Observed Social Emotional Behavior at 22 Months Predicts a Later ASD Diagnosis in High-Risk Siblings.

Social engagement, pretend play, and concern for another's distress represent fundamental features of typical social-emotional development in the second year. Children with autism spectrum disorder (ASD) display delays and deficits in these areas, and research on toddlers at heightened risk for ASD (HR; younger siblings of children with ASD) indicates these deficits may be apparent in toddlerhood. Prior research has examined these aspects of social-emotional development individually in HR toddlers. The present paper examines them jointly as predictors of ASD. We show that social engagement, pretend play, and empathic concern at 22-months each contribute uniquely to predicting later ASD diagnosis with high specificity and moderate sensitivity. Results have important implications for early diagnosis and intervention in young children with ASD.

Mother-child dyadic synchrony is associated with better functioning in hyperactive/inattentive preschool children.

BACKGROUND: Hyperactive/inattentive (HI) behaviors are common in preschoolers, but they result in functional impairment and attention deficit/hyperactivity disorder (ADHD) diagnoses in only some children. We examined whether the quality of mother-child interaction accounts for variance in level of functioning among preschool children with elevated ADHD symptoms. METHOD: Parent and teacher ADHD-RS ratings were used to assess 126 HI preschoolers, and clinician Children's Global Assessment Scale (CGAS) ratings were used to quantify level of functioning. Mother-child interactions during a 5-minute free-play and a 5-minute structured task were coded for child, parent and dyadic behaviors. RESULTS: Partial correlations, controlling for symptom severity and IQ, revealed child and dyad factors that were related to children's functioning. Regression analyses revealed that low dyadic synchrony accounted for additional unique variance in children's functioning, above and beyond the influence of symptom severity and IQ. CONCLUSIONS: Dyadic synchrony between mother and child plays a role in the functioning of preschool children displaying elevated symptoms of hyperactivity/inattention, and may represent a potential area for intervention that is not generally addressed in most parent management training programs.

Is adolescence-onset antisocial behavior developmentally normative?

Largely because of the influence of Moffitt's useful distinction between adolescence-limited and life-course persistent antisocial behavior, it has become increasingly common to view problem behavior that makes its first appearance in adolescence as developmentally normative. This study prospectively examined the lives of individuals in the NICHD Study of Early Child Care and Youth Development whose patterns of antisocial behavior varied with respect to age of onset and stability from kindergarten through age 15. Consistent with past research, early-onset, persistently deviant youth experienced more contextual adversity and evinced higher levels of intraindividual disadvantages than their peers from infancy through midadolescence. However, relative to youth who never showed significantly elevated antisocial behavior through age 15, children who showed antisocial behavior primarily in adolescence also were more disadvantaged from infancy forward, as were youth who only demonstrated significant externalizing problems in childhood. Findings generally replicated across sex and did not vary as a function of whether antisocial behavior groups were defined using T-scores normed within sex or identified using an empirically driven grouping method applied to raw data.

Predictors and sequelae of trajectories of physical aggression in school-age boys and girls.

Teacher-rated trajectories of physical aggression in boys and girls from first through sixth grade were examined using data from the NICHD Study of Early Child Care and Youth Development. In separate analyses, four trajectories were identified in boys and three in girls. Higher levels of aggression in both boys and girls were related to greater sociodemographic risk and higher maternal harshness in the preschool years; lower levels of observed maternal sensitivity during early childhood also predicted higher trajectories of aggression among girls. Trajectory groups also differed on a range of social and academic adjustment outcomes in sixth grade, with the most aggressive children and even moderately aggressive children evidencing some difficulties in adjustment. Patterns and levels of aggression in boys and girls are discussed as are their predictors and consequences.

Positive and negative peer interaction in 3- and 4-year-olds in relation to regulation and dysregulation.

Using a sample from the NICHD Study of Early Child Care (N = 435; 219 girls), the authors derived several measures of regulation and dysregulation that predicted, both concurrently and longitudinally, children's positive and negative peer interactions in multiple contexts. Observers rated peer interactions in child care and during dyadic play with a friend, and mothers rated peer behavior. The authors based the derived measures on resistance to temptation (36 months) and delay of gratification (54 months) tasks, as well as observations in child care of children's compliance and defiance with adults at both ages and maternal reports. Preschoolers who had better impulse control and who were more compliant and less defiant with adults engaged more often in friendly, positive, peer play and were less negative in their peer play across contexts. Associations between regulation and dysregulation and peer interaction were broader and more consistent at 54 months than at 36 months. Longitudinally, regulation at 36 months was only modestly associated with more positive and less negative peer play at 54 months. The authors discuss findings in the context of developing self-regulation and its importance for early peer relationships.

Resistance to temptation in toddlers at genetic risk for autism spectrum disorder.

Children with autism spectrum disorder often demonstrate difficulties with self-regulation, although studies of this construct in young children with autism spectrum disorder are limited. In this study, developmental changes were examined using a measure of self-regulation appropriate for young children, resistance to temptation. At 22, 28, and 34 months, toddlers with an older sibling with autism spectrum disorder (high risk) and toddlers with typically developing older siblings (low risk) were presented with an appealing toy and instructed not to touch it. Observers coded whether or not children touched the toy and the strategies they used to resist touching it. At 36 months, children were assessed for autism spectrum disorder, yielding three groups: high risk children with autism spectrum disorder, high risk children without autism spectrum disorder, and low risk children. At 22 months, most children, regardless of group, touched the forbidden toy; at 28 and 34 months, many high risk children without autism spectrum disorder and low risk children resisted the temptation to touch the toy, whereas most of the children with autism spectrum disorder did not. Differences in delay strategies were also evident. Some, but not all group differences, were accounted for by differences in language ability. Results highlight one early index of impulse control that differentiates children with emerging autism spectrum disorder from age-mates prior to the third birthday.

Parents' Use of Internal State Language with Toddlers at High and Low Genetic Risk for Autism Spectrum Disorder.

Parents of toddlers with an older sibling with autism spectrum disorder (ASD; high risk, HR) and parents of low risk (LR) toddlers with typically-developing older siblings read a wordless picture book to their child at 22 and 28 months. Parents' and toddlers' internal state language (ISL) was coded; parents reported on toddlers' use of ISL. Diagnostic assessments conducted at 36 months identified three groups: ASD, HR-noASD, LR. Parents did not differ in overall ISL, but parents of toddlers with later ASD attempted to elicit ISL from their children less than parents of LR toddlers. Toddlers increased their use of ISL with age, but those with ASD had lower scores and less age-related improvement than children in the other two groups.

Developmental Changes in Pretend Play from 22- to 34-Months in Younger Siblings of Children with Autism Spectrum Disorder.

Developmental trajectories of children's pretend play and social engagement, as well as parent sensitivity and stimulation, were examined in toddlers with an older sibling with autism spectrum disorder (ASD, high risk; HR) and toddlers with typically-developing older siblings (low risk; LR). Children (N = 168, 97 boys, 71 girls) were observed at 22, 28, and 34 months during free play with a parent and elicited pretend play with an examiner. At 28 and 34 months, children were asked to imagine the consequences of actions pantomimed by the examiner on a pretend transformation task. At 36 months children were assessed for ASD, yielding 3 groups for comparison: HR children with ASD, HR children without ASD (HR-noASD), and LR children. Children in all 3 groups showed developmental changes, engaging in more bouts of pretend play and obtaining higher scores on the elicited pretend and transformation tasks with age, but children with ASD lagged behind the other 2 groups on most measures. Children with ASD were also less engaged with their parents or the examiner during play interactions than either LR or HR-noASD children, with minimal developmental change evident. Parents, regardless of group, were highly engaged with their children, but parents of HR-noASD children received somewhat higher ratings on stimulation than parents of LR children. Most group differences were not accounted for by cognitive functioning. Instead, lower social engagement appears to be an important correlate of less advanced pretend skills, with implications for understanding the early development of children with ASD and for early intervention.

Trajectories of maternal depressive symptoms, maternal sensitivity, and children's functioning at school entry.

Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, the authors modeled trajectories of maternal depressive symptoms from infant age 1 month to 7 years. The authors identified 6 trajectories of maternal depressive symptoms: high-chronic, moderate-increasing, high-decreasing, intermittent, moderate-stable, and low-stable. Women on these depression trajectories varied in sociodemographic risk and in changes in observed maternal sensitivity over time. Maternal sensitivity was generally higher and increased when depressive symptoms were low; sensitivity was lower and decreased when depressive symptoms were either high or increasing. Child outcomes at 1st grade were examined by trajectory group. The authors discuss the complexity of disentangling maternal symptoms from maternal sensitivity and sociodemographic risk when predicting children's functioning.

Predicting the Early Developmental Course of Symptoms of Attention Deficit Hyperactivity Disorder.

Data from the National Institute of Child Health and Human Development Study of Early Child Care were examined to test whether: attention deficit/hyperactivity disorder (ADHD) symptoms remain stable from 54 months through early elementary school; behavioral inhibition and attention deficits assessed at 54 months predict ADHD symptoms in elementary school, even after controlling for their temporal stability; and early behavioral inhibition and attention deficits moderate the longitudinal stability in ADHD symptoms. Data were examined using continuous and categorical measures of symptoms. Modest stability in ADHD symptoms from 54 months to third grade was found. Measures of inhibition and inattention predicted later teacher ratings uniquely, but no evidence was found for moderation. Measures of preschool behavioral inhibition also predicted "persistently at risk status" defined by elevated teacher ratings over time. Results are discussed in terms of executive and motivational facets of inhibition that may be related to early signs of ADHD.

Developmental Changes in Empathic Concern and Self-Understanding in Toddlers at Genetic Risk for Autism Spectrum Disorder.

Toddlers with an older sibling with autism spectrum disorder (ASD) and low risk (LR) toddlers were observed at 22, 28, and 34 months during two empathy probes: a crying baby and an adult who pretended to hurt her finger. Toddlers with a later ASD diagnosis showed less empathic concern and self-distress at each age on both empathy probes than LR toddlers. HR toddlers with no diagnosis showed growth in empathic concern between 22 and 34 months in response to the adult's pain, differing from the children with ASD, but not the LR children, by 34 months. Developmental changes in parent-rated self-understanding showed a similar pattern. Results highlight individual differences in the social development of HR toddlers.

Pretend Play and Social Engagement in Toddlers at High and Low Genetic Risk for Autism Spectrum Disorder.

Toddlers with an older sibling with autism spectrum disorder (ASD) and low risk (LR) toddlers with typically-developing older siblings were observed during free play with a parent and elicited pretend with an examiner at 22-months. Functional and pretend play, children's social engagement, and parent sensitivity were assessed during free play. Complexity of play was assessed during the elicited pretend task. Toddlers with an ASD diagnosis showed less pretend play across contexts and less social engagement with parents or the examiner than either LR toddlers or high risk toddlers without a diagnosis (HR-noASD). Lower levels of pretend play and social engagement were associated with symptom severity within the high risk group, reflecting emerging ASD in toddlerhood.

Social engagement with parents in 11-month-old siblings at high and low genetic risk for autism spectrum disorder.

Infant siblings of children with an autism spectrum disorder are at heightened genetic risk to develop autism spectrum disorder. We observed high risk (n = 35) and low risk (n = 27) infants at 11 months during free play with a parent. Children were assessed for autism spectrum disorder in toddlerhood. High-risk infants with a later diagnosis (n = 10) were less socially engaged with their parents than were low-risk infants. Parent behavior during play did not vary by group. Within the high-risk group, ratings of social reciprocity at 11 months predicted Autism Diagnostic Observation Schedule severity scores at follow-up, suggesting that systematic observations of parent-infant play may be a useful addition to early assessments of emerging autism spectrum disorder.

Concern for Another's Distress in Toddlers at High and Low Genetic Risk for Autism Spectrum Disorder.

We examined concern for others in 22-month-old toddlers with an older sibling with autism spectrum disorder (ASD) and low risk typically-developing toddlers with older siblings. Responses to a crying infant and an adult social partner who pretended to hurt her finger were coded. Children with a later diagnosis of ASD showed limited empathic concern in either context compared to low risk toddlers. High risk toddlers without a later diagnosis fell between the ASD and low risk groups. During the crying baby probe the low risk and high risk toddlers without a diagnosis engaged their parent more often than the toddlers with ASD. Low levels of empathic concern and engagement with parents may signal emerging ASD in toddlerhood.

Mother-child interaction: a comparison of hyperactive, learning disabled, and normal boys.

Groups of thirteen hyperactive, learning disabled, and normal boys were observed interacting with their mothers in a structured problem-solving situation. Mothers of hyperactive boys showed a higher level of involement in task solution, and reported more behavior problems, than did mothers in comparison groups. Likewise, hyperactive boys interacted more than learning disabled or control boys.

A two-year follow-up of hyperactive preschoolers.

Twenty hyperactive children and 21 controls, studied in a research nursery at age four, were followed up at six-and-a-half. Hyperactives were still reported to have more behavior problems. Those rated extremely active in the nursery requested more feedback and made more comments in interactions with their mothers, and also made more immature moral judgments; children rated only moderately active did not differ from controls on these measures.

Maternal verbal responses to communication of infants at low and heightened risk of autism.

This study investigates mothers' responses to infant communication among infants at heightened genetic risk (high risk) of autism spectrum disorder compared to infants with no such risk (low risk). A total of 26 infants, 12 of whom had an older sibling with autism spectrum disorder, were observed during naturalistic in-home interaction and semistructured play with their mothers at 13 and 18 months of age. Results indicate that overall, mothers of low-risk and high-risk infants were highly and similarly responsive to their infants' communicative behaviors. However, examination of infant vocal and gestural communication development together with maternal verbal responses and translations (i.e. verbally labeling a gesture referent) suggests that delays in early communication development observed among high-risk infants may alter the input that these infants receive; this in turn may have cascading effects on the subsequent development of communication and language.

Negative emotionality moderates associations among attachment, toddler sleep, and later problem behaviors.

Secure parent-child relationships are implicated in children's self-regulation, including the ability to self-soothe at bedtime. Sleep, in turn, may serve as a pathway linking attachment security with subsequent emotional and behavioral problems in children. We used path analysis to examine the direct relationship between attachment security and maternal reports of sleep problems during toddlerhood and the degree to which sleep serves as a pathway linking attachment with subsequent teacher-reported emotional and behavioral problems. We also examined infant negative emotionality as a vulnerability factor that may potentiate attachment-sleep-adjustment outcomes. Data were drawn from 776 mother-infant dyads participating in the National Institute of Child and Human Development Study of Early Child Care. After statistically adjusting for mother and child characteristics, including child sleep and emotional and behavioral problems at 24 months, we found no evidence for a statistically significant direct path between attachment security and sleep problems at 36 months; however, there was a direct relationship between sleep problems at 36 months and internalizing problems at 54 months. Path models that examined the moderating influence of infant negative emotionality demonstrated significant direct relationships between attachment security and toddler sleep problems and between sleep problems and subsequent emotional and behavioral problems, but only among children characterized by high negative emotionality at 6 months. In addition, among this subset, there was a significant indirect path between attachment and internalizing problems through sleep problems. These longitudinal findings implicate sleep as one critical pathway linking attachment security with adjustment difficulties, particularly among temperamentally vulnerable children.

Relational Aggression in Middle Childhood: Predictors and Adolescent Outcomes.

This study examined gender differences in the level and developmental course of relational aggression in middle childhood, as well as early predictors and outcomes of relational aggression, after controlling for concurrent physical aggression. Relational (RAgg) and Physical aggression (PAgg) scores for 558 boys and 545 girls at ages 8-11 in the NICHD Study of Early Child Care and Youth Development (SECCYD) were created by combining the highest rating for each item across mother and teacher reports. Longitudinal analyses were conducted using Latent Curve Models of RAgg with PAgg as a time-varying covariate, with all parameters allowed to vary by gender. Boys and girls had different growth parameters of RAgg. Girls' RAgg intercept was higher and the slope was not different from zero; boys' RAgg intercept was lower and the slope declined. Mother-child conflict in early childhood predicted RAgg intercept for both boys and girls, but maternal harsh control and sensitivity were also uniquely predictive for girls, whereas center care was uniquely predictive for boys. RAgg intercept predicted adolescent self-reports of depression for girls and delinquency and risk-taking for both boys and girls; the magnitude of the association with risk-taking was significantly greater for boys.

Delay and inhibition as early predictors of ADHD symptoms in third grade.

We used data from a large, longitudinal study of children in the community, the NICHD Study of Early Child Care and Youth Development, to examine how well earlier measures of delay capacity, inhibitory control, planning, and attention predicted symptoms of attention deficit hyperactivity disorder (ADHD) assessed in third grade. Children with elevated symptoms of both inattention and hyperactivity-impulsivity (n = 57) and with inattentive symptoms only (n = 80) were identified via mother and teacher reports using the "or" rule, as were children without significant symptoms (n = 790). Multinomial logistic regression analyses indicated that poorer performance on earlier measures of resistance to temptation, delay of gratification, response inhibition, attention, and planning obtained from 36 months to 1st grade predicted membership in the two symptom groups relative to the comparison group in 3rd grade, albeit with somewhat different patterns of predictors. Controls for 36 month school readiness and externalizing symptoms indicated that these results were generally robust and not an artifact of initial cognitive or behavioral differences. Implications for developmental models of ADHD are discussed.