Trajectories of Autism Severity in Children Using Standardized ADOS Scores

University of Michigan Autism and Communication Disorders Center, Ann Arbor, Michigan
PEDIATRICS (Impact Factor: 5.47). 10/2012; 130(5). DOI: 10.1542/peds.2011-3668
Source: PubMed


To plot longitudinal trajectories of autism spectrum disorder (ASD) severity from early childhood to early adolescence. In line with reported trajectories in toddlers, we hypothesize that a substantial minority of children will show marked changes in ASD severity over time, with "Improvers" demonstrating the highest mean baseline and rate of growth in verbal IQ (VIQ).

Patients included 345 clinic referrals and research participants with best-estimate clinical diagnoses of ASD at 1 or more time points, and repeated Autism Diagnostic Observation Schedule (ADOS), VIQ, and nonverbal IQ scores. Standardized ADOS severity scores were applied to 1026 assessments collected longitudinally between the ages of 2 and 15 (VIQ at most recent assessment: mean = 58, SD = 35). Scores were fitted for latent severity trajectory classes with and without covariates. Adaptive behavior and VIQ trajectories over time were modeled within each of the best-fit latent classes.

A 4-class model best represented the observed data. Over 80% of participants were assigned to persistent (stable) high or moderately severe classes; 2 small classes respectively increased or decreased in severity over time. Age, gender, race, and nonverbal IQ did not predict class membership; VIQ was a significant predictor. Baseline VIQ was highest in the improving and worsening classes; it increased at the greatest rate in the improving class. Adaptive behavior declined in all but the improving class, with consistent impairment in all classes.

If replicated, identified trajectory classes of ADOS severity may contribute to clinical prognosis and to subtyping samples for neurobiological and genetic research.

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    • "In contrast, ASD Good shows steady age-appropriate progress and slight improvement in language ability over time. These results are well aligned with other clinical studies looking at a much larger age range that show that > 50% of ASD individuals have poor long-term language outcomes, while the remaining individuals have better longterm language outcomes (Anderson et al., 2007; Gotham et al., 2012; Pickles et al., 2014). "
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    ABSTRACT: Autism (ASD) is vastly heterogeneous, particularly in early language development. While ASD language trajectories in the first years of life are highly unstable, by early childhood these trajectories stabilize and are predictive of longer-term outcome. Early neural substrates that predict/precede such outcomes are largely unknown, but could have considerable translational and clinical impact. Pre-diagnosis fMRI response to speech in ASD toddlers with relatively good language outcome was highly similar to non-ASD comparison groups and robustly recruited language-sensitive superior temporal cortices. In contrast, language-sensitive superior temporal cortices were hypoactive in ASD toddlers with poor language outcome. Brain-behavioral relationships were atypically reversed in ASD, and a multimodal combination of pre-diagnostic clinical behavioral measures and speech-related fMRI response showed the most promise as an ASD prognosis classifier. Thus, before ASD diagnoses and outcome become clinically clear, distinct functional neuroimaging phenotypes are already present that can shed insight on an ASD toddler's later outcome. VIDEO ABSTRACT. Copyright © 2015 Elsevier Inc. All rights reserved.
    Neuron 04/2015; 86(2). DOI:10.1016/j.neuron.2015.03.023 · 15.05 Impact Factor
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    • ", 2013 ) , it is consistent with recent studies that suggest that in high functioning individuals the core symptoms of autism can diminish over time to the extent that they are no longer detectable ( Fein et al . , 2013 ; Gotham , Pickles , & Lord , 2012 ) . "
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