Toddlers at Elevated Likelihood for Autism: Exploring Sensory and Language Treatment Predictors.

Baseline child characteristics may predict treatment outcomes in children with or at elevated likelihood of developing autism (EL-ASD). Little is known about the role of child sensory and language features on treatment outcome. Participants were randomly assigned to a parent-mediated intervention or control condition. Analyses explored the relationship between baseline child sensory and language characteristics and changes in ASD symptoms over approximately 9 months. Higher baseline sensory hyporeactivity was significantly related to less improvement in social communication (SC) for the treatment group only. More baseline atypical vocalizations were significantly related to less improvement on SC across treatment and control groups. This work provides an initial framework to encourage the tailoring of interventions for EL-ASD children, suggesting sensory reactivity and atypical vocalizations may be useful behaviors to consider in treatment planning.

Developmental trajectories of sensory patterns from infancy to school age in a community sample and associations with autistic traits.

This prospective study examined the latent growth trajectories of sensory patterns among a North Carolina birth cohort (N = 1517; 49% boys, 87% White) across infancy (6-19 months), preschool (3-4 years), and school years (6-7 years). Change rates of sensory hyper- and hyporesponsiveness better differentiated children with an autism diagnosis or elevated autistic traits from those with other developmental conditions, including non-autistic children with sensory differences. More sensory hyper- and hyporesponsiveness at infancy followed by steeper increases differentially predicted more autistic traits at school age. Further, children of parents with higher education tended to show stable or improving trajectories. These findings highlight the importance of tracking sensory patterns from infancy for facilitating early identification of associated challenges and tailored support for families.

Early developmental profiles of sensory features and links to school-age adaptive and maladaptive outcomes: A birth cohort investigation.

Sensory-based subtypes among autistic children have been well documented, but little is known about longitudinal sensory subtypes beyond autistic populations. This prospective study aimed to identify subtypes based on trajectories of parent-reported sensory features measured at 6-19 months, 3-4, and 6-7 years of age among a community-based birth cohort (N = 1,517), and to examine their associations with school-age clinical and adaptive/maladaptive outcomes on a subset sample (N = 389). Latent class growth analysis revealed five trajectory subtypes varying in intensity and change rates across three sensory domains. In contrast to an Adaptive-All Improving subtype (35%) with very low sensory features and overall better school-age outcomes, an Elevated-All Worsening subtype (3%), comprised of more boys and children of parents with less education, was associated with most elevated autistic traits and poorest adaptive/maladaptive outcomes. Three other subtypes (62% in total) were generally characterized by stable or improving patterns of sensory features at mild to moderate levels, and challenges in certain outcome domains. Our findings indicate that characterizing children based on early sensory trajectories may contribute to earlier detection of subgroups of children with sensory challenges who are more likely to experience developmental challenges by school age, followed by early targeted interventions for improved long-term outcomes.

Sensory Features of Young Children From a Large Community Sample: Latent Factor Structures of the Sensory Experiences Questionnaire (Version 2.1, Short Form).

IMPORTANCE: Although three sensory factors (hyperresponsiveness [HYPO]; hyporesponsiveness [HYPER]; and sensory interests, repetitions, and seeking behaviors [SIRS]) have been demonstrated among a wide age range of clinical populations, they have not been well validated in the general population, especially with a large community sample of young children. OBJECTIVE: To validate the factor structure of the Sensory Experiences Questionnaire (Version 2.1, Short Form; SEQv2.1) in a community sample and to confirm the factor structure's existence in this sample. DESIGN: Caregivers completed the SEQv2.1, a parent-reported questionnaire designed to capture children's everyday sensory experiences. The latent factors of the SEQv2.1 were examined using confirmatory factor analysis. SETTING: North Carolina. PARTICIPANTS: Caregivers of 2,195 children age 3 yr were initially recruited through state birth records and were eligible to participate if the child did not have a history of serious medical problems and English was the family's primary language. OUTCOMES AND MEASURES: SEQv2.1. RESULTS: The SEQv2.1 showed validity in the community sample. Similar to previous research with clinical populations, the three broad patterns of sensory responsiveness were also confirmed in this large community sample of young children, but associations among the factors differed. CONCLUSIONS AND RELEVANCE: Validation of the three-sensory-factor structure in the general population suggests that these constructs are similar to those found with samples of participants with autism spectrum disorder and developmental disabilities. This finding underscores the importance of understanding the normative development of sensory features across a wider age range to better delineate qualitative differences underlying sensory features between clinical and general populations. What This Article Adds: Occupational therapists seeking to assess children's sensory features can use the SEQv2.1 not only with clinical samples but also with children in the general population.

Lexicogrammatical skills in 2-year-old children with and without repaired cleft palate.

The purpose of the current research was to compare the lexical-grammatical skills of two-year-old children with and without repaired cleft palate (CP), accounting for the effect of variables such as vocabulary size at 18 months of age, maternal education level, and gender. Participants included 52 children with CP and 25 typically developing (TD) children. The CDI-WS was employed to measure vocabulary and grammatical skills. Significant differences were observed between the CP and TD groups with respect to the number of words, word forms (irregular nouns and verbs), word endings (overuse of plural (-s) and past tense (-ed) markers), the mean number of morphemes in their three longest utterances (M3L), and sentence complexity. In addition, compared to TD children, significantly smaller proportions of children with CP were observed to use words to talk about past and future events or use words to talk about an absent object. The difference between the CP and TD groups in terms of the size of vocabulary at 24 months of age remained statistically significant in the multivariable model. Among all predictors, the size of vocabulary at 18 months of age was identified as the most robust precursor of lexical and grammatical skills at 24 months of age. Gender was identified as a predictor of the M3L measure as an index for syntactic ability.

Measuring Parent-Child Transactions for Early Identification of Young Autistic Children.

This study explored the salient characteristics of transactions within parent-child engagement and investigated relationships between transactional characteristics and future identification of autism. The main aims of the study were to (1) examine if parents/children and their initial behaviors impact the length of transaction; (2) determine miscue differences among parents and children; and (3) determine if transactional characteristics are predictive of autism at preschool age.The study sample was drawn from extant data of a parent-mediated intervention for young children showing early sings of autism. Thirty parent-child dyad videos were randomly selected and coded for transactions. Statistical analyses were applied to examine the study aims and to perform post-hoc analyses.The length of transaction increased when children initiated with a look cue. Parents displayed a higher proportion of miscues and greater variance in their miscue behavior than their children. Neither the length of transaction nor the proportion of child miscues at 1-year of age predicted an autism diagnosis at preschool age. Post-hoc analyses revealed that girls with high variance of transaction length at 1-year of age, had a lower likelihood of showing autism traits at preschool age. Sustained transactions were more likely when children initiated engagement by looking. Early transactional characteristics were associated with later autism identification among girls, namely longer median transaction length with lower variance of transaction length. This transaction profile is believed to represent high fixation on topics with less ability to explore varied topics.

Measuring Transactional Engagement Among Young Children with Elevated Likelihood for Later Autism Spectrum Disorder Diagnosis.

This analytical study documented the presence of transactions in parent-child engagement within a sample of young children at an elevated likelihood for an eventual diagnosis of autism spectrum disorder (ASD). Specifically, the study examined the establishment of transactional engagement through reciprocal behaviors between parents and their young children at-risk for ASD. In the study sample, established transactional engagement occurred at a higher rate than other levels of engagement. Additionally, transactional engagement had a higher likelihood of being established when parents initiated. Post-hoc analyses revealed possible early markers of ASD within a certain behavior displayed in transactions. This study signifies the initial efforts in identifying transactions within parent-child engagement, and foremost, how transactional engagement is established.

Scoping review of behavioral coding measures used to evaluate parent responsiveness of children with autism or elevated risk of autism.

LAY ABSTRACT: The topic of how parents react (e.g., how they talk and act) to their child with autism or elevated likelihood of autism, often called parent responsiveness, has been studied by researchers for over 50 years. Many methods for measuring behaviors around parent responsiveness have been created depending on what researchers were interested in discovering. For example, some include only the behaviors that the parent does/says in reacting to something the child does/says. Other systems look at all behaviors in a period of time between child and parent (e.g., who talked/acted first, how much the child or parent said/did). The purpose of this article was to provide a summary of how and what researchers looked at around parent responsiveness, describe the strengths and barriers of these approaches, and suggest a "best practices" method of looking at parent responsiveness. The model suggested could make it more possible to look across studies to compare study methods and results. The model could be used in the future by researchers, clinicians, and policymakers to provide more effective services to children and their families.

Caregiver responsiveness as a mechanism to improve social communication in toddlers: Secondary analysis of a randomized controlled trial.

Early intensive behavioral interventions (EIBI) for children at elevated likelihood for a later diagnosis of autism spectrum disorder (EL-ASD), are often delivered through parent-mediated models. An area of current exploration is whether changes in caregiver behaviors are a mechanism through which to improve and track child behaviors in these interventions. Toddlers and their caregivers participated in an intervention trial (randomized controlled trial) and were randomized to either a parent-mediated intervention (adapted responsive teaching; ART) or a control condition (referral to early intervention and monitoring; REIM). Changes in toddler social communication (SC) behaviors and characteristics of caregiver responsiveness (CR) were quantified over 8 months. Analyses were conducted to assess whether changes in CR mediated the relation between group (ART vs. REIM) and changes in child SC. Results of the current study indicated that caregivers who participated in a parent-mediated intervention improved in three domains of CR (contingent verbal sensitivity, responsivity, affect). CR was also found to be a mechanism through which children's SC skills improved. This work provides evidence that qualities of CR serve as mechanisms through which to improve and monitor child behaviors over the course of EIBIs. These results may lead to novel intervention targets, methods for tracking change, and tailored treatment planning for toddlers with EL-ASD. The data used in this study comes from a clinical trial that was prospectively registered with the Registry of Efficacy and Effectiveness Studies (Registry ID: 316.1v1). LAY SUMMARY: Interventions for toddlers with high likelihood for a later diagnosis of autism often include the caregiver as an active participant in the intervention. In this study, we aimed to understand qualities of caregiver responsiveness (CR) that facilitate improvements in child behaviors during intervention. Results show that increasing verbal CR and affect are ways to improve child social skills over the course of intervention.

Early measurement of autism risk constructs in the general population: A new factor structure of the First Years Inventory (FYIv3.1) for ages 6-16 months.

Early detection of autism risk in the community is critical to increasing families' access to early intervention, yet few measures have been developed and tested for the general population of infants <16 months to tap a broader range of autism risk constructs. This study aimed to (a) examine the factor structure of the First Years Inventory, version 3.1 (FYIv3.1), with a sample of 6454 infants 6-16 months, and (b) determine the ability of the resulting factors to discriminate clinical outcome groups at 3 years of age. The FYIv3.1 is a parent-report tool designed to detect early behavioral risk signs that may be associated with a later diagnosis of ASD and related neurodevelopmental conditions. Factor analytic models were used to determine the number of constructs and inter-factor correlations. Findings supported a seven-factor structure: communication, imitation and play (CIP); social attention and affective engagement (SAE); sensory hyperresponsiveness (HYPER); sensory hyporesponsiveness (HYPO); self-regulation in daily routines (SREG); sensory interests, repetitions, and seeking behaviors (SIRS); motor coordination and milestones (MCM). Mean comparisons on these factors demonstrated significant discrimination of the three outcome groups at age 3 years including those classified as having an ASD diagnosis and/or high autism symptoms, those classified as having other developmental disorders/conditions/concerns, and those classified with no known conditions/concerns. These findings support the validity and multidimensionality of early ASD risk constructs, as well as the potential use of the FYIv3.1 for phenotypic subtyping in the general population, and early detection in a broader age range of 6-16 months in future clinical studies. LAY SUMMARY: The FYIv3.1 is a 69-item parent-report questionnaire about infant behaviors that may indicate an elevated likelihood for later neurodevelopmental conditions such as autism. Analyses of responses from 6454 parents of infants 6-16 months indicated that items could be grouped reliably into seven categories. Compared to children with or without other developmental conditions, children in the outcome group with autism spectrum disorder and/or high autism symptoms at age three showed more behavioral risk signs in social-communication, sensory, and motor domains during infancy.

Sensory Reactivity of Infants at Elevated Likelihood of Autism and Associations with Caregiver Responsiveness.

Infants at elevated likelihood of developing autism display differences in sensory reactivity, especially hyporeactivity, as early as 7 months of age, potentially contributing to a developmental cascade of autism symptoms. Caregiver responsiveness, which has been linked to positive social communication outcomes, has not been adequately examined with regard to infant sensory reactivity. This study examined the multiplicative impact of infant sensory hypo- and hyperreactivity on caregiver responsiveness to sensory reactivity and regulation cues in 43 infants at elevated likelihood of autism. Sensory hyperreactivity was found to moderate the association between sensory hyporeactivity and caregiver responsiveness, such that caregivers of infants with moderately high sensory hypo- and hyperreactivity demonstrated higher responsiveness.

Infant Attentional behaviors Are Associated With ADHD Symptomatology and Executive Function in Early Childhood.

Objective: We explored associations between infant attentional behaviors as measured by the First Year Inventory (FYIv2.0) and dimensional ratings of ADHD symptomatology and executive function (EF) in early childhood. Methods: This study included parents (N = 229) who filled out the FYIv2.0 when their children were 12 months of age. When children were approximately 54 months (4.5 years) of age, parents completed reports of children's ADHD symptomatology and EF abilities. Correlation and regression analyses were conducted among measures. Results: We found significant associations among the variables of interest, both cross-sectionally and longitudinally, as well as gender differences. Notably, non-social sensory attention (NSA) was significantly related to 54-month ADHD symptom severity. All three 12-month attention variables were significantly related to 54-month EF. Conclusion: Results suggest that infant attentional behaviors predict later ADHD-related behaviors in early childhood. Future research should explore associations using laboratory-based measures and could inform early intervention efforts.

Construct validity of the First-Year Inventory (FYI Version 2.0) in 12-month-olds at high-risk for Autism Spectrum Disorder.

LAY ABSTRACT: The First-Year Inventory 2.0 is a parent-report screening instrument designed to identify 12-month-old infants at risk for an eventual diagnosis of Autism Spectrum Disorder. This instrument focuses on Social-Communication and Sensory-Regulatory areas of infant behavior. Although the First-Year Inventory 2.0 screening performance has been previously studied, its validity has not been examined. Establishing validity of an instrument is important because it supports the effectiveness and the reliability of the instrument. In this study, we examined relationship between the First-Year Inventory 2.0 (Social-Communication and Sensory-Regulatory areas) and other instruments that measure similar areas of infant behavior in a sample of high-risk infant siblings of children with Autism Spectrum Disorder. These other instruments share some common aims and theoretical areas with the First-Year Inventory 2.0: the Autism Observation Scale for Infants, the Mullen Scales of Early Learning, the Vineland Adaptive Behavior Scales-II, and the Infant Behavior Questionnaire. Findings generally supported the validity of the First-Year Inventory 2.0 with other instruments. In particular, the Social-Communication area of the First-Year Inventory 2.0 showed greater commonality with other instruments than in the Sensory-Regulatory area. The Sensory-Regulatory area seemed to be a unique feature of the First-Year Inventory 2.0 instrument. Considering different aims and strengths of assessments, researchers and clinicians are encouraged to utilize a variety of instruments in a comprehensive evaluation of a child.

Parent responsiveness mediates the association between hyporeactivity at age 1 year and communication at age 2 years in children at elevated likelihood of ASD.

Studies suggest that higher parent responsiveness is associated with higher child language abilities. Infants and toddlers later diagnosed with autism spectrum disorder (ASD) often display hyporeactivity to sensory stimuli, which has also been associated with lower child communication abilities and lower parent responsiveness. Yet, whether parent responsiveness mediates the relationship between child hyporeactivity and later communication outcomes remains unexplored. This study is a secondary data analysis which includes children (n = 83; 56 males) identified as at elevated likelihood of later ASD. Children completed an observational measure of sensory reactivity and a standard developmental assessment at 14 (Time 1) and 23 months old (Time 2). At each time point, parents reported on the child's adaptive communication behaviors and sensory behaviors, and Parent Verbal Responsiveness (AvgPVR) was coded from parent-child free-play videos. Results indicated that the association between child sensory hyporeactivity at Time 1 (observed and parent-reported) and communication at Time 2 (observed and parent reported) was significantly mediated by AvgPVR. Although child hyporeactivity predicts poorer communication outcomes, increased parent verbal responsiveness may attenuate this negative impact. Parent responsiveness, a focus of many parent-mediated interventions, may be an important mechanism of treatment response that should be directly tested in future research. LAY SUMMARY: Toddlers at elevated likelihood of autism spectrum disorder (ASD) are often under-reactive (hyporeactive) to sensory stimuli. This hyporeactivity slows learning of communication skills and provides parents with fewer opportunities to respond to their children. In this study, children with hyporeactivity at 14 months generally had poorer communication at 23 months; however, the more responsive their parents were, the weaker the relationship between early hyporeactivity and later communication. Thus, increasing parent responsiveness may lead to better communication outcomes for toddlers with the early ASD symptom of hyporeactivity.

Joint Attention and Sensory-Regulatory Features at 13 and 22 Months as Predictors of Preschool Language and Social-Communication Outcomes.

Purpose The purpose of this study was to understand how joint attention and sensory-regulatory features are related in early childhood and predict language and social-communication outcomes in preschool in order to build mechanistic theories that can inform early intervention directed at improving these outcomes. Method Cross-lagged panel analysis models were used to examine the association between joint attention and sensory-regulatory features at 13 and 22 months of age in children (n = 87) who were identified via community screening at 12 months as having a higher likelihood than the general population for being diagnosed with autism spectrum disorder. Results Significant concurrent correlations and predictive correlations were found between these constructs at 13 and 22 months. Joint attention skills at 13 months predicted both joint attention and sensory-regulatory features at 22 months. Distal language and social-communication outcomes at preschool age (n = 48) were best predicted by sensory-regulatory features at 22 months. Conclusions Both joint attention and sensory regulation are important factors in the first and second years of life for impacting later preschool language and social-communication outcomes in this sample. These findings may have implications for future early childhood intervention research for children at a higher likelihood for autism spectrum disorder.

Use of gesture development in profiling children's prelinguistic communication skills.

PURPOSE: Comparing children's skills across and within domains of development has become a standard in providing early intervention services. Profiling a child's strengths and challenges can help in making decisions regarding eligibility, diagnosis, and intervention. Profiling is particularly important for children who are not yet talking, due to the variability in production skills and the lack of guidelines as to which children are "at risk" for communication deficits versus those who are "late talkers." One area underutilized in profiling is gesture development, despite the fact that research has indicated that the amount and type of gesture use can help in early identification and is predictive of later language. METHOD: To guide practicing professionals and researchers in using gesture development to profile children's communication skills, this article provides an overview of the types of gestures and their development, describes assessment methods and tools to document gesture development, pinpoints behaviors and factors important in identifying children with disabilities, and ends with brief examples of using profiling in assessment and intervention planning. CONCLUSIONS: Gesture use should be an important component in profiling children's communication skills, and this type of profiling can enhance both the assessment and intervention process.

Vocabulary Growth From 18 to 24 Months of Age in Children With and Without Repaired Cleft Palate.

Purpose This study investigated vocabulary growth from 18 to 24 months of age in young children with repaired cleft palate (CP), children with otitis media, and typically developing (TD) children. In addition, the contributions of factors such as hearing level, middle ear status, size of consonant inventory, maternal education level, and gender to the development of expressive vocabulary were explored. Method Vocabulary size of 40 children with repaired CP, 29 children with otitis media, and 25 TD children was measured using the parent report on MacArthur-Bates Communicative Development Inventories: Words and Sentences (Fenson et al., 2007) at 18 and 24 months of age. All participants underwent sound field audiometry at 12 months of age and tympanometry at 18 months of age. A multiple linear regression with and without covariates was used to model vocabulary growth from 18 to 24 months of age across the 3 groups. Results Children with CP produced a significantly smaller number of words at 24 months of age and showed significantly slower rate of vocabulary growth from 18 to 24 months of age when compared to TD children (p < .05). Although middle ear status was found to predict vocabulary growth from 18 to 24 months of age across the 3 groups (p < .05), the confidence interval was large, suggesting the effect should be interpreted with caution. Conclusions Children with CP showed slower expressive vocabulary growth relative to their age-matched TD peers. Middle ear status may be associated with development of vocabulary skills for some children.

The Performance of the First Year Inventory (FYI) Screening on a Sample of High-Risk 12-Month-Olds Diagnosed with Autism Spectrum Disorder (ASD) at 36 Months.

This study examined the performance of the First Year Inventory (FYI; version 2.0), a community-normed parent-reported screening instrument, in a high-risk (HR) sample of 12-month-olds with older siblings diagnosed with autism spectrum disorder (ASD). The FYI 2.0 was completed by parents of 86 HR infants and 35 low-risk control infants at age 12 months, followed by clinical diagnosis at 36 months. HR infants later diagnosed with ASD had significantly higher FYI 2.0 risk scores in both the social-communication and sensory-regulatory domains than typically developing infants. New FYI 2.0 cutoff scores for HR sample were explored by evaluating various cutoff options after considering tradeoffs between sensitivity and specificity and sample characteristics.

Communicative Function Use of Preschoolers and Mothers From Differing Racial and Socioeconomic Groups.

Purpose: This study explores whether communicative function (CF: reasons for communicating) use differs by socioeconomic status (SES), race/ethnicity, or gender among preschoolers and their mothers. Method: Mother-preschooler dyads (N = 95) from the National Center for Early Development and Learning's (2005) study of family and social environments were observed during 1 structured learning and free-play interaction. CFs were coded by trained independent raters. Results: Children used all CFs at similar rates, but those from low SES homes produced fewer utterances and less reasoning, whereas boys used less self-maintaining and more predicting. African American mothers produced more directing and less responding than European American and Latino American mothers, and Latino American mothers produced more utterances than European American mothers. Mothers from low SES homes did more directing and less responding. Conclusions: Mothers exhibited more sociocultural differences in CFs than children; this suggests that maternal demographic characteristics may influence CF production more than child demographics at school entry. Children from low SES homes talking less and boys producing less self-maintaining coincided with patterns previously detected in pragmatic literature. Overall, preschoolers from racial/ethnic minority and low SES homes were not less deft with CF usage, which may inform how their pragmatic skills are described. Supplemental Material: https://doi.org/10.23641/asha.5890255.

The Impact of Individual Differences on a Bilingual Vocabulary Approach for Latino Preschoolers.

Purpose: The purpose of this study was twofold: First, we replicated in a new sample our previous findings that a culturally and linguistically responsive (CLR) bilingual approach for English vocabulary instruction for preschool Latino dual language learners was effective. Subsequently, we investigated whether the positive effect of CLR instruction varies as a function of individual child characteristics, including baseline vocabulary levels and gender. Method: Using a randomized pretest-posttest follow-up group design, we first replicated our previous study (N = 42) with a new sample by randomly assigning 35 Spanish-speaking Latino preschoolers to a CLR bilingual group or an English-only group. The preschoolers received small-group evidence-informed shared readings targeting 30 English words 3 times a week for 5 weeks in their preschools. Vocabulary outcomes were measured using both standardized and researcher-developed measures. We subsequently conducted further studies with the combined sample size of 77 children to examine the variability in intervention effects related to child gender and baseline vocabulary levels. Results: The direct replication study confirmed findings of our earlier work suggesting that the CLR bilingual approach promoted greater gains in L1 and L2 vocabulary than in an English-only approach. The extension studies revealed that the effect of the CLR bilingual vocabulary approach on English and Spanish vocabulary outcomes was not impacted by gender or vocabulary status at baseline. Conclusion: This study provides additional evidence of the benefits of strategically combining L1 and L2 for vocabulary instruction over an English-only approach. Our findings also suggest that preschool Latino dual language learners can benefit from a bilingual vocabulary instructional approach regardless of gender or baseline vocabulary levels in L1.