Early Indicators of Autism Spectrum Disorders in the Second Year of Life

Three groups of 18 children were selected for this study, one group with autism spectrum disorders (ASD), one group with developmental delays in which ASD was ruled out (DD), and one group with typical development (TD), from a pool of 3026 children who were screened with the Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP, Wetherby & Prizant, 2002) Infant-Toddler Checklist under 24 months of age. The CSBS DP Behavior Sample was videotaped on selected children as a second-level evaluation during the second year of life. The Infant-Toddler Checklist had a sensitivity and specificity of 88.9% for this sample of children. Significant group differences were found on the Infant-Toddler Checklist and the Behavior Sample, however, these differences did not distinguish children with ASD and DD with high accuracy. The videotapes of the Behavior Sample were reanalyzed to identify red flags of ASD. Nine red flags differentiated children in the ASD group from both the DD and TD groups and four red flags differentiated children in the ASD Group from the TD group but not the DD group. These 13 red flags were found to discriminate the three groups with a correct classification rate of 94.4%.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44624/1/10803_2004_Article_492544.pd

Toward Innovative, Cost-Effective, and Systemic Solutions to Improve Outcomes and Well-Being of Military Families Affected by Autism Spectrum Disorder

The burdens faced by military families who have a child with autism are unique. The usual challenges of securing diagnostic, treatment, and educational services are compounded by life circumstances that include the anxieties of war, frequent relocation and separation, and a demand structure that emphasizes mission readiness and service. Recently established military autism-specific health care benefits set the stage for community-viable and cost-effective solutions that can achieve better outcomes for children and greater well-being for families. Here we argue for implementation of evidence-based solutions focused on reducing age of diagnosis and improving access to early intervention, as well as establishment of a tiered menu of services, individualized to the child and family, that fit with the military ethos and system of health care. Absence of this new model of care could compromise the utility and sustainability of the autism-specific benefit

Coordinated social communication in toddlers with and without autism spectrum disorder during a home observation

Background & Aims: Social communication and language skills have been found to be important predictors of long-term outcomes in individuals with autism spectrum disorder (ASD). However, the development of coordinated social communication (i.e., gestures and sounds or words) remains relatively understudied in young children with ASD and developmental delays (DD). This study used a prospective, longitudinal design and granular observational coding to document the coordination of gestures, sounds, and words in a large, heterogeneous sample of toddlers identified with ASD, DD, or typical development (TD) during a naturalistic home observation. Specific aims were: (1) to compare rates per minute and proportions of coordinated child communicative acts across groups; (2) to examine concurrent relationships between coordinated communication and measures of social communication and autism symptoms; and (3) to examine prospective relationships between coordinated communication, receptive and expressive language skills, and autism symptoms collected at 3 years of age. Methods: At a mean age of 20.3 months (SD = 2.0), 211 children (nASD = 121; nDD = 46; nTD = 44) participated in everyday activities with a parent during an hourlong home observation. Rates per minute and proportions of gestures, sounds and words, as well as temporally overlapping gesture + sound, gesture + word, and gesture + phrase combinations, were compared using one-way ANOVA. Pearson product moment correlations between coordinated communicative acts and measures of social communication, language, and autism symptoms were examined. Results: On average, children with ASD used sounds and gesture + sounds at significantly lower rates than DD and TD groups, who did not differ. Children with ASD and DD coordinated gesture + single words and gesture + phrases at significantly lower rates than the TD group. Groups did not differ with respect to the rate per minute at which they used gestures alone. Children with TD used a smaller proportion of sounds alone and higher proportions of words and phrases, with and without coordinated gestures, than ASD and DD groups. Children with ASD and DD used a significantly higher proportion of gestures alone than children with TD. Rates per minute and proportions of single words and gesture + words had significant correlations with measures of social communication, language skills, and autism symptoms. Conclusions: Results suggest that a significantly lower rate per minute of sounds and gesture + sound combinations was a distinguishing feature of ASD in our sample. Further, limited use of single words and gesture + single words was observed in children ASD and DD. Significant prospective relationships between single words and gesture + words with language skills measured over a year later underscores the importance of acquiring these forms. Implications: Results support the idea that clinicians should include opportunities to observe and encourage coordinated social communication while screening and assessing young children for DD and ASD in the home environment. The significant associations between rate of single words and gesture + word combinations with language development over a year later have implications for incorporating intervention targets that encourage the use of gesture-speech combinations

Rate of Communicative Gestures and Developmental Outcomes in Toddlers With and Without Autism Spectrum Disorder During a Home Observation

Purpose Most toddlers with autism spectrum disorder and other developmental delays receive early intervention at home and may not participate in a clinic-based communication evaluation. However, there is limited research that has prospectively examined communication in very young children with and without autism in a home-based setting. This study used granular observational coding to document the communicative acts performed by toddlers with autism, developmental delay, and typical development in the home environment. Method Children were selected from the archival database of the FIRST WORDS Project ( = 211). At approximately 20 months of age, each child participated in everyday activities with a caregiver during an hour-long, video-recorded, naturalistic home observation. Inventories of unique gestures, rates per minute, and proportions of types of communicative acts and communicative functions were coded and compared using a one-way analysis of variance. Concurrent and prospective relationships between rate of communication and measures of social communication, language development, and autism symptoms were examined. Results A total of 40,738 communicative acts were coded. Children with autism, developmental delay, and typical development used eight, nine, and 12 unique gestures on average, respectively. Children with autism used deictic gestures, vocalizations, and communicative acts for behavior regulation at significantly lower rates than the other groups. Statistically significant correlations were observed between rate of communication and several outcome measures. Conclusion Observation of social communication in the natural environment may improve early identification of children with autism and communication delays, complement clinic-based assessments, and provide useful information about a child\u27s social communication profile and the family\u27s preferred activities and intervention priorities. Supplemental Material https://doi.org/10.23641/asha.14204522

Verbal Responsiveness in Parents of Toddlers With and Without Autism During a Home Observation

This study examined patterns of verbal responsiveness in parents of toddlers (M age = 20 months) later identified with autism (n = 121), developmental delay (n = 46), or typical development (n = 44) during an hourlong home observation. Parent verbal responsiveness (PVR) was compared using MANOVA across groups and by child expressive language phase. Multiple regression analyses controlling for child age and maternal education were employed to examine the extent to which PVR predicted variance in concurrent child social communication and prospective language skills. Parents provided synchronous responses approximately 90% of the time. Parents of children with autism and developmental delay used smaller proportions of responses that added linguistic information (i.e., expansions and follow-in directives for language) than those of children with typical development. Parents of children in the preverbal phase were more likely, on average, to affirm their children’s acts of intentional communication or provide a follow-in directive for action that did not necessitate a verbal response than to expand or elicit language. Regression results indicated that parental use of expansions and follow-in directives for language made significant contributions to child language outcomes. The patterns we observed may reflect parents’ attunement to their child’s developmental level. Responsiveness to a child’s focus of attention is vital in the earlier stages of language learning; however, results point to the potential importance of parental expansions and follow-in directives for promoting language development across groups in this sample. Directions for intervention research targeting PVR and language skills in toddlers with autism and developmental delays are discussed

Measures of early social communication and vocabulary production to predict language outcomes at two and three years in late-talking toddlers

Background: Late talkers are a heterogeneous group of toddlers and reliable predictors of persistent language delay have been elusive. The purpose of this study was to determine the extent to which early social communication and vocabulary production predicted variance in language outcomes at 2 and 3 years of age. Methods: Participants were 408 typically developing and late-talking toddlers who completed the Communication and Symbolic Behavior Scales Caregiver Questionnaire and Behavior Sample (CSBS CQ and CSBS BS) at a mean of 20 months, the Language Development Survey (LDS) at a mean of 24 months, and the Mullen Scales of Early Learning (MSEL) at a mean of 25 months. A subgroup of 198 children completed a second MSEL at 3 years of age. Associations among the LDS, CSBS CQ, CSBS BS, and MSEL were examined using correlational and hierarchical linear regression analyses. Logistic regression was used to examine each measure\u27s contribution to predicting language delay at 2 and 3 years. Results: Moderate to large correlations were observed among all variables. The LDS, CSBS CQ, and CSBS BS added unique contributions to the prediction of 2- and 3-year expressive and receptive language outcomes. Measures of speech and vocabulary production were the strongest predictors of language outcomes at age 2. At age 3, social and symbolic communication played a more significant role in accounting for variance in expressive and receptive language outcome. A similar pattern emerged for the categorical prediction of language delay. Conclusions: Measures of social communication between 18–21 months added important information to predicting language outcomes at 2 and 3 years, above and beyond parent-reported expressive vocabulary production measured at 24 months, with small effect sizes overall. Implications for identifying younger children who are at risk for continued language delay and recommendations for referral to early intervention programs are discussed

Verbal and nonverbal outcomes of toddlers with and without autism spectrum disorder, language delay, and global developmental delay

Background and Aims Children with autism spectrum disorder (ASD) exhibit a heterogeneous clinical phenotype with wide variability in their language and intellectual profiles that complicates efforts at early detection. There is limited research examining observational measures to characterize differences between young children with and without ASD and co-occurring language delay (LD) and global developmental delay (GDD). The first aim of this study was to compare early social communication measured in the second year of life in children diagnosed at age 3 with ASD, developmental delays (DD), and typical development (TD). The second aim was to compare early social communication in six subgroups of children: ASD, ASD+LD, ASD+GDD, LD, GDD, and TD. Our third aim was to determine the collective and unique contributions of early social communication to predict verbal and nonverbal developmental outcomes at three years of age for children with and without ASD. Methods Analyses of covariance controlling for maternal education were employed to examine group differences in social communication in 431 toddlers recruited through screening in primary care. Multiple linear regression analyses were conducted to evaluate associations between the Communication and Symbolic Behavior Scales (CSBS) Behavior Sample composite standard scores and Mullen Scales of Early Learning T scores for children with and without ASD. Results Distinct patterns of early social communication were evident by 20 months. Children with TD differed significantly from children with ASD and DD on all three CSBS Behavior Sample composites. Children with ASD had significantly lower scores than those with DD and TD on the social and symbolic composites. Among the six subgroups, all three composites of the CSBS Behavior Sample differentiated children with TD from all other subgroups. Children with ASD+GDD scored significantly lower than all other subgroups on social and symbolic composites. Patterns of social communication emerged for children with and without ASD, which held among subgroups divided by developmental level. The CSBS Behavior Sample social and symbolic composites contributed unique variance in predicting developmental outcomes in both groups. The speech composite contributed unique variance to expressive language, receptive language, and visual reception in children without ASD, and contributed uniquely to expressive language only for children with ASD. Conclusions The CSBS Behavior Sample, an observational measure for children aged 12–24 months, detected social communication delays and explained a significant amount of variance in verbal and nonverbal outcomes a year later in this large sample of young children grouped by ASD diagnosis and developmental level. Implications In light of the continued search for early predictors of ASD and developmental delay, our findings underscore the importance of monitoring early social communication skills, including the expression of emotions, eye gaze, gestures, rate of communication, joint attention, understanding words, and object use in play. There is a need for clinical utility of screening and evaluation tools that can detect social communication delays in very young children. This would enable intervention for infants and toddlers who show social communication delays which may be early signs for ASD or other DD, rather than waiting to confirm a formal diagnosis

sj-docx-1-aut-10.1177_13623613231223784 – Supplemental material for Feasibility of the Autism Navigator® JumpStart to Coaching in Everyday Activities course in South Africa

Supplemental material, sj-docx-1-aut-10.1177_13623613231223784 for Feasibility of the Autism Navigator® JumpStart to Coaching in Everyday Activities course in South Africa by Nola Chambers, Petrus J de Vries and Amy M Wetherby in Autism</p