PTOTCohortThe American journal of occupational therapy : official publication of the American Occupational Therapy Association2024

Early Play Behaviors of Infants at Elevated Likelihood for Autism Spectrum Disorder.

Joanne E Flanagan, Barbara B Demchick, Rebecca Landa and 2 others

PMID 38768096

WHAT IT FOUND

Six-month-old infants later diagnosed with autism had lower overall play scores than those who were not.

Atypical movement patterns did not differ between the groups, though asymmetrical reflexes were seen in more infants with autism. This pilot suggests play quality may offer early clues.

Key findings

01Total play scores at 6 months were significantly lower for infants later diagnosed with ASD compared to those without a later ASD diagnosis.

02The presence of atypical positions at 6 months did not significantly differ between infants in the ASD group and infants in the non-ASD groups.

03A higher percentage of infants in the ASD group displayed asymmetrical tonic neck reflex (ATNR) positions compared to the non-ASD groups, despite the overall atypical positions measure showing no significant difference.

STILL TO COME

How it was doneWhat they foundWhat it means for PTsWhat it means for OTs

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What it does not show

The sample size was very small, particularly the number of infants later diagnosed with ASD (12), which limits the reliability of the findings. The study was a pilot, so it is not powered to detect small differences or establish definitive predictive validity. Videos were coded from a standardized clinical setting, which may not reflect how infants play in natural home environments. The Revised Knox Preschool Play Scale had not been previously validated for identifying ASD risk in infants at elevated likelihood. Some data was missing for a few infants due to poor video quality, and the analysis did not impute these values.

Declared interests

The authors declared no conflicts of interest. The study was part of a larger federally funded longitudinal study.

The easy way to misread this

Do not assume that atypical movement patterns are a reliable early marker for ASD based on this study, as the overall measure of atypical positions showed no significant difference between groups. The specific finding of increased ATNR in the ASD group was not the primary outcome and needs confirmation in larger studies.

Read it on PubMed →