Autism spectrum disorder (ASD) can now be reliably diagnosed in preverbal toddlers and early diagnosis is becoming more common since the development of early autism screening practices. However, the positive predictive value of widely used screening tools remains low, which leads to a high number of false positive cases requiring further evaluation. Given that access to specialists is limited, there is a pressing need to develop easily accessible and broadly applicable direct measures that will further streamline screening and diagnosis for at risk toddlers. The primary aim of the current study is to examine the utility of a novel, direct measure of social attribution in measuring this skill in toddlers with and without ASD and examining the utility of this measure in reliably identifying ASD in a sample of at risk toddlers with a broad range of verbal and cognitive abilities.
Participants include 35 toddlers considered at risk for an ASD (i.e., 15 with ASD, 20 with non-ASD delays; DD) and 22 typically developing (TD) toddlers. Children were presented with two versions of a nonverbal social attribution measure featuring a visual habituation-based violation of expectation paradigm; a live puppet show version previously studied in infant populations and a novel touchscreen adaptation. It was hypothesized that toddlers without a diagnosis of ASD would demonstrate evidence of social attribution whereas children with ASD would demonstrate reduced social attribution. Furthermore, it was predicted that performance would have clinical utility in predicting a diagnosis of ASD and symptom severity. Results indicated that no groups showed gross looking time differences evidencing social attribution, bringing into question whether this paradigm is appropriate for capturing social attribution in this age range. Despite this, toddlers in the TD group demonstrated evidence of social evaluation in the live puppet show task whereas toddlers within the ASD and DD groups did not. Differential habituation characteristics between the DD and TD groups suggest that other factors may have impeded success in the DD group. Future research is warranted to examine whether deficient social evaluation is specific to ASD or characterizes developmental delays more broadly. Findings have implications for future research examining theories of social attribution and informing the use of new technologies in toddler research and clinical tool development