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.     

Factors related to parental age of first concern in toddlers with autism spectrum disorder

Purpose: The age of first concern (AOC) of parents of children with autism spectrum disorders (ASD) has substantial implications for early diagnosis and intervention. The current study sought to determine the average AOC, what types of first concerns are most common, and what factors predict earlier AOC in toddlers with ASD. Methods: This study analyzed the predictive influence of the type of concern, symptom severity, medical diagnoses, and other independent variables on AOC among toddlers with ASD using multiple regressions. Results: The mean AOC was found to be 13.97 months (SD = 7.86). The most commonly reported first concern was speech/language. First concerns related to communication, speech/language predicted later AOC, while motor concerns predicted earlier AOC. Conclusions: Concerns that are more closely related to social communication deficits characteristic of ASD predicted later AOC. The implications of these findings on screening/assessment and intervention are discussed.     

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.     

The Baby and Infant Screen for Children with aUtIsm Traits-Part 3: The development of age-based scoring procedures

The objective of the current study was to develop age-based scoring procedures for the BISCUIT-Part 3, an assessment measure of challenging behaviors in infants and toddlers aged 17–37 months. Separate age-based cutoffs were developed for those with an autism spectrum disorder (ASD) and those with non-ASD related developmental delays, using the standard deviation from the mean method. The sample consisted of 3022 infants and toddlers and their parents. As age increased in those with ASD, higher cutoff scores were required. Less variation was seen in the cutoff scores established for those with non-ASD related delays. The findings suggest that as children with ASD grow older, challenging behaviors become more frequent and severe. Additionally, they become easier to detect in comparison to same-aged peers. The implications of these results are discussed.     

The relationship between race and comorbid symptoms in infants and toddlers with autism spectrum disorder

Researchers have indicated that persons with autism spectrum disorder (ASD) population evince higher rates of comorbid symptoms. While the relationship between comorbid symptoms and factors such as autism symptom severity, IQ level, age, communication abilities, and degree of social impairment were previously examined, there has been limited research on the effect of race in this area. The current study examined the potential role of race in comorbid symptoms in toddlers with ASD and atypically developing toddlers without a diagnosis of ASD using The Baby and Infant Screen for Children with aUtIsm Traits – Part 2 (BISCUIT-Part 2). Based on the current findings, African-American toddlers evinced higher rates of comorbid symptoms than Caucasian toddlers and toddlers of other races. In addition, toddlers with ASD evinced higher rates of comorbid symptoms than atypically developing toddlers without a diagnosis of ASD. Implications regarding these findings are discussed.     

Practitioner’s Guide to Assessment of Autism Spectrum Disorders in Infants and Toddlers

Recent advances in clinical research have made it possible to diagnosis autism spectrum disorders (ASD) as early as the second year of life. The diagnostic process early in development is often complex, and thus, familiarity with the most recent findings in clinical assessment instruments, early symptoms, and developmental trajectories of young children with autism is essential. This paper provides an empirically based practitioner's guide to issues and concerns related to early diagnosis of ASD in very young children, documentation of the course and patterns of ASD symptomatology in infants and toddlers, and current understanding in the field of diagnostic outcomes of children identified in the first and second year of life.     

Brief Report: Sex Differences in Parental Concerns for Toddlers with Autism Risk

Research on sex differences in autism spectrum disorder (ASD) suggests both higher prevalence and a more easily observable presentation of core ASD symptomology in males, which may lead to sex differences in parental concerns. The current study examined whether sex and diagnosis relate to the timing, number, and types of pre-diagnosis concerns for 669 (N_male = 468) toddlers who screened at risk for ASD. No sex differences in parents’ concerns emerged for toddlers diagnosed with ASD; however, in the overall at-risk sample, parents of boys endorsed ASD symptoms, including restricted and repetitive behaviors, more than parents of girls. Future research should examine why sex differences in pre-diagnosis concerns emerge and how they might impact early diagnosis for at-risk boys versus girls.     

Parental Recognition of Developmental Problems in Toddlers with Autism Spectrum Disorders

Symptoms of Autism Spectrum Disorders (ASD) begin to manifest during the first 2 years; there is limited evidence regarding type and timing of symptom onset. We examined factors related to parental age of recognition (AOR) of early abnormalities and the association between AOR and diagnosis and levels of functioning at 2 and 4 years in 75 toddlers with ASD. Results suggest significant differences between autism and PDD-NOS in the AOR and type of first concerns. Early social and motor delays as well as maternal age was associated with AOR. Later AOR was associated with poorer social-communicative and nonverbal cognitive functioning at 2 and 4. The findings are discussed in a context of identifying distinct developmental trajectories within the autism spectrum.     

The impact of familial autism diagnoses on autism symptomatology in infants and toddlers

Debate regarding the etiology of Autism Spectrum Disorders (ASD) is on the rise with numerous theories being put forth. Currently, the theory with the most empirical support is the interaction of multiple genes. Many studies have provided evidence that as the incidence of ASD increases so do genetic similarities. However, very little research has focused on the presentation of ASD symptomatology in those individuals with or without ASD diagnoses who have biological relatives with or without ASD diagnoses. The aim of the current study was to first examine the percentage of toddlers with and without ASD who had biological relatives with ASD. Next, the impact familial ASD had on ASD symptomatology within infants and toddlers with and without diagnoses of ASD was investigated. In the first study, 438 toddlers with an ASD diagnosis and 1,071 who were atypically developing without an ASD diagnosis were examined. A greater percentage of toddlers with ASD were noted to have a biological relative with an identified ASD in comparison to atypically developing toddlers. In the second study, no significant differences emerged between groups dependent on familial ASD of symptoms of autism as measured by the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). As such, despite previous research indicating a strong genetic link to ASD, this link is undoubtedly complex and not necessarily related to ASD symptomatology. Suggestions for further research are provided.     

Mirroring effect in 2- and 3-year-olds with autism spectrum disorder

Previous studies have suggested that being imitated by an adult is an effective intervention with children with autism and developmental delay. The purpose of this study wais to investigate whether “mirroring” interaction, which includes being imitated by an adult, can facilitate the social responsiveness of toddlers with autism spectrum disorder (ASD). Participants were 16 toddlers (2- and 3-year-olds) with ASD. This study consisted of three experimental phases: in the first baseline phase, the experimenter manipulated toys in front of the participant; in the second phase, the experimenter reproduced (mirrored) all of the child's behaviors; and in the third phase, the first baseline phase was repeated. Our results demonstrated that although the mirroring effect differed by age, the effect was observed in both 2- and 3-year-olds with ASD. In addition, the overall magnitude of the mirroring effect differed by IQ, but not by the severity of autistic symptoms. Mirroring interaction is promising as an early intervention for a wide range of children with ASD.     

Parent-Reported Temperament Trajectories Among Infant Siblings of Children with Autism

Temperament atypicalities have been documented in infancy and early development in children who develop autism spectrum disorders (ASD). The current study investigates whether there are differences in developmental trajectories of temperament between infants and toddlers with and without ASD. Parents of infant siblings of children with autism completed the Carey Temperament Scales about their child at 6, 12, 18, 24, and 36 months of age. Temperament trajectories of children with ASD reflected increases over time in activity level, and decreasing adaptability and approach behaviors relative to high-risk typically developing (TD) children. This study is the first to compare temperament trajectories between high-risk TD infants and infants subsequently diagnosed with ASD in the developmental window when overt symptoms of ASD first emerge.     

Autism Spectrum Disorder as Early Neurodevelopmental Disorder: Evidence from the Brain Imaging Abnormalities in 2–3 Years Old Toddlers

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition that occurs within the first 3 years of life, which is marked by social skills and communication deficits along with stereotyped repetitive behavior. Although great efforts have been made to clarify the underlying neuroanatomical abnormalities and brain-behavior relationships in adolescents and adults with ASD, literature is still limited in information about the neurobiology of ASD in the early age of life. Brain images of 50 toddlers with ASD and 28 age, gender, and developmental quotient matched toddlers with developmental delay (DD) (control group) between ages 2 and 3 years were captured using combined magnetic resonance-based structural imaging and diffusion tensor imaging (DTI). Structural magnetic resonance imaging was applied to assess overall gray matter (GM) and white matter (WM) volumes, and regional alterations were assessed by voxel-based morphometry. DTI was used to investigate the white matter tract integrity. Compared with DD, significant increases were observed in ASD, primarily in global GM and WM volumes and in right superior temporal gyrus regional GM and WM volumes. Higher fractional anisotropy value was also observed in the corpus callosum, posterior cingulate cortex, and limbic lobes of ASD. The converging findings of structural and white matter abnormalities in ASD suggest that alterations in neural-anatomy of different brain regions may be involved in behavioral and cognitive deficits associated with ASD, especially in an early age of 2–3 years old toddlers.     

Developmental Changes in Empathic Concern and Self-Understanding in Toddlers at Genetic Risk for Autism Spectrum Disorder

Toddlers with an older sibling with autism spectrum disorder (ASD) and low risk (LR) toddlers were observed at 22, 28, and 34 months during two empathy probes: a crying baby and an adult who pretended to hurt her finger. Toddlers with a later ASD diagnosis showed less empathic concern and self-distress at each age on both empathy probes than LR toddlers. HR toddlers with no diagnosis showed growth in empathic concern between 22 and 34 months in response to the adult’s pain, differing from the children with ASD, but not the LR children, by 34 months. Developmental changes in parent-rated self-understanding showed a similar pattern. Results highlight individual differences in the social development of HR toddlers.     

Challenging behaviors in toddlers diagnosed with autism spectrum disorders with the DSM-IV-TR and the proposed DSM-5 criteria

With publication of the DSM-5 slated for May 2013, it has been predicted that the new diagnostic criteria will cause a decrease in the prevalence of autism spectrum disorders (ASDs), seriously impacting children no longer meeting criteria for the disorder. A majority of individuals with ASD have behavior problems which are not considered core features of the disorder but are significantly impairing and often the focus of intervention. The aim of the current study was to investigate types of challenging behaviors in toddlers who may no longer meet diagnostic criteria for ASD using a psychometrically sound measure, the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) – Part 3. The study included 3339 toddlers, 501 who will retain ASD diagnosis according to the DSM-5; 439 who will no longer meet criteria, and a comparison group of 2399 toddlers referred for evaluation due to atypical development. Though toddlers diagnosed under the DSM-5 exhibited the most challenging behaviors, those who did not meet DSM-5 criteria exhibited significantly more challenging behaviors than the atypically developing toddlers. The effect of the changes in ASD diagnostic criteria on access to early behavioral interventions warrants careful consideration as the new DSM-5 criteria are adopted.     

Expressive and receptive fast-mapping in children with autism spectrum disorders and typical development: The influence of orienting cues

Typically developing toddlers accurately follow an adult's gaze learn object labels. However, children with autism spectrum disorders (ASD) mis-map new words to their own focus of attention. Children with ASD and typical development participated in three word learning conditions. In the follow-in condition, the adult labeled an object which was the focus of the child's attention. In the redirecting condition, the adult labeled an object which was the focus of their own attention. In the orienting cue condition, the adult used a verbal cue to attract the child's attention, then labeled an object which was the focus of their own attention. Typically developing children learned receptive labels in all conditions. Children with ASD mis-mapped words to their own focus of attention during redirecting trials, but showed a trend toward correct receptive mapping during orienting cue trials. During expressive trials, both groups were most likely to map successfully during follow-in trials and least likely to map successfully during redirecting trials. Using a verbal orienting cue may help children with ASD learn new words. Following a child's focus of attention may confer vocabulary learning benefits for both children with ASD and children with typical development during expressive vocabulary learning tasks.     

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.     

Feeding and sleep difficulties in toddlers with autism spectrum disorders

Children with autism spectrum disorders (ASD) present with a variety of comorbid difficulties, some of which relate to seemingly simply activities of daily living. Feeding and sleep difficulties are purportedly common within the ASD population, although the association between these problems and ASD symptomatology has rarely been addressed. The current study examined the feeding and sleep difficulties of 1747 toddlers who had a diagnosis of Autistic Disorder (n = 506), PDD-NOS (n = 522), or atypical development (n = 719) using the Baby and Infant Screen for Children with aUtIsm Traits-Part 2, a screening tool designed to identify comorbid difficulties of toddlers with ASD and/or atypical development. Individuals with Autistic Disorder were found to exhibit significantly more feeding and sleep difficulties than those with PDD-NOS, who in turn presented with more difficulties of this type than those with atypical development. While developmental quotient (DQ) was also related to feeding and sleep difficulties, DQ could not account for the differences between these groups.     

Gender differences in symptoms of Autism Spectrum Disorders in toddlers

Gender differences in symptoms representing the triad of impairments of Autism Spectrum Disorders remain unclear. To date, the majority of research conducted on this topic has utilized samples of older children. Thus, the purpose of the current study was to utilize a sample of toddlers to investigate gender differences in symptom endorsements of ASD. Also, deficits in areas such as cognition have been shown to affect gender in this same population (i.e., gender ratios). Therefore, each toddler's level of developmental ability was accounted for in the current study. In this sample of toddlers, gender differences were only found in regards to the restricted interests and repetitive behavior domain, with females with an average Developmental Quotient having significantly fewer endorsements on items related to restrictive and repetitive behaviors. Implications of the findings are discussed.     

The baby and infant screen for children with autism traits-part 2: The development of age-based cutoffs

Abstract

Objective: To create age-based scoring procedures for the BISCUIT-Part 2, an assessment measure of comorbid psychopathology in infants and toddlers aged 17–37 months.

Method: The standard deviation from the mean method was used to develop separate age-based cutoffs for those with an autism spectrum disorder (ASD) and those with non-ASD related developmental delays, using a sample of 2867 infants and toddlers and their parents.

Results: As age increased in those with ASD, higher cutoff scores were indicated. Less variation was seen in the cutoff scores established for those with non-ASD related delays.

Conclusion: The findings suggest that as children with ASD grow older, symptoms of comorbidity become more prevalent and easier to detect. The implications of these results, as well as possible areas of future research, are discussed.