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The Effects of Early Language on Age at Diagnosis and Functioning at School Age in Children with Autism Spectrum Disorder

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Abstract

Research suggests that toddlers with no language delay (NLD) should have better outcomes than those with language delay (LD). However, the predictive utility of language milestones relative to co-varying factors such as age at diagnosis, IQ, and ASD symptomatology is unclear. This study compared school-aged children with ASD and NLD (n = 59) to a well-matched group with ASD and LD (n = 59). The LD group was diagnosed at younger ages and their historical ASD symptoms were more severe than the NLD group. The groups were similar in current ASD symptoms and adaptive functioning at school age. Language milestones were correlated with adaptive functioning, but IQ and social symptoms of ASD were stronger predictors of functioning at school age. Therefore, language milestones may not be the best indicators of prognosis for children who are diagnosed after toddlerhood.

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Notes

  1. The ADI-R provides a single set of cut-offs for Autism, with no lower cut-offs provided for ASD. Although most participants met ADI-R criteria for Autism, some met criteria provided by other authors for Borderline Autism (n = 3; Buxbaum et al. 2001, pgs. 1515–1516), Asperger’s Disorder or PDD-NOS (ns = 1 and 6, respectively; Seltzer et al. 2003, pg. 569).

  2. Spearman correlations account for skewness and kurtosis by rank-ordering values of each variable prior to correlating them. They are also robust to outliers. The resulting value, Spearman’s rho (ρ), is equivalent to Pearson’s r in interpretation.

  3. Although neither the current study nor the study by Frost and colleagues included children across the full range of language abilities, it is reasonable to assume that the presence vs. absence of language would be a strong predictor of functioning (e.g., Venter et al. 1992).

  4. We thank an anonymous reviewer for this suggestion.

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Acknowledgments

We gratefully acknowledge the contributions of SARRC research staff to data collection. We also thank all children and families whose participation made this research possible.

Funding

This study was supported by internal funds at SARRC.

Author Contributions

AG conceived of the study, performed the statistical analysis, interpreted the results, drafted and revised the manuscript. NLM edited the manuscript and contributed to its design. CJS supervised data collection, edited the manuscript and contributed to its design. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Southwest Autism Research and Resource Center, 300 North 18th Street, Phoenix, AZ, 85006, USA

    Anthony Goodwin, Nicole L. Matthews & Christopher J. Smith

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  1. Anthony Goodwin
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  2. Nicole L. Matthews
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  3. Christopher J. Smith
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Correspondence to Anthony Goodwin.

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The authors have no conflict of interest to disclose.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors. This study involved retrospective review of previously-collected de-identified data; as such, it was exempt from the U.S. Department of Health and Human Services Human Subjects Research policy 45 CFR 46.

Informed Consent

This research met criteria for the American Psychological Association’s ethical standard 8.05: Dispensing with Informed Consent for Research. For this type of study, formal consent is not required.

Appendix

Appendix

See Table 6.

Table 6 Average age of diagnosis (in years) stratified by date of birth and minority status
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Goodwin, A., Matthews, N.L. & Smith, C.J. The Effects of Early Language on Age at Diagnosis and Functioning at School Age in Children with Autism Spectrum Disorder. J Autism Dev Disord 47, 2176–2188 (2017). https://doi.org/10.1007/s10803-017-3133-1

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