Recognising autism: a latent transition analysis of parental reports of child autistic spectrum disorder ‘red flag’ traits before and after age 3

Abstract

Purpose It has been proposed that parents should be educated about child autistic spectrum disorder (ASD) 'red flag' traits to help professionals identify and address concerning behaviours as early as possible. This study aimed to empirically demonstrate that established/recognised 'red flag' traits in the first 3 years of life would reliably predict ASD risk severity in later childhood, associated with established ASD risk correlates and mirroring functioning diagnostic categories. Methods Using retrospective parental report data from the Mental Health of Children and Young People in Great Britain survey (N = 7977), latent class analysis (LCA) and a quasi-latent transition analysis were used to (1) identify profiles of variation in parent reports of child 'red flag' traits before and after age 3 and (2) model transitions in risk from 3 years and below to ≥ 3 years, respectively, per the 'optimal outcome' model. Results Three distinct classes, each characterised by variation in parent 'red flag' trait reporting were identified for the '≤ 3 years of age' and the '≥ 3 years of age' data. Both LCA class profiles comprised groups of children characterised by low, medium and high ASD risk. Dose-response effects for a number of recognised ASD correlates across the low, moderate and high risk '≥ 3 years of age' classes seemed to validate older classes in terms of ASD relevance. Over 54% of children characterised by the highest levels of ASD 'red flag' trait probability at 3 years and below (2% of sample), also populated the high-risk class evidenced in the '≥ 3 years of age' LCA. Conclusions Retrospective parental reports of child ASD 'red flag' traits ≤ 3 years of age were reliable indicators of ASD risk in later childhood.

Autism Spectrum Disorders in Greece: Nationwide Prevalence in 10–11 Year-Old Children and Regional Disparities

“…The proportion of diagnoses made up to and including the third year was particularly low in our population (3.8%); at this stage the prevalence was only 0.04%, increasing to 0.20% the following year and 0.49% in the fifth year. We agree with previous authors that low prevalence at young ages might be related to a number of factors: low parental concern related to poor recognition of behavioral or communication challenges [ 19 , 83 ]; limited access to medical evaluation or awareness about early intervention services; developmental deviations raising concern for unidentified ASD or delayed referral if identified; low awareness of physicians regarding ASD presentation at early ages, or potential reluctance to diagnose a young child as autistic in order to avoid perceived stigmatization [ 12 , 82 , 84 ]. In Greece, many infants and toddlers are followed regularly by a pediatrician who monitors the development of the child and the acquisition of developmental milestones in the first years of life.…”

Ten frequently asked questions about latent transition analysis.

“…Another extension would be to use retrospective data in an LTA. Spikol et al (2019) used retrospective parents’ report data on their child’s autism-related behaviors prior to age 3 and postage 3 in what they called a “quasi-LTA” (p. 709) to examine how parent reports may predict autism behavior in later childhood.…”

Can pictorial narration offer a solution to teacher training on the effective inclusion of students with autism spectrum disorder in low-resource settings? Investigation on knowledge and stigma change

“…The extent to which the behavioral expression of the neurobiological characteristics of ASD is interpreted can vary across cultures. For example, in Western cultures, speech delay and the lack of socialization are typically associated with initial concerns of ASD by parents and caretakers (Spikol et al, 2019). However, speech delay is less seen as an indication of a development concern in cultures that value behavioral compliance in young children, such as in Indian, Korean, or Chinese communities (Daley, 2004;Donohue et al, 2019;Kim, 2012; see La Roche et al, 2018 for a review).…”