Language and social related risk factors for Autism in

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Language and social related risk factors for Autism in
Language and Social Risk Factors for Autism in Young Infants
Leslie Abney, BHS, MHS Candidate
Research Supervisor: Ashleigh Ohmes Boyd, MHS, CCC-SLP
Department of Communication Science and Disorders, University of Missouri
MU Leadership Education in Neurodevelopmental Disabilities (LEND) Program
Introduction
Importance of early intervention: Outcomes are better for children with autism
spectrum disorder (ASD) the earlier treatment is provided. The sooner ASD can be
identified and accurately diagnosed, the sooner treatment can be provided.
Familial risk: In order to identify risk factors, many studies compare “high risk”
infants (i.e., those with siblings who have ASD) to “low risk” infants (i.e., those
without family history of ASD) and follow them until they have received a diagnosis
of ASD or non-ASD.
• Siblings of children with ASD are at increased risk for ASD (~ 20%) [1, 2]
• Siblings of children with ASD are also at risk for ASD traits or “greater
autism phenotype” and other developmental differences/disorders [1, 2]
• Significant number of “high risk” infants carry features of the broader
autism phenotype: traits associated with ASD that differentiate these
infants from “low risk” infants in the control group. In other words, family
members of children diagnosed with ASD may present with characteristics
associated with ASD, without having the disorder. (p. 145) [1]
Before 12 months, few behavioral patterns are specific to ASD. Rather,
patterns appear that signal risk of developmental delay. (p. 145) [1]
Research Questions
What are the language and social risk factors associated
with ASD for children 18 months and younger?
What are the best practice guidelines for assessing children
for associated language and social risk factors of ASD?
Research Methods
Search Terms: social, language, risk factors, ASD, young infants, assessment,
screening, best practice, 18 months
Risk Factors
< 9 months:
• Lack of gestural communication is one of the first areas used to identify risk. Delays in
gestural use may be detected before delays in language for children with ASD. [3]
• Gestural communication precedes spoken language and provides a foundation for the
emergence of verbal language. In typically developing children, gestures develop
spontaneously and in tandem with first words, which are usually spoken as early as
approximately 9 months.
9 – 12 months:
• Delayed language – at 12 months vocalize significantly less than typically developing
infants. Average age of first word for kids with ASD is 38 months. [1, 2]
• Receptive < Expressive (this is an unusual pattern). Language is no longer a core feature
of ASD, but this pattern can help us identify those at risk. [1, 2]
• Approach caregivers less to share objects, give objects to caregivers less frequently, use
locomotor skills (i.e., crawling) less to engage with caregivers in meaningful ways and
more for non-social exploration. [6]
• As compared to typically developing infants:
• Share by approaching and giving significantly less often
• Crawl “elsewhere” instead of toward caregivers or objects more often
• But similar to typically developing infants in that once they start walking, rate of
sharing increases
• Significant delays in communicative gestures at 12 months. [3]
• At 12 months, “high risk” infants later diagnosed with autism produced fewer early
(giving, showing, pointing, lift arms to be picked up, shaking and nodding head) and
late (eat with toy spoon, telephone to ear) gestures.
12 – 15 months:
• Receptive < Expressive (this is an unusual pattern). Language is no longer a core feature
of ASD, but this pattern can help us identify those at risk. [1, 2]
• Using words to communicate at approximately 12-15 months and then regressing. [1]
• Approach caregivers less to share objects, give objects to caregivers less frequently, use
locomotor skills (i.e., walking) less to engage with caregivers in meaningful ways and more
for non-social exploration. [6]
15 – 18 months:
• Understand and produce fewer words than typically developing children.
• At 18 months the infants later diagnosed with ASD, reported to understand and
produce fewer words than either non-ASD siblings or controls. (p. 74-77) [3]
Databases: ASHAWire, EBSCOhost, PubMed, University of Missouri Library online
database
Screening/Assessment
Role of SLP
Screening with M-CHAT-R/F successfully identifies children at risk for ASD.
According to the American Academy of Pediatrics, an autism-specific screener
should be administered at a child’s 18 and 24 month well-child check. [5]
• M-CHAT-R is also available for free online:
https://www.autismspeaks.org/what-autism/diagnosis/mchat
• Speech-language pathologists (SLPs) play a crucial role in every
step of the diagnostic process for infants with ASD. [7]
• Screening: SLPs can play a direct role or indirect role [7]
• Direct role: actively screening infants with developmental
screeners and autism-specific screeners
• Indirect role: encouraging mothers to advocate for
developmental screening and autism-specific screening to be
conducted by their child’s pediatrician at their child’s 18 month
and 24 month well-child visits
• It is well within the scope of practice of an SLP to administer both
developmental screeners and autism-specific screeners. [7]
• SLPs and other health professionals, should be directly screening
or advocating for children to be screened at their well-child
checks. [7]
Development of a remote eye tracking assessment, Autism Risk Index (ARI),
for autism would provide the first objective measurement. [4]
• Still being tested in the research, but shows promising results with
children aged 3-8; very good discrimination of ASD vs. non-ASD and was
strongly correlated with ADOS-2 severity scores. [4]
• Research is needed on young infants. [4]
ASD can accurately be diagnosed by age 2. The GOLD STANDARD of
assessment: ADOS-2 Toddler Module + Autism Diagnostic Interview, Revised
(ADI-R) + judgement of expert clinician [2]
Very few appropriate pragmatic language assessments for infants 18 months
and younger [3]
Summary
Several language and social risk factors are present before 18
months of age: lack of gestures, delayed language, poorer
receptive language than expressive, decline in spoken language
abilities, less object sharing with caregivers, and more non-social
exploration.
More research is needed on remote eye tracking system for
infants at risk for ASD.
SLPs play a crucial role in identifying the early language and social
risk factors for ASD in young infants, and where appropriate,
administering autism-specific screeners.
The gold standard for accurately diagnosing ASD is the ADOS-2
Toddler Module + Autism Diagnostic Interview, Revised (ADI-R) +
judgement of expert clinician.
References
[1] Tager-Flusberg, H. (2016). Risk factors associated with language in autism spectrum disorder:
Clues to underlying mechanisms. Journal of Speech, Language, and Hearing Research, 59(1),
143-154.
[2] Drumm, E. & Brian, J. (2013). The developing language abilities and increased risks of ‘unaffected’
siblings of children with autism spectrum disorder. Neuropsychiatry, 3(5), 1-12.
[3] Mitchell, S., Brian, J., Zwaigenbaum, L., Roberts, W., Szatmari, P., Smith, I., & Bryson, S. (2006).
Early language and communication development of infants later diagnosed with autism
spectrum disorder. Developmental and Behavioral Pediatrics, 27(2), 69-78.
[4] Frazier, T. W., Klingemier, E. W., Beukemann, M., Speer, L., Markowitz, L., Parikh, S., ………
Strauss, S. M. (2016). Development of an objective autism risk index using remote eye
tracking. Journal of the American Academy of Child & Adolescent Psychiatry, 55(4), 301-309.
[5] Robins, D. L., Casagrande, K., Barton, M., Chen, C. A., Dumont-Mathieu, T., & Fein, D. (2014).
Validation of the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHATR/F). Pediatrics, 133 (1), 37-45.
[6] Srinivasan, S. M. & Bhat, A. N. (2016). Differences in object sharing between infants at risk for
autism and typically developing infants from 9 to 15 months of age. Infant Behavior and
Development, 42, 128-141.
[7] Swineford, L. (2017). Screening for ASD in toddlers: An update on recommendations and
practices. Perspectives of the ASHA Special Interest Groups, 2 (1), 5-10.
Acknowledgements
This research was supported by the Training in Interdisciplinary Programs and
Services for Kids, Missouri LEND (Leadership Education in Neurodevelopmental
Disabilities)
Author Contacts: Leslie Abney, BHS – [email protected]
Ashleigh Ohmes Boyd, MHS, CCC-SLP – [email protected]

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