Autism Diagnosis at Toddler Age May Not Persist to Elementary School Years

Credit: Unsplash / Caleb Woods

A child diagnosed with autism spectrum disorder (ASD) at 12-26 months of age may not meet the diagnostic criteria for autism years later, according to a new cohort study led by Elizabeth Harstad, MD, of the division of developmental medicine at Boston Children’s Hospital.

Previously, psychologists believed it was best to detect ASD from an early age so they could provide necessary interventions, but Harstad and colleagues in their study wrote it was best to watch out for ASD in toddlers, but to not immediately put a definitive label on it.

“If our findings are replicated in other samples, it may be appropriate to conceptualize ASD at a young age as an ‘early ASD profile’ that requires treatment and monitoring, rather than an immutable diagnosis,” investigators wrote.

The new study examined data from participant children’s initial clinical assessment and their second research assessment. The initial clinical assessment took place when the children were 12-26 months old, when they took several tests: Bayley Scales of Infant and Toddler Development, Third Edition, and Vineland Adaptive Behavior Scales, Second or Third Editions. The parents also completed a developmental history and explained their child’s past behavior.

The second research assessment took place when the same children were followed up with at 5-7 years old. Their assessments included ADOS-2; Differential Abilities Scale, Second Edition; Preschool Language Scales, Fifth Edition; Vineland Adaptive Behavior Scales, Fifth Edition; and Bayley III for the children whose cognitive abilities prevented them from completing the Differential Abilities Scales.

Every child in the study also received intervention, and the parent’s recorded ABA; ESDM; Floor time; Social Communication/Emotional Regulation/Transactional Support (SCERTS); Relationship Developmental Intervention (RDI); speech language therapy; physical therapy; occupational therapy; developmental specialist; and toddler play.

The team used frequencies and descriptive statistics to describe the sample. They also used an independent sample 2-tailed t tests and x2 tests when contrasting means and proportions, as well as a logistic regression model with predictive factors, including age; sex; maternal educational level; interventions received; and cognitive, language, and adaptative scores.

The research found a child with a baseline Vineland Adaptive Behavior Scale score of 85 would have a 44.72% likelihood of having persistent ASD. As for a child with a baseline score of 70, they had a 70.43% likelihood of having persistent ASD.

With the logistic regression model, the team also found children with a higher baseline adaptative functioning scores, as well as girls, were more likely to have nonpersistent ASD.

In fact, of the 213 children in the study, many had nonpersistent ASD.

The mean diagnostic certainty for children with persistent ASD was 4.6, and for nonpersistent it was 4.3.

“The 37.1% rate of nonpersistent ASD at 5 - 7 years of age is higher than may have been expected based on prior research,” investigators wrote.

The team noted that the number of children in the study with nonpersistent ASD “may raise questions about accuracy of the initial diagnosis” since the new assessment did not show some children with persistent ASD who previously had been diagnosed.

“Other research suggests that even when ASD is nonpersistent, some developmental challenges may remain,” investigators wrote. “It is also uncertain how the development of these children will progress over time, since they are only 5 - 7 years of age at research assessment.”

References

^{Harstad E, Hanson E, Brewster SJ, et al. Persistence of Autism Spectrum Disorder From Early Childhood Through School Age. JAMA Pediatr. Published online October 02, 2023. doi:10.1001/jamapediatrics.2023.4003}