Journal of Autism and Developmental Disorders

, Volume 42, Issue 12, pp 2636–2647 | Cite as

Predicting Developmental Status from 12 to 24 Months in Infants at Risk for Autism Spectrum Disorder: A Preliminary Report

  • Suzanne L. MacariEmail author
  • Daniel Campbell
  • Grace W. Gengoux
  • Celine A. Saulnier
  • Ami J. Klin
  • Katarzyna Chawarska
Original Paper


The study examined whether performance profiles on individual items of the Toddler Module of the Autism Diagnostic Observation Schedule at 12 months are associated with developmental status at 24 months in infants at high and low risk for developing Autism Spectrum Disorder (ASD). A nonparametric decision-tree learning algorithm identified sets of 12-month predictors of developmental status at 24 months. Results suggest that identification of infants who are likely to exhibit symptoms of ASD at 24 months is complicated by variable patterns of symptom emergence. Fine-grained analyses linking specific profiles of strengths and deficits with specific patterns of symptom emergence will be necessary for further refinement of screening and diagnostic instruments for ASD in infancy.


Autism Infancy High risk studies Longitudinal studies Pervasive developmental disorder 



This study was supported by National Institute of Child Health and Human Development P01 HD003008, Project 1 (PI: KC); National Institutes of Mental Health R01 MH 087554-01 (PI: KC); Simons Foundation 187398 (PI: AK). Preliminary data from this study were presented at the International Meeting for Autism Research, May 2011, San Diego. We would like to thank Karen Bearss, Amanda Steiner, Tina Goldsmith, Anne Snow, Rhea Paul, Elizabeth Schoen Simmons, Megan Lyons, and Sarita Austin for their contribution to subject characterization; Karyn Bailey, Daniela Blum, and Amy Carney for their clinical support of the families; and Amy Margolis, Martha Dye, Kerry O’Loughlin, Jessi Garzarek, Amanda Smith, Deanna Simeone, Mairin Meltvedt, Marika Coffman, Grace Chen, Jessica Bradshaw, Brittany Butler, and Jessa Reed for their assistance with data collection. We wish to express our sincere appreciation to the families and their infants for their time and participation.


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn., text revision). Washington, DC: Author.Google Scholar
  2. Bailey, A., Phillips, W., & Rutter, M. (1996). Autism: Towards an integration of clinical, genetic, neuropsychological, and neurobiological perspectives. Journal of Child Psychology and Psychiatry, 37(1), 89–126.PubMedCrossRefGoogle Scholar
  3. Bates, E., Benigni, L., Bretherton, L., Camaioni, L., & Volterra, V. (1979). The emergence of symbols: Cognition and communication in infancy. New York: Academic Press.Google Scholar
  4. Breiman, L., Friedman, J., Olshen, R., & Stone, C. (1984). Classification and regression trees. New York, NY: Wadsworth.Google Scholar
  5. Bryson, S. E., Zwaigenbaum, L., Brian, J., Roberts, W., Szatmari, P., Rombough, V., et al. (2007). A prospective case series of high-risk infants who developed autism. Journal of Autism and Developmental Disorders, 37(1), 12–24.PubMedCrossRefGoogle Scholar
  6. Carpenter, M., Nagell, K., Tomasello, M., Butterworth, G., & Moore, C. (1998). Social cognition, joint attention, and communicative competence from 9 to 15 months of age. Monographs of the society for research in child development, 63(4), 1–143.CrossRefGoogle Scholar
  7. Carr, T., Colombi, C., MacDonald, M., & Lord, C. (2011). Measuring response to intervention with the autism diagnostic observation schedule-change (ADOS-C). Presented at the Society for Research in Child Development: Montreal, CA.Google Scholar
  8. Charman, T., Taylor, E., Drew, A., Cockerill, H., Brown, J.-A., & Baird, G. (2005). Outcome at 7 years of children diagnosed with autism at age 2: Predictive validity of assessments conducted at 2 and 3 years of age and pattern of symptom change over time. Journal of Child Psychology and Psychiatry, 46(5), 500–513.PubMedCrossRefGoogle Scholar
  9. Chawarska, K., Klin, A., Paul, R., Macari, S., & Volkmar, F. (2009). A prospective study of toddlers with ASD: Short-term diagnostic and cognitive outcomes. Journal of Child Psychology and Psychiatry, 50(10), 1235–1245.PubMedCrossRefGoogle Scholar
  10. Chawarska, K., Klin, A., Paul, R., & Volkmar, F. (2007). Autism Spectrum Disorder in the second year: Stability and change in syndrome expression. Journal of Child Psychology and Psychiatry, 48(2), 128–138.PubMedCrossRefGoogle Scholar
  11. Chawarska, K., Macari, S., & Shic, F. (2012). Context modulates attention to social scenes in toddlers with autism. [Electronic version]. Journal of Child Psychology and Psychiatry.Google Scholar
  12. Chawarska, K. & Shic, F. (2009). Looking but not seeing: Abnormal visual scanning and recognition of faces in 2 and 4-year old children with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 39(12), 1663–1672.PubMedCrossRefGoogle Scholar
  13. Colombi, C., Carr, T., MacDonald, M., & Lord, C. (2011). Developing a measure of treatment outcome: The Autism Diagnostic Observation Schedule-Change. Presented at the Society for Research in Child Development, Montreal, CA.Google Scholar
  14. Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., et al. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The early start denver model. Pediatrics, 125(1), e17–e23.PubMedCrossRefGoogle Scholar
  15. Eisenberg, L., & Kanner, L. (1956). Early infantile autism, 1943–55. American Journal of Orthopsychiatry, 26, 556–566.PubMedCrossRefGoogle Scholar
  16. Gamliel, I., Yirmiya, N., & Sigman, M. (2007). The development of young siblings of children with autism from 4 to 54 Months. Journal of Autism and Developmental Disorders, 37(1), 171–183.PubMedCrossRefGoogle Scholar
  17. Gengoux, G. W., Steiner, A. M., & Chawarska, K. (2010). Parent stress related to infants at-risk for Autism Spectrum Disorder. Presented at the International Meeting for Autism Research, Philadelphia, PA.Google Scholar
  18. Hastie, T., Tibshirani, R., & Friedman, J. (2009). The elements of statistical learning: Data mining, inference, and prediction (2nd ed.). New York, NY: Springer.Google Scholar
  19. Jones, W., Carr, K., & Klin, A. (2008). Absence of preferential looking to the eyes of approaching adults predicts level of social disability in 2-year-olds with autism spectrum disorder. Archives of General Psychiatry, 65, 946–954.PubMedCrossRefGoogle Scholar
  20. Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217–250.Google Scholar
  21. Landa, R., & Garrett-Mayer, E. (2006). Development in infants with Autism Spectrum Disorders: A prospective study. Journal of Child Psychology and Psychiatry, 47(6), 629–638.PubMedCrossRefGoogle Scholar
  22. Landa, R. J., Holman, K. C., & Garrett-Mayer, E. (2007). Social and communication development in toddlers with early and later diagnosis of Autism Spectrum Disorders. Archives of General Psychiatry, 64(7), 853.PubMedCrossRefGoogle Scholar
  23. Lord, C., Luyster, R., Gotham, K., Guthrie, W., Risi, S., & Rutter, M. (in press). Autism diagnostic observation scheduletoddler module manual. Los Angeles, CA: Western Psychological Services.Google Scholar
  24. Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, A., & Pickles, A. (2006). Autism from 2 to 9 years of age. Archives of General Psychiatry, 63(6), 694–701.PubMedCrossRefGoogle Scholar
  25. Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., et al. (2000). The autism diagnostic observation schedule—generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.PubMedCrossRefGoogle Scholar
  26. Lord, C., Rutter, M., & LeCouteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685.PubMedCrossRefGoogle Scholar
  27. Luyster, R., Gotham, K., Guthrie, W., Coffing, M., Petrak, R., Pierce, K., et al. (2009). The autism diagnostic observation schedule—toddler module: A new module of a standardized diagnostic measure for Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 39(9), 1305–1320.PubMedCrossRefGoogle Scholar
  28. Mitchell, S., Brian, J., Zwaigenbaum, L., Roberts, W., Szatmari, P., Smith, I., et al. (2006). Early language and communication development of infants later diagnosed with Autism Spectrum Disorder. Journal of Developmental and Behavioral Pediatrics, 27(2), S69.PubMedCrossRefGoogle Scholar
  29. Muhle, R., Trentacoste, S. V., & Rapin, I. (2004). The genetics of autism. Pediatrics, 113(5), e472–e486.PubMedCrossRefGoogle Scholar
  30. Mullen, E. M. (1995). Mullen Scales of Early Learning. Circle Pines, MN: American Guidance Service.Google Scholar
  31. Mundy, P., Sigman, M., & Kasari, C. (1994). Joint attention, developmental level, and symptom presentation in autism. Development and Psychopathology, 6(3), 389–401.CrossRefGoogle Scholar
  32. Ozonoff, S., Heung, K., Byrd, R., Hansen, R., & Hertz-Picciotto, I. (2008a). The onset of autism: Patterns of symptom emergence in the first years of life. Autism Research, 1(6), 320–328.PubMedCrossRefGoogle Scholar
  33. Ozonoff, S., Iosif, A. M., Baguio, F., Cook, I. C., Hill, M. M., Hutman, T., et al. (2010). A prospective study of the emergence of early behavioral signs of autism. Journal of the American Academy of Child and Adolescent Psychiatry, 49(3), 256–266.PubMedGoogle Scholar
  34. Ozonoff, S., Macari, S., Young, G. S., Goldring, S., Thompson, M., & Rogers, S. J. (2008b). Atypical object exploration at 12 months of age is associated with autism in a prospective sample. Autism, 12(5), 457–472.PubMedCrossRefGoogle Scholar
  35. Ozonoff, S., Williams, B. J., & Landa, R. (2005). Parental report of the early development of children with regressive autism. Autism, 9(5), 461–486.PubMedCrossRefGoogle Scholar
  36. Ozonoff, S., Young, G. S., Carter, A., Messinger, D., Yirmiya, N., Zwaigenbaum, L., Bryson, S., et al. (2011a). Recurrence risk for Autism Spectrum Disorders: A Baby Siblings Research Consortium study. Pediatrics, 128, 2010–2825.Google Scholar
  37. Ozonoff, S., Young, G. S., Hutman, T., Sigman, M., Rogers, S. J., Hill, M. M., Steinfeld, M. B., & Rozga, A. (2011b). Stability of ASD in a high risk sample. Paper presented at the Biennial Meeting of the Society for Research in Child Development (SRCD), Montreal.Google Scholar
  38. Ozonoff, S., Young, G. S., Steinfeld, M. B., Hill, M. M., Cook, I., Hutman, T., et al. (2009). How early do parent concerns predict later autism diagnosis? Journal of Developmental and Behavioral Pediatrics, 30(5), 367.PubMedCrossRefGoogle Scholar
  39. Paul, R., Fuerst, Y., Ramsay, G., Chawarska, K., & Klin, A. (2011). Out of the mouths of babes: Vocal production in infant siblings of children with ASD. Journal of Child Psychology and Psychiatry, 52(5), 588–598.PubMedCrossRefGoogle Scholar
  40. Rozga, A., Hutman, T., Young, G. S., Rogers, S. J., Ozonoff, S., Dapretto, M., et al. (2011). Behavioral profiles of affected and unaffected siblings of children with autism: Contribution of measures of mother–infant interaction and nonverbal communication. Journal of Autism and Developmental Disorders, 41(3), 287–301.PubMedCrossRefGoogle Scholar
  41. Shic, F., Bradshaw, J., Klin, A., Scassellati, B., & Chawarska, K. (2011). Limited activity monitoring in toddlers with autism spectrum disorder. Brain Research, 1380, 246–254.PubMedCrossRefGoogle Scholar
  42. Siperstein, R., & Volkmar, F. (2004). Brief report: Parental reporting of regression in children with pervasive developmental disorders. Journal of Autism and Developmental Disorders, 34(6), 731–734.PubMedCrossRefGoogle Scholar
  43. Stone, W. L., Coonrod, E. E., Turner, L. M., & Pozdol, S. L. (2004). Psychometric properties of the STAT for early autism screening. Journal of Autism and Developmental Disorders, 34(6), 691–701.PubMedCrossRefGoogle Scholar
  44. Sullivan, M., Finelli, J., Marvin, A., Garrett-Mayer, E., Bauman, M., & Landa, R. (2007). Response to joint attention in toddlers at risk for Autism Spectrum Disorder: A prospective study. Journal of Autism and Developmental Disorders, 37(1), 37–48.PubMedCrossRefGoogle Scholar
  45. Toth, K., Dawson, G., Meltzoff, A. N., Greenson, J., & Fein, D. (2007). Early social, imitation, play, and language abilities of young non-autistic siblings of children with autism. Journal of Autism and Developmental Disorders, 37(1), 145–157.PubMedCrossRefGoogle Scholar
  46. Virkud, Y. V., Todd, R. D., Abbacchi, A. M., Zhang, Y., & Constantino, J. N. (2009). Familial aggregation of quantitative autistic traits in multiplex versus simplex autism. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 150B(3), 328–334.CrossRefGoogle Scholar
  47. Volkmar, F., Chawarska, K., & Klin, A. (2007). Autism Spectrum Disorders in infants and toddlers: An introduction. Autism Spectrum Disorders in infants and toddlers: Diagnosis, assessment, and treatment (pp. 1–22). New York, NY: Guilford Press.Google Scholar
  48. Werner, E., & Dawson, G. (2005). Validation of the phenomenon of autistic regression using home videotapes. Archives of General Psychiatry, 62(8), 889–895.PubMedCrossRefGoogle Scholar
  49. Werner, E., Dawson, G., Munson, J., & Osterling, J. (2005). Variation in early developmental course in autism and its relation with behavioral outcome at 3–4 years of age. Journal of Autism and Developmental Disorders, 35(3), 337–350.PubMedCrossRefGoogle Scholar
  50. Wetherby, A., Allen, L., Cleary, J., Kublin, K., & Goldstein, H. (2002). Validity and reliability of the Communication and Symbolic Behavior Scales Developmental Profile with very young children. Journal of Speech, Language and Hearing Research, 45(6), 1202–1218.CrossRefGoogle Scholar
  51. Wetherby, A., Woods, J., Allen, L., Cleary, J., Dickinson, H., & Lord, C. (2004). Early indicators of Autism Spectrum Disorders in the second year of life. Journal of Autism and Developmental Disorders, 34, 473–493.PubMedCrossRefGoogle Scholar
  52. Yoder, P., Stone, W. L., Walden, T., & Malesa, E. (2009). Predicting social impairment and ASD diagnosis in younger siblings of children with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 39(10), 1381–1391.PubMedCrossRefGoogle Scholar
  53. Zwaigenbaum, L., Bryson, S., Rogers, T., Roberts, W., Brian, J., & Szatmari, P. (2005). Behavioral manifestations of autism in the first year of life. International Journal of Developmental Neuroscience, 23(2–3), 143–152.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Suzanne L. Macari
    • 1
    • 4
    Email author
  • Daniel Campbell
    • 1
  • Grace W. Gengoux
    • 1
    • 2
  • Celine A. Saulnier
    • 1
    • 3
  • Ami J. Klin
    • 1
    • 3
  • Katarzyna Chawarska
    • 1
  1. 1.Child Study CenterYale University School of MedicineNew HavenUSA
  2. 2.Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordUSA
  3. 3.Marcus Autism CenterEmory University School of Medicine and Children’s Healthcare of AtlantaAtlantaUSA
  4. 4.Toddler Developmental Disabilities ClinicYale Child Study CenterNew HavenUSA

Personalised recommendations