Abstract
The objective of this study was to identify subgroups of toddlers with DSM-5 ASD based on core ASD symptoms using a person-based analytical framework. This is a retrospective study of 500 toddlers (mean age 26 months, 79% male) with DSM-5 ASD. Data were analyzed using latent class analyses in which profiles were formed based on ASD symptomatology. Social communication (SC) symptoms favored a three-class solution, while restricted/repetitive behaviors (RRBs) favored a two-class solution. Classes with higher consistency of SC deficits were younger, with lower developmental functioning. The class with more RRBs was older, with higher functioning. If confirmed in other populations, these classes may more precisely characterize subgroups within the heterogeneous group of toddlers at time of ASD diagnosis.
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08 March 2021
A Correction to this paper has been published: https://doi.org/10.1007/s10803-021-04954-5
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D.C.: American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890423349.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596.744053.
Anderson, D. K., Liang, J. W., & Lord, C. (2014). Predicting young adult outcome among more and less cognitively able individuals with autism spectrum disorders. Journal of Child Psychology and Psychiatry, 55(5), 485–494. https://doi.org/10.1111/jcpp.12178.
Barbaresi, W. J., Katusic, S. K., Colligan, R. C., Weaver, A. L., & Jacobsen, S. J. (2005). The incidence of autism in Olmsted County, Minnesota, 1976–1997: Results from a population-based study. Archives of Pediatrics and Adolescent Medicine. https://doi.org/10.1001/archpedi.159.1.37.
Barton, M. L., Robins, D. L., Jashar, D., Brennan, L., & Fein, D. (2013). Sensitivity and specificity of proposed DSM-5 criteria for autism spectrum disorder in toddlers. Journal of Autism and Developmental Disorders, 43(5), 1184–1195. https://doi.org/10.1007/s10803-013-1817-8.
Bayley, N. (2006). Bayley Scales of infant and toddler development, third edition: Administration manual. J Psychoeduc Assess. https://doi.org/10.1177/0734282906297199.
Ben-Itzchak, E., Watson, L. R., & Zachor, D. A. (2014). Cognitive ability is associated with different outcome trajectories in autism spectrum disorders. Journal of Autism and Developmental Disorders, 44(9), 2221–2229. https://doi.org/10.1007/s10803-014-2091-0.
Bitsika, V., Sharpley, C. F., & Orapeleng, S. (2008). An exploratory analysis of the use of cognitive, adaptive and behavioural indices for cluster analysis of ASD subgroups. Journal of Intellectual Disability Research, 52(11), 973–985. https://doi.org/10.1111/j.1365-2788.2008.01123.
Bozdogan, H. (1987). Model selection and Akaike’s Information Criterion (AIC): The general theory and its analytical extensions. Psychometrika, 52, 345–370. https://doi.org/10.1007/BF02294361.
Carter, A. S., Black, D. O., Tewani, S., Connolly, C. E., Kadlec, M. B., & Tager-Flusberg, H. (2007). Sex differences in toddlers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37(1), 86–97. https://doi.org/10.1007/s10803-006-0331-7.
Charman, T., Swettenham, J., Baron-Cohen, S., Cox, A., Baird, G., & Drew, A. (1998). An experimental investigation of socialcognitive abilities in infants with autism: Clinical implications. Infant Mental Health Journal, 19(2), 260–275. https://doi.org/10.1002/(SICI)1097-0355(199822)19:2%3c260::AID-IMHJ12%3e3.0.CO;2-W.
Charman, T., Taylor, E., Drew, A., Cockerill, H., Brown, J. A., & Baird, G. (2005). Outcome at 7 years of children diagnosed with autism at age 2: Predictive validity of assessments conducted at 2 and 3 years of age and pattern of symptom change over time. Journal of Child Psychology and Psychiatry and Allied Disciplines. https://doi.org/10.1111/j.1469-7610.2004.00377.
Chawarska, K., Klin, A., Paul, R., Macari, S., & Volkmar, F. (2009). A prospective study of toddlers with ASD: Short-term diagnostic and cognitive outcomes. Journal of Child Psychology and Psychiatry and Allied Disciplines, 50(10), 1235–1245. https://doi.org/10.1111/j.1469-7610.2009.02101.
Cuccaro, M. L., Shao, Y., Grubber, J., Slifer, M., Wolpert, C. M., Donnelly, S. L., … Pericak-Vance, M. A. (2003). Factor analysis of restricted and repetitive behaviors in autism using the autism diagnostic interview-R. Child Psychiatry and Human Development, 34(1), 3–17.https://doi.org/10.1023/A:1025321707947.
Estes, A., Zwaigenbaum, L., Gu, H., St John, T., Paterson, S., Elison, J. T., … Piven, J. (2015). Behavioral, cognitive, and adaptive development in infants with autism spectrum disorder in the first 2 years of life. Journal of Neurodevelopmental Disorders, 7(1), 24.https://doi.org/10.1186/s11689-015-9117-6.
Fountain, C., Winter, A. S., & Bearman, P. S. (2012). Six developmental trajectories characterize children with autism. Pediatrics, 129(5), e1112–e1120. https://doi.org/10.1542/peds.2011-1601.
Frazier, T. W., Georgiades, S., Bishop, S. L., & Hardan, A. Y. (2014). Behavioral and cognitive characteristics of females and males with autism in the simons simplex collection. Journal of the American Academy of Child and Adolescent Psychiatry, 153(3), 329–340. https://doi.org/10.1016/j.dcn.2011.01.002.The.
Georgiades, S., Boyle, M., Szatmari, P., Hanna, S., Duku, E., Zwaigenbaum, L., … Thompson, A. (2014). Modeling the phenotypic architecture of autism symptoms from time of diagnosis to age 6. Journal of Autism and Developmental Disorders, 44(12), 3045–3055.https://doi.org/10.1007/s10803-014-2167-x.
Georgiades, S., Szatmari, P., Boyle, M., Hanna, S., Duku, E., Zwaigenbaum, L., … Thompson, A. (2013). Investigating phenotypic heterogeneity in children with autism spectrum disorder: A factor mixture modeling approach. Journal of Child Psychology and Psychiatry and Allied Disciplines, 54(2), 206–215.https://doi.org/10.1111/j.1469-7610.2012.02588.
Gibbs, V., Aldridge, F., Chandler, F., Witzlsperger, E., & Smith, K. (2012). Brief report: an exploratory study comparing diagnostic outcomes for autism spectrum disorders under DSM-IV-TR with the proposed DSM-5 revision. Journal of Autism and Developmental Disorders, 42(8), 1750–1756. https://doi.org/10.1007/s10803-012-1560-6.
Gotham, K., Pickles, A., & Lord, C. (2012). Trajectories of autism severity in children using standardized ADOS scores. Pediatrics, 130(5), 1278. https://doi.org/10.1542/peds.2011-3668.
Guthrie, W., Swineford, L. B., Nottke, C., & Wetherby, A. M. (2013). Early diagnosis of autism spectrum disorder: stability and change in clinical diagnosis and symptom presentation. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 54(5), 582–590. https://doi.org/10.1111/jcpp.12008.
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010.
Harris, S. L., & Handleman, J. S. (2000). Age and IQ at intake as predictors of placement for young children with autism: a four- to six-year follow-up. Journal of Autism and Developmental Disorders, 30(2), 137–142. https://doi.org/10.1023/a:1005459606120.
Harstad, E. B., Fogler, J., Sideridis, G., Weas, S., Mauras, C., & Barbaresi, W. J. (2015). Comparing diagnostic outcomes of autism spectrum disorder using DSM-IV-TR and DSM-5 criteria. Journal of Autism and Developmental Disorders, 45(5), 1437–1450. https://doi.org/10.1007/s10803-014-2306-4.
Jashar, D. T., Brennan, L. A., Barton, M. L., & Fein, D. (2016). Cognitive and adaptive skills in toddlers who meet criteria for autism in DSM-IV but not DSM-5. Journal of Autism and Developmental Disorders, 46(12), 3667–3677. https://doi.org/10.1007/s10803-016-2901-7.
Kang, E., Gadow, K. D., & Lerner, M. D. (2019). Atypical communication characteristics, differential diagnosis, and the autism spectrum disorder phenotype in youth. Journal of Clinical Child & Adolescent Psychology, 49(2), 1–13. https://doi.org/10.1080/15374416.2018.1539912.
Kim, H., Keifer, C., Rodriguez-Seijas, C., Eaton, N., Lerner, M., & Gadow, K. (2019). Quantifying the optimal structure of the autism phenotype: A comprehensive comparison of dimensional, categorical, and hybrid models. Journal of the American Academy of Child and Adolescent Psychiatry, 58(9), 876-886.e2. https://doi.org/10.1016/j.jaac.2018.09.431.
Kim, S. H., Bal, V. H., Benrey, N., Choi, Y. B., Guthrie, W., Colombi, C., & Lord, C. (2018). Variability in autism symptom trajectories using repeated observations from 14 to 36 months of age. Journal of the American Academy of Child and Adolescent Psychiatry, 57(11), 837–848.e2. https://doi.org/10.1016/j.jaac.2018.05.026.
Kim, S. H., Macari, S., Koller, J., & Chawarska, K. (2016). Examining the phenotypic heterogeneity of early autism spectrum disorder: Subtypes and short-term outcomes. Journal of Child Psychology and Psychiatry and Allied Disciplines, 57(1), 93–102. https://doi.org/10.1111/jcpp.12448.
Landry, S. H., & Loveland, K. A. (1988). Communication behaviors in autism and developmental language delay. Journal of Child Psychology and Psychiatry. https://doi.org/10.1111/j.1469-7610.1988.tb01884.
Lawson, L. P., Joshi, R., Barbaro, J., & Dissanayake, C. (2018). Gender differences during toddlerhood in autism spectrum disorder: A prospective community-based longitudinal follow-up study. Journal of Autism and Developmental Disorders, 48(8), 2619–2628. https://doi.org/10.1007/s10803-018-3516-y.
Long, C., Gurka, M. J., & Blackman, J. (2011). Cognitive skills of young children with and without autism spectrum disorder using the BSID-III. Autism Research and Treatment, 2011, 1–7. https://doi.org/10.1155/2011/759289.
Lord, C., Luyster, R., Guthrie, W., & Pickles, A. (2012b). Patterns of developmental trajectories in toddlers with autism spectrum disorder. Journal of Consulting and Clinical Psychology, 80(3), 477–489. https://doi.org/10.1037/a0027214.
Lord, C., & Pickles, A. (1996). Language behaviors level and nonverbal social-communicative in autistic and language-delayed children. Journal of the American Academy of Child & Adolescent Psychiatry. https://doi.org/10.1097/00004583-199611000-00024.
Lord, C., Rutter, M., DiLavore, P., Risi, S., Gotham, K., & Bishop, S. (2012a). Autism diagnostic observation schedule, second edition (ADOS-2) manual (Part I): Modules 1–4. Firenze: Giunti OS.
Mandy, W., Chilvers, R., Chowdhury, U., Salter, G., Seigal, A., & Skuse, D. (2012). Sex differences in autism spectrum disorder: Evidence from a large sample of children and adolescents. Journal of Autism and Developmental Disorders, 42(7), 1304–1313. https://doi.org/10.1007/s10803-011-1356-0.
Mandy, W. P. L., & Skuse, D. H. (2008). Research Review: What is the association between the social-communication element of autism and repetitive interests, behaviours and activities? Journal of Child Psychology and Psychiatry and Allied Disciplines, 49(8), 795–808. https://doi.org/10.1111/j.1469-7610.2008.01911.
Masyn, K. E. (2013). Latent Class analysis and finite mixture modeling. In T.D. Little (Ed.). In The oxford handbook of quantitative methods: Vol 2: Statistical Analysis: Oxford University Press. Retrieved 17 Jun. 2020, from https://www.oxfordhandbooks.com/view/https://doi.org/10.1093/oxfordhb/9780199934898.001.0001/oxfordhb-9780199934898-e-025.
McFayden, T. C., Albright, J., Muskett, A. E., & Scarpa, A. (2019). Brief report: Sex differences in ASD diagnosis—A brief report on restricted interests and repetitive behaviors. Journal of Autism and Developmental Disorders, 49(4), 1693–1699. https://doi.org/10.1007/s10803-018-3838-9.
Moulton, E., Barton, M. L., Robins, D. L., Abrams, D. N., & Fein, D. A. (2016). Early characteristics of children with ASD who demonstrate optimal progress between age two and four. Journal of Autism and Developmental Disorders, 46(6), 2160–2173. https://doi.org/10.1016/j.coviro.2015.09.001.
Munson, J., Dawson, G., Sterling, L., Beauchaine, T., Zhou, A., Koehler, E., … Abbott, R. (2008). Evidence for latent classes of IQ in young children with autism spectrum disorder. American Journal on Mental Retardation, 113(6), 439–452.https://doi.org/10.1352/2008.113:439-452.
Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007). Structural equation modeling: A multidisciplinary journal deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Structural Equation Modeling, 14(4), 535–569. https://doi.org/10.1080/10705510701575396.
Pierce, K., Gazestani, V. H., Bacon, E., Barnes, C. C., Cha, D., Nalabolu, S., … Courchesne, E. (2019). Evaluation of the diagnostic stability of the early autism spectrum disorder phenotype in the general population starting at 12 months. JAMA Pediatrics, 173(6), 578–587.https://doi.org/10.1001/jamapediatrics.2019.0624.
Richler, J., Bishop, S. L., Kleinke, J. R., & Lord, C. (2007). Restricted and repetitive behaviors in young children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37(1), 73–85. https://doi.org/10.1007/s10803-006-0332-6.
Ros‐Demarize, R., Bradley, C., Kanne, S. M., Warren, Z., Boan, A., Lajonchere, C., … Carpenter, L. A. (2020). ASD symptoms in toddlers and preschoolers: An examination of sex differences. Autism Research, 13(1), 157–166.https://doi.org/10.1002/aur.2241.
Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland-II adaptive behavior scales, second edition. San Antonio: PsychCorp.
Sparrow, S. S., & Cichetti, D. V. (2016). Vineland adaptive behavior scales, third edition (Vineland-3) manual. San Antonio: PsychCorp.
Stevens, M. C., Fein, D. A., Dunn, M., Allen, D., Waterhouse, L. H., Feinstein, C., & Rapin, I. (2000). Subgroups of children with autism by cluster analysis: A longitudinal examination. Journal of the American Academy of Child and Adolescent Psychiatry, 39(3), 346–352. https://doi.org/10.1097/00004583-200003000-00017.
Szatmari, P., Georgiades, S., Bryson, S., Zwaigenbaum, L., Roberts, W., Mahoney, W., … Tuff, L. (2006). Investigating the structure of the restricted, repetitive behaviours and interests domain of autism. Journal of Child Psychology and Psychiatry and Allied Disciplines, 47(6), 582–590.https://doi.org/10.1111/j.1469-7610.2005.01537.
Szatmari, P., Liu, X. Q., Goldberg, J., Zwaigenbaum, L., Paterson, A. D., Woodbury-Smith, M., … Thompson, A. (2012). Sex differences in repetitive stereotyped behaviors in autism: Implications for genetic liability. American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics, 159 B(1), 5–12. https://doi.org/10.1002/ajmg.b.31238.
Szatmari, P., Georgiades, S., Duku, E., Bennett, T. A., Bryson, S., Fombonne, E., … Pathways in ASD Study Team. (2015). Developmental trajectories of symptom severity and adaptive functioning in an inception cohort of preschool children with autism spectrum disorder. JAMA Psychiatry, 72(3), 276–283. https://doi.org/10.1001/jamapsychiatry.2014.2463.
Thurm, A., Farmer, C., Salzman, E., Lord, C., & Bishop, S. (2019). State of the field: Differentiating intellectual disability from autism spectrum disorder. Frontiers in Psychiatry. https://doi.org/10.3389/fpsyt.2019.00526.
Tillmann, J., Ashwood, K., Absoud, M., Bölte, S., Bonnet-Brilhault, F., Buitelaar, J. K., … Charman, T. (2018). Evaluating sex and age differences in ADI-R and ADOS scores in a large European multi-site sample of individuals with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(7), 2490–2505.https://doi.org/10.1007/s10803-018-3510-4.
Trillingsgaard, A., Sørensen, E. U., Němec, G., & Jørgensen, M. (2005). What distinguishes autism spectrum disorders from other developmental disorders before the age of four years? European Child and Adolescent Psychiatry. https://doi.org/10.1007/s00787-005-0433-3.
Ventola, P., Kleinman, J., Pandey, J., Wilson, L., Esser, E., Boorstein, H., … Fein, D. (2007). Differentiating between autism spectrum disorders and other developmental disabilities in children who failed a screening instrument for ASD. Journal of Autism and Developmental Disorders, 37(3), 425–436.https://doi.org/10.1007/s10803-006-0177-z.
Wiggins, L. D., Robins, D. L., Adamson, L. B., Bakeman, R., & Henrich, C. C. (2012). Support for a dimensional view of autism spectrum disorders in toddlers. Journal of Autism and Developmental Disorders, 42(2), 191–200. https://doi.org/10.1007/s10803-011-1230-0.
Wiggins, L. D., Tian, L. H., Levy, S. E., Rice, C., Lee, L. C., Schieve, L., … Thompson, W. (2017). Homogeneous subgroups of young children with autism improve phenotypic characterization in the study to explore early development. Journal of Autism and Developmental Disorders, 47(11), 3634–3645.https://doi.org/10.1007/s10803-017-3280-4.
Yang, S., Paynter, J. M., & Gilmore, L. (2016). Vineland adaptive behavior scales: II profile of young children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(1), 64–73. https://doi.org/10.1007/s10803-015-2543-1.
Zwaigenbaum, L., Bryson, S., & Garon, N. (2013). Early identification of autism spectrum disorders. Behavioural Brain Research, 251, 133–146. https://doi.org/10.1016/j.bbr.2013.04.004.
Acknowledgments
All phases of this study were supported by the Palmer Family Fund for Autism Research. Study data were collected and managed using REDCap electronic data capture tools hosted at Boston Children’s Hospital. REDCap (Research Electronic Data Capture) is a secure, web-based application designed to support data capture for research studies, providing: (1) an intuitive interface for validated data entry; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages; and (4) procedures for importing data from external sources. In light of the use of RedCap for this project, this publication was supported by NIH/NCRR Colorado CTSI Grant Number UL1 RR025780. Its contents are the authors’ sole responsibility and do not necessarily represent official NIH views.
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HKH, GDS, WJB, and EH contributed to the study conception and design. HKH and CL contributed to data collection. EH oversaw data collection and review. GDS performed statistical analyses. The first draft of the manuscript was written by HKH and GDS, WJB, and EH provided significant edits on subsequent revised versions of the manuscript. All authors read and approved the final manuscript.
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Harris, H.K., Lee, C., Sideridis, G.D. et al. Identifying Subgroups of Toddlers with DSM-5 Autism Spectrum Disorder Based on Core Symptoms. J Autism Dev Disord 51, 4471–4485 (2021). https://doi.org/10.1007/s10803-021-04879-z
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DOI: https://doi.org/10.1007/s10803-021-04879-z