DSM-5 symptom expression in toddlers.
Kirsty L Coulter, Marianne L Barton, Diana L Robins and 2 others
PMID 33779335WHAT IT FOUND
Caregiver reports distinguish autism from other delays in toddlers.
Repetitive behaviors and relationship deficits were most common. Insistence on sameness was rare, so two of the three remaining repetitive behavior criteria are needed for diagnosis. No single behavior is unique to autism.
Key findings
01Stereotyped/repetitive movements, object use, and speech were endorsed in 97% of children with ASD, compared to 42% of those with other developmental disorders and 44% of those with typical development/no diagnosis.
02Insistence on sameness was the least frequently endorsed symptom, appearing in only 36% of the ASD group, and its presence was associated with an average age of 23.7 months versus 20.5 months when absent.
03For deficits in social-emotional reciprocity, requiring two behaviors rather than one improved discrimination, yielding endorsement in 82% of ASD, 60% of DD, and 22% of TD/ND groups.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The ASD group had significantly lower cognitive abilities than the other groups, so some behavioral differences may be due to cognitive level rather than autism specifically. The sample was not large enough to analyze results for Black and other minority children separately, and white children were disproportionately found in the typical development group. The 'typical development' group included children with mild delays who did not meet full diagnostic criteria, so it does not represent a truly unaffected population. The same clinicians administered the TASI and made the final diagnosis, which could introduce bias.
Declared interests
Drs. Robins, Barton, and Fein are co-owners of M-CHAT LLC, which licenses the M-CHAT and related tools like the TASI. Dr. Robins also sits on the advisory board of Quadrant Biosciences Inc.
The easy way to misread this
Do not assume that the presence of repetitive behaviors or social deficits confirms autism. The study found that all behaviors were endorsed by some children in the non-ASD groups, and no single behavior is pathognomonic. Diagnosis requires looking at the whole picture, including the frequency and clustering of symptoms, not just their presence.