Establishing New Norms for Developmental Milestones

Sheldrick, R. Christopher; Schlichting, Lauren E.; Berger, Blythe; Clyne, Ailis; Ni, Ping; Perrin, Ellen C.; Vivier, Patrick M.

doi:10.1542/peds.2019-0374

Cited by 38 publications

(44 citation statements)

References 46 publications

(35 reference statements)

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“…The finding that age of first concern, which were later in females, predicted age of diagnosis further supports the need for more awareness and targeted screening for females, especially those who are verbal. Our findings, together with previous research [McCormick et al, 2020], can help inform prospective screening practices and suggest that screening criteria might need to be modified to identify verbal females who may not get “flagged” as early if their language is not as delayed as males or developing in line with CDC milestones [Sheldrick et al, 2019].…”

Section: Discussionsupporting

confidence: 59%

“…Differences in language milestones reported between NT males and females appear to be mirrored in ASD. However, while females with ASD may have an advantage over males with ASD, their language milestones are still delayed compared to NT populations with the average age of first word in children with NT outcomes reported around 12 months of age [Darley & Winitz, 1961; Nelson, 1981; Sheldrick et al, 2019]. In the current sample, while age of first word and age of first three‐word phrase did not predict age of first concerns or age at diagnosis, these results are consistent with recent population‐based findings suggesting that ASD females with more advanced language abilities are diagnosed later than ASD males [McCormick et al, 2020].…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, other studies have suggested this advantage is weighted toward males [Reinisch, Rosenblum, Rubin, & Schulsinger, 1991]. In two recent studies, females were reported as meeting milestones before males; Sheldrick, Schlichting, and Berger [2019] reported sex effects across early developmental milestones from over 41,000 infants, however cautioned against assuming females develop at a more rapid rate than males. Ertem et al [2018] reported equivalence for 96% of milestones across 4949 males and females.…”

Section: Introductionmentioning

confidence: 99%

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Do Biological Sex and Early Developmental Milestones Predict the Age of First Concerns and Eventual Diagnosis in Autism Spectrum Disorder?

et al. 2020

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, and the GENDAAR Consortium Despite advances in early detection, the average age of autism spectrum disorder (ASD) diagnosis exceeds 4 years and is often later in females. In typical development, biological sex predicts inter-individual variation across multiple developmental milestones, with females often exhibiting earlier progression. The goal of this study was to examine sex differences in caregiver-reported developmental milestones (first word, phrase, walking) and their contribution to timing of initial concerns expressed by caregivers and eventual age of diagnosis. 195 (105 males) children and adolescents aged 8 to 17 years with a clinical diagnosis of ASD were recruited to the study (mean IQ = 99.76). While developmental milestones did not predict timing of diagnosis or age parents first expressed concerns, females had earlier first words and phrases than males. There was a marginal difference in the age of diagnosis, with females receiving their diagnosis 1 year later than males. Despite sex differences in developmental milestones and diagnostic variables, IQ was the most significant predictor in the timing of initial concerns and eventual diagnosis, suggesting children with lower IQ, regardless of sex, are identified and diagnosed earlier. Overall, biological sex and developmental milestones did not account for a large proportion of variance for the eventual age of ASD diagnosis, suggesting other factors (such as IQ and the timing of initial concerns) are potentially more influential.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Do Biological Sex and Early Developmental Milestones Predict the Age of First Concerns and Eventual Diagnosis in Autism Spectrum Disorder?

et al. 2020

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“…The copyright holder for this preprint this version posted April 10, 2021. ; https://doi.org/10.1101/2021.04.07.21254183 doi: medRxiv preprint DEVELOPMENTAL MILESTONES 7 developmental milestones of interest. The minimum age was selected because normative acquisition of the milestones considered in these analyses occurs before the age of 3 years (Centers for Disease Control, June 10, 2020; Sheldrick et al, 2019;World Health Organization, 2006). This allowed for the interpretation of milestones which were reportedly "not yet achieved" as "delayed.…”

Section: Sample Selectionmentioning

confidence: 99%

Milestone Development in Genetic Conditions from SFARI Registries

Wickstrom

Farmer

et al. 2021

Preprint

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Background: Several recent initiatives have sought to better understand characteristic behaviors of rare genetic conditions associated with autism spectrum disorder (ASD). The onset of developmentally expected skills, such as walking and talking, serve as readily quantifiable aspects of the behavioral phenotype. The goals of this study were to describe attainment of major motor and language milestones in genetic conditions implicated in the etiology of ASD and other neurodevelopmental disorders and to compare those phenotypes to idiopathic ASD. Methods: Participants ages 3 years and older were drawn from two Simons Foundation Autism Research Initiative-funded registries with consistent phenotyping protocols. Inclusion criteria consisted of a confirmed genetic diagnosis for one of 16 specific genetic conditions (Simons Searchlight), and absence of pathogenic genetic findings in idiopathic ASD controls (SPARK). Parent-reported age of acquisition of three motor and two language milestones was described and quantified as on-time or delayed relative to normative expectations. Results: Delay was more common among participants with rare genetic conditions than idiopathic ASD for all milestones. Compared to the idiopathic ASD group, the median odds of delay among the genetic groups were 8.3 times (IQR 5.8-16.3) higher for sitting, 12.4 times (IQR 5.3-19.5) higher for crawling, 26.8 times (IQR 7.7-41.1) higher for walking, 2.7 times (IQR 1.7-5.5) higher for single words, and 5.7 times (IQR 2.8-18.3) higher for combined words. Conclusion: Delays in major developmental milestones, particularly in motor skills, may be among the earliest clues that developmental processes may be differentially affected in specific genetically defined conditions versus a behaviorally defined disorder such as idiopathic ASD.

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“…Finally, there is the issue of broad-band versus narrowband screening tests and questionnaires. Broad-band instruments such as the Survey of Well Being of Young Children (Sheldrick et al, 2019) that measures milestones, socialemotional function, ASD, and family risk factors, or the Developmental Indicators for the Assessment of Learning (4th ed. ; Mardell & Goldenberg, 2011) are useful when the referral reason is more general because they can pinpoint previously unidentified areas of concern.…”

Section: Problems In Test Selection and Interpretationmentioning

confidence: 99%

Conducting a Developmental Assessment in Young Children

Aylward¹

2020

J Health Serv Psychol

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Developmental assessment of infants and toddlers presents a host of clinical challenges, many of which are unique to this age range. These include determining whether the child has a delay or a deficit, selecting the proper assessment tools, and accurately interpreting the findings. This process has four components: administration of structured items, direct observations, caregiver report, and history. Clinical Vignette Jenny is a 2-year, 1-month-old toddler whose parents report continuing concerns about her development. Her pediatrician has responded with a request for a detailed developmental assessment. Language is a major area of worry, although motor skills are delayed, and Jenny is described as "clumsy." Jenny was born at 25 weeks gestational age. She spent her first 130 days after birth in the hospital. She had numerous health issues, including respiratory distress syndrome, intraventricular hemorrhage (IVH) Grade IV, and bronchopulmonary dysplasia (BPD). Jenny had Apgar scores of 3, 5, and 7 at 1, 5, and 10 minutes, respectively. An early intervention specialist screened Jenny at 18 months but found her to be ineligible for services because the magnitude of delay was not enough to warrant intervention. Sharing the parents' concerns, the pediatrician is now asking for more detailed assessment, observation, and measurement of the toddler's current functioning and development. What tests should you give to obtain critical information regarding Jenny's developmental status? Will the test findings provide insight with regard to what interventions are needed? What developmental problems might you expect, given Jenny's medical history? Clinical Challenges Prevalence of Developmental Problems Approximately 15% of the pediatric population has developmental problems. Of this subset, 45% have speech or language issues, 38% display developmental delay in other domains such as motor or adaptive skills, and 17% have autism or other disabilities (Feldman, 2020).

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Establishing New Norms for Developmental Milestones

Cited by 38 publications

References 46 publications

Do Biological Sex and Early Developmental Milestones Predict the Age of First Concerns and Eventual Diagnosis in Autism Spectrum Disorder?

Do Biological Sex and Early Developmental Milestones Predict the Age of First Concerns and Eventual Diagnosis in Autism Spectrum Disorder?

Milestone Development in Genetic Conditions from SFARI Registries

Conducting a Developmental Assessment in Young Children

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