How Early Do Parent Concerns Predict Later Autism Diagnosis?

Abstract

Objective-To study the relationship between parent concerns about development in the first year and a half of life and later autism diagnostic outcomes.Method-Parent concerns about development were collected for infants at high and low risk for autism, using a prospective, longitudinal design. Parents were asked about developmental concerns at study intake and when their infant was 6, 12, and 18 months. Infants were then followed up until 36 months, when diagnostic status was determined.Results-By the time their child was 12 months, parents who have an older child with autism reported significantly more concerns in autism spectrum disorders-related areas than parents of children with typical outcomes. These concerns were significantly related to independent measures of developmental status and autism symptoms and helped predict which infants would later be diagnosed with autism or autism spectrum disorders. At 6 months, however, the concerns of parents who have an older child with autism do not predict outcome well.Conclusion-Explicitly probing for parent concerns about development is useful for identifying children in need of closer monitoring and surveillance, as recommended by the American Academy of Pediatrics.A fundamental component of pediatric practice is parent appraisal of child development. 1 Developmental history taking, including elicitation of parental concerns, is standard in most routine pediatric visits and is used to alert physicians to the possibility of conditions requiring further evaluation. As the incidence of and media attention to autism spectrum disorders (ASD) increase, concerns about the possibility of these conditions are increasingly being raised by parents. 2 Recently published guidelines from the American Academy of Pediatrics recommend that pediatricians ask parents about developmental concerns at each well-child visit and screen all children for autism twice by the second birthday. 3 If concerns are identified by parents, the American Academy of Pediatrics' surveillance and screening algorithm 3 recommends that an autism-specific screener should be administered and/or the child should be referred for a diagnostic evaluation, depending on the level of concern. Thus, parent report alone can trigger a referral for further evaluation.Retrospective studies indicate that parents recognize signs of autism far earlier than it is diagnosed. Although symptoms are typically present by the second birthday and one third of suggesting that it might be useful to screen for ASD as well. This finding was not replicated in a study screening 18-to 30-month old infants in primary care settings, 15 however, leading these authors to suggest that ASD-specific tools will be needed in the universal screening process. NIH Public AccessHowever, the importance of assessing the accuracy of parent reports of early development and their predictive validity for identifying autism is complicated in several ways. Several studies suggest that signs of autism emerge gradually over time and that the earlies...

What can autism teach us about the role of sensorimotor systems in higher cognition? New clues from studies on language, action semantics, and abstract emotional concept processing

“…Some studies do not detect movement deficits at all (Zwaigenbaum et al, 2005: these authors use an insensitive measure which does interestingly reveal motor deficits in another baby sibs study [Brian et al, 2008]), whereas some studies find differences in one motor battery but not another (Toth, Dawson, Meltzoff, Greenson, & Fein, 2007). Studies which investigate parental concerns corroborate the variation in findings: where some report that parents of infants who are later diagnosed as autistic express significantly more concerns about movement problems from 6 to 24 months than do parents of HR-TD infants (Sacrey et al, 2015), others classify motor skills among more general concerns (e.g., eating and sleeping problems) and in comparison with specific social autistic symptoms, find them less discriminatory between groups (Ozonoff et al, 2009). Lebarton and Iverson (2013) found parents to report significant manual and oral motor delays at 12 and 18 months in HR compared with LR infants, but again reported substantial variation between infants.…”

Recurrence Risk for Autism Spectrum Disorders: A Baby Siblings Research Consortium Study

“…Overselection of infants with preexisting developmental delays was minimized in the present investigation by the early age at enrollment, with two-thirds of the sample recruited before the age of 6 months, when behavioral signs and parent concerns of ASD are rare. 17,[23][24][25][26] That there were no effects of age at enrollment on rates of ASD outcomes suggests that overselection was not a significant bias in the present study.…”

“…15,16 Parents who already have an affected child may focus more attention on the new infant's development, 17 which may increase the probability of both truepositive and false-positive identification. Samples may be more or less biased by the strictness of the inclusion criteria, the age of participant enrollment, and diagnostic methods.…”

Self-Presentation and the Role of Perspective Taking and Social Motivation in Autism Spectrum Disorder

“…Even though parent reports of children's behavior are generally reliable (e.g., Dirks and Boyle 2010), meaningful (Verhulst et al 1994) and diagnostically relevant (Ozonoff et al 2009), it may be difficult for parents to report on the internal motives of their child. Future studies on the role of children's social motivation in self-presentation or reputation management should therefore ideally include both broad and narrow operationalizations of social motivation and different informants (parent and child) or methods (experiment and questionnaires).…”