Diagnostic Stability in Very Young Children with Autism Spectrum Disorders

Department of Psychology, University of Connecticut, 406 Babbidge Rd., Storrs, CT 06269-1020, USA.
Journal of Autism and Developmental Disorders (Impact Factor: 3.34). 05/2008; 38(4):606-15. DOI: 10.1007/s10803-007-0427-8
Source: PubMed


Autism Spectrum Disorders (ASD) diagnosis in very young children may be delayed due to doubts about validity. In this study, 77 children received a diagnostic and developmental evaluation between 16 and 35 months and also between 42 and 82 months. Diagnoses based on clinical judgment, Childhood Autism Rating Scale, and the Autism Diagnostic Observation Schedule were stable over time. Diagnoses made using the Autism Diagnostic Interview were slightly less stable. According to clinical judgment, 15 children (19%) moved off the autism spectrum by the second evaluation; none moved onto the spectrum. Results indicate diagnostic stability at acceptable levels for diagnoses made at age 2. Movement off the spectrum may reflect true improvement based on maturation, intervention, or over-diagnosis at age 2.

Download full-text


Available from: Juhi Pandey,
  • Source
    • "These classifications and sub-classifications are not available when children with ASD are classified using clinician judgment, diagnostic criteria, or one diagnostic instrument alone. We found that 16.9 % of children with a previous ASD diagnosis did not meet SEED criteria for an ASD, which could suggest improvement in symptoms or challenges with ASD assessment and diagnosis at young ages (Lord et al. 2006; Kleinman et al. 2008; Sutera et al. 2007; Turner et al. 2006; Wiggins et al. 2012). Conversely, we found many children met SEED criteria for an ASD or had ASD symptoms noted on the SCQ, ADOS, and/or ADI-R despite the fact they had not been recognized as having an ASD in community settings. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The Study to Explore Early Development (SEED) is a multi-site case-control study designed to explore the relationship between autism spectrum disorder (ASD) phenotypes and etiologies. The goals of this paper are to (1) describe the SEED algorithm that uses the Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS) to classify children with ASD, (2) examine psychometric properties of different ASD classification methods, including the SEED method that incorporates rules for resolving ADI-R and ADOS discordance, and (3) determine whether restricted interests and repetitive behaviors were noted for children who had instrument discordance resolved using ADI-R social and communication scores. Results support the utility of SEED criteria when well-defined groups of children are an important clinical or research outcome.
    Journal of Autism and Developmental Disorders 10/2014; 45(5). DOI:10.1007/s10803-014-2287-3 · 3.34 Impact Factor
  • Source
    • "As markers for ASD are identified earlier in life, an important question will be how to diagnose and characterize ASD in infancy. Although there is some evidence that a reliable and stable diagnosis can be made as early as 14 months in children with ASD (Chawarska, Klin, Paul, Macari, & Volkmar, 2009; Chawarska, Klin, Paul, & Volkmar, 2007), other studies suggest that ASD diagnoses before 3 years may be relatively unstable, particularly in siblings of children with ASD (Kleinman et al., 2008; Lord et al., 2006; Sutera et al., 2007; Turner & Stone, 2007). Practice guidelines in the United States, such as those developed by the American Academy of Child and Adolescent Psychiatry suggest that any early developmental assessment include several questions related to ASD symptoms (Volkmar, Cook, Pomeroy, Realmuto, & Tanguay, 1999). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This article suggests future directions for research aimed at improving our understanding of the etiology and pathophysiology of autism spectrum disorder (ASD) as well as pharmacologic and psychosocial interventions for ASD across the lifespan. The past few years have witnessed unprecedented transformations in the understanding of ASD neurobiology, genetics, early identification, and early intervention. However, recent increases in ASD prevalence estimates highlight the urgent need for continued efforts to translate novel ASD discoveries into effective interventions for all individuals with ASD. In this article we highlight promising areas for ongoing and new research expected to quicken the pace of scientific discovery and ultimately the translation of research findings into accessible and empirically supported interventions for those with ASD. We highlight emerging research in the following domains as particularly promising and pressing: (a) preclinical models, (b) experimental therapeutics, (c) early identification and intervention, (d) psychiatric comorbidities and the Research Domain Criteria initiative, (e) ecological momentary assessment, (f) neurotechnologies, and (g) the needs of adults with ASD. Increased research emphasis in these areas has the potential to hasten the translation of knowledge on the etiological mechanisms of ASD to psychosocial and biological interventions to reduce the burden of ASD on affected individuals and their families.
    Journal of Clinical Child & Adolescent Psychology 09/2014; 43(5):828-843. DOI:10.1080/15374416.2014.945214 · 1.92 Impact Factor
    • "In this study, we report on the clinical characteristics of children diagnosed with ASD at age 2 years or less. The diagnosis of ASD in very young children is challenging, although recent research has documented that the diagnosis of ASD in toddlers is valid and stable over time.[2324] The clinical characteristics found in the majority of the ASD children included lack of joint attention, unusual play, lack of pretend play, no index finger pointing, difficulty in playing with toys in a constructive manner, inability of the child to follow language, motor stereotypies, and poor eye contact. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To retrospectively examine the developmental and clinical characteristics of children with autism spectrum disorders (ASD) in the first 2 years of life in order to narrow the interval between parental concern and getting a reliable diagnosis of autism. The case records of 21 children in whom a diagnosis of ASD was made in the first 2 years of life and confirmed 6 months to 1 year later were examined. The inclusion criterion was absence of neurological, metabolic, or genetic disorders and sensory or motor impairments. These case records were maintained in the Pediatric Psychology Clinic at the Department of Pediatrics of a tertiary care teaching hospital in North India. The average age at presentation to the clinic was 21.23 months (SD = 2.18). The clinical characteristics that were found in two-thirds or more children included lack of speech, inability to follow verbal commands, lack of pretend play, no index finger pointing, difficulty in playing with toys in a constructive manner, lack of joint attention, and motor stereotypies. The mean IQ was 66.62 (SD = 15.11) and the mean SQ as measured by the Vineland Social Maturity Scale was 80.43 (SD = 17.45). Given the validity of early diagnosis over time, clinicians should be encouraged not only to make an early diagnosis but also to initiate early interventions in children with ASD.
    Annals of Indian Academy of Neurology 03/2014; 17(1):25-9. DOI:10.4103/0972-2327.128537 · 0.60 Impact Factor
Show more