Onset patterns in autism: Variation across informants, methods, and timing.
Sally Ozonoff, Devon Gangi, Elise P Hanzel and 7 others
PMID 29524310WHAT IT FOUND
Infants later diagnosed with autism had early social behaviors that decreased over time.
Parents captured this when rating current behavior, but often did not label it as skill loss in yes-or-no questions.
Key findings
01For children later diagnosed with ASD, examiner and parent prospective ratings showed declining social engagement from 6 months, while non-ASD groups were stable or increased.
02Within the 32 children with ASD, examiner trajectory analysis classified 28 as initially high social engagement that declined over time; parent ratings classified 22 as showing decline.
03Parents who prospectively rated declining current behavior often did not report skill loss when asked yes-or-no or later.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Only 32 children were later classified as ASD, so the within-group trajectory estimates are small. The sample was enriched for children with an older sibling with autism, so findings may not apply to children without that family history. The paper did not describe blinding of examiners or parents, and no gold standard for onset type was used. Many children were not seen at all seven visits; only 36% were seen at all seven ages. One child was missing from the retrospective ADI-R comparison. The study was observational and did not test whether intervention during decline changes outcomes.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that yes-or-no questions about skill loss reliably identify children who are declining. Parents often rated current social behaviors as declining but did not report loss when asked yes-or-no or later.