to predict school-age academic achievement in reading and mathematics from both concurrent (i.e. school-age) and preschool variables. Results: Children with ASD demonstrated a weakness in reading comprehension relative to word reading. There was a smaller difference between mathematics skills; math reasoning was lower than numerical operations, but this did not quite reach trend level significance. Concurrent IQ and social skills were associated with school-age academic achievement across domains. Preschool verbal abilities significantly predicted school-age reading comprehension, above and beyond concurrent IQ, and early motor functioning predicted later math skills. Conclusions: Specific developmental features of early ASD predict specific aspects of school-age achievement. Early intervention targeting language and motor skills may improve later achievement in this population.     

Rehabilitation issues in Landau–Kleffner Syndrome

Abstract

Objective: Attention-deficit hyperactivity disorder (ADHD) has been linked to deficits in socialization and communication, similar to those observed in children with ASD. In the present study, we examine the differences in developmental quotient and subscale scores between children with ASD and children with ADHD.

Methods: We compared the developmental scores in a sample of 2990 children who presented to an early intervention program, who met criteria for ASD, inattentive ADHD, hyperactive/impulsive ADHD, combined ASD/ADHD, or are at risk for developmental disorders.

Results: The overall developmental quotient did not significantly differ between those in the ADHD inattentive and hyperactive subtype groups. Adaptive skills differed most greatly between the ASD groups and the ADHD/atypically-developing groups.

Conclusion: The present study represents a first step towards understanding the relationship of ADHD to ASD in early childhood. Young children with ASD symptoms are more greatly impaired than those with symptoms of ADHD.     

Early language milestones predict later language,but not autism symptoms in higher functioning children with autism spectrum disorders

Language ability is a known predictor of outcome in children with autism but plays a more controversial role for higher functioning children with autism spectrum disorders (ASD). We studied the relationship between early language milestones and later structural language, adaptive functioning and autism symptoms in a sample of 76 children (mean age = 9.1 years) with an ASD, using two different language milestones: first phrase by 24 or 36 months. After controlling for age and nonverbal abilities, retrospectively reported early language milestones were predictive of later structural language abilities, measured by a sentence repetition task, and adaptive communication skills, but not autism symptoms or adaptive social skills. Acquisition of phrase speech by 24 months was sensitive to language and communication impairments in our ASD group, the majority (84%) of which had already acquired phrase speech by 36 months of age. Early available and easily collectable milestone data may be a useful marker of later language performance even in higher functioning, verbal children on the autism spectrum. When a detailed assessment of language is not possible, data on early milestones may be useful for identifying children at-risk in clinical settings and for language phenotyping in the laboratory.     

Language Assessment and Development in Toddlers with Autism Spectrum Disorders

One of the primary diagnostic criteria for the diagnosis of autism spectrum disorders (ASD) is the presence of a language delay or impairment. Children with ASD are now being identified at significantly younger ages, and prior research has consistently found that early language skills in this population are heterogeneous and an important predictor for later outcome. The goal of this study was to systematically investigate language in toddlers with ASD and to identify early correlates of receptive and expressive language in this population. The study included 164 toddlers with ASD between the ages of 18 and 33 months who were evaluated on several cognitive, language and behavioral measures. Results suggested good agreement among different measures of early language, including direct assessment and parent report measures. Significant concurrent predictors of receptive language included gestures, non-verbal cognitive ability and response to joint attention. For expressive language, the most significant predictors were non-verbal cognitive ability, gestures and imitation. These findings have important implications for intervention programs targeting this population.     

The relationship between gender and age of first concern in toddlers with autism spectrum disorders

The age at which parents first developed concerns over their child's development was examined in 965 toddlers with autism spectrum disorders (ASD) and atypical development to examine the potential role of gender. A two-way analysis of covariance was conducted with gender and diagnosis entered as independent variables, age at assessment entered as a covariate, and age of parents’ first concerns entered as the dependent variable. The average age of parents’ first concerns was significantly younger for females when compared to males. Additionally, the age of parents’ first concerns was significantly younger for toddlers with ASD when compared to toddlers with atypical development. No significant interaction was found. Possible explanations for the results and their implications are discussed.     

Factor structure and diagnostic fidelity of the Baby and Infant Screen for Children with aUtIsm Traits–Part 1 (BISCUIT–part 1)

Objective: Due to the effectiveness of early intervention on the outcome of individuals with ASD, there is a race to identify children with ASD at younger ages. The Baby and Infant Screen for Children with aUtIsm Traits–Part 1 (BISCUIT–Part 1) is a new assessment tool designed to assess symptoms of ASD in children between the ages of 17–37 months. The aim of this study was to identify the factor structure of BISCUIT–Part 1 and investigate group differences with regards to these factors.

Methods: Participants (n = 1287) were enrolled in a state-funded early intervention programme for children at-risk for a developmental disability. The BISCUIT was administered to a parent or other significant caregiver along with other developmental measures as part of the assessment protocol for the early intervention programme.

Results: The exploratory factor analysis yielded a three-factor solution consistent with symptom clusters characteristic of ASD. Furthermore, participants diagnosed with ASD exhibited significantly higher scores on the factors of the BISCUIT–Part 1, compared to toddlers without a diagnosis of ASD.

Conclusion: The BISCUIT–Part 1 shows promise in aiding clinicians in the diagnosis of ASD in infants and toddlers.     

Interventions for toddlers with autism spectrum disorder: A meta-analysis of single-subject experimental studies

BackgroundProgress in diagnostic assessment made it possible to diagnose ASD at a young age. Concurrently, intervention research for toddlers with ASD has increased since the past decade.MethodIn this study, we report on a five-level meta-analysis of 34 single-subject experimental studies, intended to offer a better insight into what types of interventions are effective for toddlers under the age of three with or at risk for ASD.ResultsThe analysis revealed a significant positive overall effect size. We found that interventions at home were significantly more effective compared to those in other settings. Other significant moderators regarding intervention characteristics were the agent of intervention and duration in weeks. No moderator effects of study and child characteristics were found.ConclusionsOn average, interventions for toddlers with or at risk for ASD are successful.     

Autism spectrum disorder severity as a predictor of Battelle Developmental Inventory – Second Edition (BDI-2) scores in toddlers

Objective: The study aimed to evaluate the relationship between the severity of autism spectrum disorder (ASD) symptomology and scores on the Battelle Developmental Inventory, Second Edition (BDI-2) in toddlers (n?=?325).

Methods: Total scores on the BDI-2 and individual domain scores were examined to explore the relationship between severity of ASD and developmental quotient, impairment in personal-social skills, adaptive functioning, cognition, and communication.

Results: Regression analyses controlled for the impact of age and IQ on results, indicating that higher autism severity scores were associated with overall greater impairment and in the total scores and the individual domains of the BDI-2. The domains were found to be differentially affected by severity of ASD.

Conclusion: These findings suggest severity of ASD may influence symptom presentation. Clinical implications of study findings are discussed.     

The relationship between autism spectrum disorders and symptoms of conduct problems: The moderating effect of communication

Objective: To examine the relationship between ASD diagnosis (i.e. Autism, Pervasive Developmental Disorder–Not Otherwise Specified (PDD-NOS) and atypical developing control) and tantrum/conduct symptoms in infants and toddlers. Then examine the moderating role of communication.

Design: Analysis of Covariance was conducted for study 1 followed by hierarchical regression analyses for study 2.

Methods: The Baby and Infant Screen for Children with aUtIsm Traits, Part 2 was administered to the caregivers of 774 infants and toddlers.

Results: Those with autism exhibited the greatest tantrum/conduct symptoms followed by those with PDD-NOS and then atypical controls, F(3, 771)?=?94.42, p?=?0.003. Communication was not a significant moderator.

Conclusions: Those with Autistic Disorder exhibited greater symptoms of tantrum/conduct problems, which is consistent with previous research. It seems that the relationship with communication as a moderator may differ in young children as their language skills are still in the early stages of development.     

The effect of DSM-5 criteria on the developmental quotient in toddlers diagnosed with autism spectrum disorder

Objective: To determine the effect of the changing fifth edition of the Diagnostic and Statistical Manual (DSM-5) criteria on the developmental profiles of children diagnosed with an Autism spectrum disorder (ASD).

Methods: This study examines the effect of DSM-5 changes on impairment profiles of a population of 2054 at-risk toddlers aged 17–36 months using the Battelle Developmental Inventory, Second Edition.

Results: Toddlers diagnosed with an ASD according to the DSM-5 were found to represent a more impaired population compared to those who qualified for a diagnosis of an ASD based on the DSM-IV-TR, but not the DSM-5. The group diagnosed according to the DSM-IV-TR represented a population of toddlers who were more impaired than atypically developing peers.

Conclusions: The proposed changes to the DSM will likely result in those diagnosed with an ASD according to the new criteria representing a more functionally impaired group. Implications of this proposed change are discussed.     

Predictive and Concurrent Validity of Parent Concern About Young Children at Risk for Autism

Parents’ concerns about their children’s development were examined prospectively at 14, 24, and 36 months for 89 younger siblings of a child with autism. Parent reported concern was high at all ages (40–75%) and was higher at 24 and 36 months in children with ASD than non-ASD outcomes (p < .05). Communication concerns were reported most frequently. Parent concern compared to impairment classification based on concurrent standardized tests provided better specificity than sensitivity, and was better for communication than social functioning. Parent communication concern (but not social concern) at 24 months and 36 months predicted ASD versus non-ASD outcome; however, children’s impairment on standardized tests yielded greater predictive value at all ages (p < .001). Close monitoring of this at risk group is warranted.     

Speech and Language Therapy: Its Potential Role in CAMHS

This review examines the implications of a recent systematic review of speech and language therapy interventions for child mental health services. The premise is that communication skills and mental health are closely related and that intervention in the one field may have an impact on skills and achievement in the other. The paper begins by discussing what we know about the relationship between speech/language and behavioural difficulties; it then reports results from the review, before examining the implications for practice and policy.     

The relationship between ethnicity and age of first concern in toddlers with autism spectrum disorder

The current study examined the relationship between ethnicity and the age at which parents first become concerned about their children's development in 1478 toddlers with autism spectrum disorder (ASD) and atypical development. Based on the current findings, there were no racial/ethnic differences in age of parent's first concerns. Caregivers of toddlers with ASD first developed concerns around the same time independent of which ethnic groups they belong to. In addition, the age of caregivers’ first concerns was significantly younger for those with ASD compared to those who are atypically developing without an ASD diagnosis. Implications regarding these findings are discussed.