Association of Child and Family Attributes With Outcomes in Children With Autism

Abstract

IMPORTANCEThe prevalence and attributes of positive outcomes (or doing well) among children with autism spectrum disorder (ASD) in midchildhood are not well known.OBJECTIVE To estimate the prevalence of doing well according to metrics of proficiency and growth and to investigate the extent to which significant associations exist between child-and family-level variables and doing well. DESIGN, SETTING, AND PARTICIPANTSThis longitudinal cohort study included children with ASD from regional clinics across Canada. Participants were sampled 3 times between ages 2 and 4.9 years (T1) and twice in follow-up into middle childhood (T2). Data were analyzed March 2018 through January 2020.EXPOSURES Language and IQ assessments at first sample; household income, parent coping, and family functioning. MAIN OUTCOMES AND MEASURESKey outcome domains of developmental health included measures of socialization, communication, independent living skills, and measures of internalizing and externalizing behaviors. Thresholds for doing well in these domains by either proficiency or growth were established. The extent to which language, IQ, household income, parent coping, and family functioning were associated with assessed outcomes was determined by logistic regression. The association between outcomes and concurrent Autism Diagnostic Observation Schedule (ADOS) classification scores was also estimated. RESULTS In a total cohort of 272 children (234 [86.0%] boys; mean [SD] age, 10.76 [0.26] years),approximately 78.8% (95% CI, 73.2%-84.4%) of the sample were estimated to be doing well by either metric on at least 1 domain, and 23.6% (95% CI, 17.7%-29.4%) were doing well in 4 or 5 domains. It was possible to be doing well by either proficiency or growth and still meet ADOS criteria for ASD. For the growth metric, between 61.5% (95% CI, 40.7%-79.1%) and 79.6% (95% CI, 66.0%-88.9%) of participants had ADOS scores of 4 or greater; for the proficiency metric, between 63.8% (95% CI, 48.4%-76.9%) and 75.8% (95% CI, 63.0%-85.4%) had scores of 4 or greater. Doing well by either metric for all domains was associated with T1 scores on that outcome domain (eg, T1 daily living skills associated with doing well at T2 daily living by the proficiency metric as measured by the Vineland Adaptive Behavior Scales-Second Edition daily living skills scale [202 participants]: β = 0.07; OR, 1.07; 95% CI, 1.03-1.11; P < .001). Doing well in socialization by the growth metric was also associated with better T1 language skills scores (202 participants) (β = 0.04; OR, 1.04; 95% CI, 1.00-1.07, P = .04). Doing well in externalizing by the growth metric was also associated with higher household income at T1 (178 participants) (β = 0.10; OR, 1.10; 95% CI, 1.06-1.15; P < .001). Better family functioning at T1 was associated with doing well on both socialization and externalizing by proficiency metric and on internalizing by growth metric (socialization by proficiency [202 (continued) Key Points Question How prevalent is "doing well" in 5 developmental domains (communicat...

The effects of JASPER intervention for children with autism spectrum disorder: A systematic review

“…The high proportion of proximal measures is perhaps unsurprising as JASPER is a focussed treatment, where the primary aim is to promote child learning in select areas (Odom et al, 2010). Difficulties in these areas are hypothesised to underpin much of child early social learning (Kasari et al, 2006; Szatmari et al, 2021). Thus, improvements in joint attention, joint engagement and play may enable children with autism to better learn from their environment.…”

Prognostic early snapshot stratification of autism based on adaptive functioning

“…This result indicates that early subtype stratification is possible and the resulting information can be outcome-sensitive, especially if individuals fall into the high or low subtype. For individuals falling into the early medium subtype, it may be pertinent for future work to examine what might be the predictors that nudge these individuals into better or worse outcome subtypes (e.g., influence of intervention, comorbid ADHD, executive functioning, environmental or educational influences, etc) 15,[18][19][20] . In either situation (early high or low versus medium) the information can be used in highly clinically-useful ways and be important for designed future research studies (e.g., a priori stratification in clinical trials).…”

Challenges Surrounding the Diagnosis of Autism in Children

“…Szatmari et al 160 observed in an adjunct to an ongoing Canadian longitudinal and multiregional ASD investigation (Pathways) that while studies of children with ASD tend to focus on their deficits, there is a lack in examining their positive outcomes. The researchers launched a study, using Lounds Taylor's protocol for adult ASD studies, 161 to uncover the presence and prevalence of positive outcomes or "children doing well" by middle childhood, and determine the factors associated with "doing well".…”