Brief Report: Symptom Onset Patterns and Functional Outcomes in Young Children with Autism Spectrum Disorders

Pediatrics and Developmental Neuroscience Branch, National Institute of Mental Health, Bethesda, MD 20892-1255, USA.
Journal of Autism and Developmental Disorders (Impact Factor: 3.06). 03/2011; 41(12):1727-32. DOI: 10.1007/s10803-011-1203-3
Source: PubMed


This study examined the relationship between onset status and current functioning using a recently proposed onset classification system in 272 young children with autism spectrum disorder (ASD). Participants were classified into one of the following groups, based on parent report using the Autism Diagnostic Interview--Revised: Early Onset (symptoms by 12 months, no loss), Delay + Regression (symptoms by 12 months plus loss), Plateau (no early symptoms or loss), and Regression (no early symptoms, followed by loss). Findings indicate that current functioning does not differ according to onset pattern, calling into question the use of onset categorizations for prognostic purposes in children with ASD.

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    • "Ozonoff et al. [32] identified three patterns of onset of ASD: early onset, regression, and plateau. More research is needed, bearing in mind that symptom emergence can be considered as a continuum of many phenotypes containing different characteristics and varying in severity [5,32,33]. "
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    ABSTRACT: Background Little is known about the stability of behavioural and developmental problems as children develop from infants to toddlers in the general population. Therefore, we investigated behavioural profiles at two time points and determined whether behaviours are stable during early development. Methods Parents of 4,237 children completed questionnaires with 62 items about externalizing, internalizing, and social-communicative behaviour when the children were 14–15 and 36–37 months old. Factor mixture modelling identified five homogeneous profiles at both time points: three with relatively normal behaviour or with mild/moderate problems, one with clear communication and interaction problems, and another with pronounced negative and demanding behaviour. Results More than 85% of infants with normal behaviour or mild problems at 14–15 months were reported to behave relatively typically as toddlers at 36–37 months. A similar percentage of infants with moderate communication problems outgrew their problems by the time they were toddlers. However, infants with severe problems had mild to severe problems as toddlers, and did not show completely normal behaviour. Improvement over time occurred more often in children with negative and demanding behaviour than in children with communication and interaction problems. The former showed less homotypic continuity than the latter. Conclusions Negative and demanding behaviour is more often transient and a less specific predictor of problems in toddlerhood than communication and interaction problems.
    Child and Adolescent Psychiatry and Mental Health 07/2014; 8(1):19. DOI:10.1186/1753-2000-8-19
    • "It is not clear why such discrepant findings have been observed across studies comparing outcomes between regression and non-regression groups. One explanation could be that the potentially deleterious effects of skill losses are less obvious at earlier ages and become more pronounced over time, as the studies that consistently found few or no differences across groups were those who had the youngest samples (i.e., Hansen et al., 2008; Lord et al., 2004; Schumway et al., 2011; Werner et al., 2005a; Werner, Dawson, Munson, & Osterling, 2005b). However, this does not explain why some studies note differences across virtually all parameters of functioning and others, only a few. "
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    ABSTRACT: Studies using varied methods report that developmental regression occurs in a sizeable proportion of children with autism spectrum disorder (ASD). Findings are equivocal as to whether regression is associated with poorer cognitive and adaptive functioning. This study examined retrospective parent report in 2105 Simons Simplex Collection participants with ASD. Children were classified as having “full” or “subthreshold” losses on language and/or other skills using items from the Autism Diagnostic Interview-Revised (ADI-R) and a supplemental interview to capture more subtle regressions. Overall, 36.9% of children had some type of regression (27.8% language, 27.0% other-skill loss), with the supplemental interview capturing 11.7% of losses that would have been missed using the ADI-R alone. This figure is consistent with previous parent-report studies but lower than clinician-observed rates in prospective investigations. Early language losses—either full or subthreshold—and full other-skill losses appear to be associated with more deleterious outcomes by middle childhood. Findings may signify the need for more immediate and/or intense therapies for children who have even minor skill losses, particularly in language skills. Results further demonstrate the utility of an expanded set of additional queries with slightly modified criteria to capture such early, subtle losses.
    Research in Autism Spectrum Disorders 07/2014; 8(7):890–898. DOI:10.1016/j.rasd.2014.04.002 · 2.96 Impact Factor
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    • "However, the M:F ratio has not been specifically examined in the subpopulation of ASD and epilepsy. Furthermore , previous studies have not described M:F ratio differences in ASD with developmental regression [Parr et al., 2011; Shumway et al., 2011]. As ASD occurs more frequently in males, we hypothesized that the relatively small group of females with ASD may have a different clinical expression than males. "
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    ABSTRACT: Autism spectrum disorder (ASD) is a heritable disorder occurring predominantly in males. The aim of this study was to compare sex differences in the prevalence of specific neurological phenotypes commonly described in ASD. The study included 663 participants, aged 18 months to 15 years, diagnosed with ASD. Neurological and behavioral assessments were performed using standardized tests, and obtaining medical, developmental, and familial histories from the parents. Phenotypes under investigation were macro- and microcephaly, developmental regression, minor neurological and musculoskeletal deficits (MNMD), and seizures. Male : female ratio in the ASD group was 6.7:1. No sex differences in autism severity, cognitive ability, and adaptive functioning were noted. Mean head circumference percentile for males (50.1 ± 25.6) was significantly larger than females (43.4 ± 30.2). Micro- and macrocephaly were more frequent in ASD than expected (5.9%; 18.1%, respectively). Microcephaly in females (15.1%) was significantly more prevalent than in males (4.5%). The prevalence of macrocephaly in both sexes did not differ significantly. Regression was noted in 30.2% of the females with ASD, significantly higher than in males (18.9%). MNMD was documented in 73.8% of the females, significantly higher than in males (57.1%). M:F ratio decreased in a group with two or more phenotypes (3.6:1), while male predominance was more significant in the group without phenotypes (13.6:1). Neurological phenotypes associated with ASD are more prevalent in females than in males, resulting in more complex clinical and neurological manifestations in females. Therefore, involvement of different etiologies is suggested in ASD in females. Autism Res 2013, ●●: ●●-●●. © 2013 International Society for Autism Research, Wiley Periodicals, Inc.
    Autism Research 12/2013; 6(6). DOI:10.1002/aur.1319 · 4.33 Impact Factor
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