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Can Parents’ Concerns Predict Autism Spectrum Disorder? A Prospective Study of High-Risk Siblings From 6 to 36 Months of Age

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Objective

This prospective study characterized parents’ concerns about infants at high risk for developing autism spectrum disorder (ASD; each with an older sibling with ASD) at multiple time points in the first 2 years, and assessed their relation to diagnostic outcome at 3 years.

Method

Parents of low-risk controls (LR) and high-risk infant siblings (HR) reported any concerns that they had regarding their children’s development between 6 and 24 months of age regarding sleep, diet, sensory behavior, gross/fine motor skills, repetitive movements, communication, communication regression, social skills, play, and behavioral problems, using a parent concern form designed for this study. At 3 years of age, an independent, gold-standard diagnostic assessment for ASD was conducted for all participants.

Results

As predicted, parents of HR children who received an ASD diagnosis reported more concerns than parents of LR and HR children who did not have ASD. The total number of concerns predicted a subsequent diagnosis of ASD as early as 12 months within the HR group. Concerns regarding sensory behavior and motor development predicted a subsequent diagnosis of ASD as early as 6 months, whereas concerns about social communication and repetitive behaviors did not predict diagnosis of ASD until after 12 months.

Conclusion

Parent-reported concerns can improve earlier recognition of ASD in HR children.

Section snippets

Study Participants

Parent concerns were analyzed in respect to infants at HR and LR who were participating in a longitudinal study of early behavioral markers of ASD at 1 of 4 sites in Canada (Glenrose Rehabilitation Hospital in Edmonton, Alberta; Holland Bloorview Kids Rehab in Toronto, Ontario; Offord Centre for Child Studies in Hamilton, Ontario; IWK Health Centre in Halifax, Nova Scotia).20 All infants were enrolled between 6 and 12 months and underwent comprehensive assessment of their cognitive,

Participant Characteristics by Outcome Group

Participant characteristics are presented in Table 1. Three groups based on 3-year diagnostic outcomes were compared: 69 LR (31 boys); 106 HR-N (55 boys); and 62 HR-ASD (48 boys). There was a group difference for sex, with fewer girls in the HR-ASD group compared to HR-N and LR groups (F2,218 = 5.3, p = .006). There was a group difference for exact age at 6 months (F2,136 = 3.3, p =.04), with HR-N (mean ± SD = 6.27 ± 0.35 months) being younger than LR (mean ± SD = 6.46 ± 0.37 months), but

Discussion

This study provides the most detailed description of prospectively examined parental concerns to date, comparing rates of concerns in multiple domains in infants at LR and HR for ASD from 6 to 24 months. Overall, parents of children with ASD recognize very early developmental differences in their later-born infants who develop ASD that distinguish them from other infants. Notably, the relative rates of types of concerns reported over time were remarkably similar across risk and outcome groups,

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  • Cited by (0)

    Clinical guidance is available at the end of this article.

    This study was supported by the Canadian Institutes of Health Research (CIHR), Alberta Innovates: Health Solutions (AI-HS), Stollery Children’s Hospital Foundation, and Neuro-DevNet.

    Dr. Vaillancourt served as the statistical expert for this research.

    Disclosure: Dr. Zwaigenbaum was a site principal investigator on a biomarker study funded by SynapDx, receiving operating funds but no honoraria or other financial benefits from this role. Dr. Szatmari has received royalties from Guilford Press. Drs. Sacrey, Bryson, Brian, Smith, Roberts, Roncadin, Garon, Vaillancourt, and Armstrong, Mr. Novak, Ms. McCormick, Ms. MacKinnon, and Ms. Jilderda report no biomedical financial interests or potential conflicts of interest.

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