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Deviations from Typical Developmental Trajectories Detectable at 9 Months of Age in Low Risk Children Later Diagnosed with Autism Spectrum Disorder

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Abstract

This study was designed to track the developmental trajectory, during the first 24 months of life, of 335 low-risk infants later diagnosed with Autism Spectrum Disorder and identify early deviations observed in routine Well Care checkups. We compared their achievements to typically developing children and to children later diagnosed with non-autistic developmental impairments. The results show that in the first 6 months, the children with autism showed normal acquisition of milestones, whereas by 9 months of age they began to fail the language/communication, as well as motor items when compared to typical and delayed non-autistic children. Regular check-up visits may be useful in detecting early failure in achieving milestones, leading to earlier referral for further evaluation and treatment.

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Acknowledgments

The authors thank Lior Ganor and Diana Kogan for editing the manuscript.

Author Contributions

MD made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data and was involved in drafting the manuscript. NS made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data. GK made substantial contributions to analysis and interpretation of data, and was involved and revising it critically for important intellectual content. BCF made substantial contributions to analysis and interpretation of data and was involved in drafting the manuscript.

Author information

Authors and Affiliations

  1. Department of Child Development, Medical Division, Maccabi Healthcare Services, 27 Hamered St., 6812509, Tel Aviv, Israel

    Michael Davidovitch

  2. Nursing Department, Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel

    Nataly Stein

  3. Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel

    Gideon Koren

  4. University of Western Ontario, London, ON, Canada

    Gideon Koren

  5. Child Development Center, Maccabi Healthcare Services, Haifa, Israel

    Bat Chen Friedman

  6. Child Neurology Department, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel

    Bat Chen Friedman

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  1. Michael Davidovitch
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  2. Nataly Stein
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  3. Gideon Koren
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Corresponding author

Correspondence to Michael Davidovitch.

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Conflict of interest

All authors are employees of Maccabi Healthcare Services.

Ethical Approval

The study was approved by the Ethics Review Board of Maccabi Healthcare Services.

Appendix: Percentages of Children Who Failed Each Milestone in the Different Developmental Ages

Appendix: Percentages of Children Who Failed Each Milestone in the Different Developmental Ages

6 weeks

Group

Age performed

(Months)

Language communication milestone

Motor milestone

Response to loud noise (changing activity)

Social smile

Makes noises in response to stimulation

Elevates head—prone position

Follows a moving object

ASD (N = 324)

2.1

2.8

5.6

4.3

12.3

9.2

DI (N = 297)

2.2

2

2.7

2

12.5

5.7

TD (N = 311)

2

2.6

2.9

3.5

11.3

9.7

  1. ASD autism spectrum disorder, DI developmental impairment, TD typical development, N number of children

3 months level

Group

Age performed

(Months)

Language communication milestone

Motor milestone

Laughs

Makes sounds

Turning head toward sound

Reaching for an object

Elevates head and chest—prone position

Crosses fingers of the two hands

ASD (N = 320)

3.9

7.8

13.4

11.3

19.1

8.4

7.2

DI (N = 295)

3.9

3.7

(0.03)

11.2

9.5

13.6

6.4

5.1

TD (N = 306)

3.9

4.2

9.2

7.2

10.5

(0.002)

5.5

4.2

  1. In parenthesis: P value (comparison with the ASD group)
  2. ASD autism spectrum disorder, DI developmental impairment, TD typical development, N number of children

6 months Level

Group

Age performed

(Months)

Language communication milestone

Motor milestone

Reacts differently to familiar and strangers

Makes repetitive syllables

Lifts head—supine

Transfers objects between hands

Rolls over

ASD (N = 319)

6.2

7.2

12.9

6.3

7.2

19.1

DI

(N = 289)

6.3

9.7

15.6

8

5.5

24.6

TD (N = 317)

6.3

3.8

9.8

3.8

0.6

(< 0.001)

14.5

  1. In parenthesis: P value (comparison with the ASD group)
  2. ASD autism spectrum disorder, DI developmental impairment, TD typical development, N number of children

9 months level

Group

Age performed

(Months)

Language communication milestone

Motor milestone

Says one word or meaningful syllable

Understands simple command

Imitates sounds

Stands up

Sits

Pincer grasp

ASD (N = 234)

9.4

38.1

30.8

15.8

41.4

39.7

18.9

DI (N = 196)

9.7

27.7

(0.02)

18.1

(0.002)

8.8

(0.009)

33.8

29.3

(0.02)

11.5

(0.03)

TD (N = 205)

9.3

26.6

(0.01)

12.7

(< 0.001)

10.2

25.5

(< 0.001)

22.1

(< 0.001)

8.2

(0.001)

  1. In parenthesis: P value (comparison with the ASD group)
  2. ASD autism spectrum disorder, DI developmental impairment, TD typical development, N number of children

12 months level

Group

Age performed

(Months)

Language communication milestone

Motor milestone

Says 2–3 words

Knows body part

Points

Rolls a ball

Walks with support

ASD (N = 322)

12.6

44.8

46.4

36

15.3

15.3

DI (N = 320)

12.9

28.7

(< 0.001)

28

(< 0.001)

15.3

(< 0.001)

9.4

(0.02)

12.1

TD (N = 332)

12.6

21.7

(< 0.001)

25.4

(< 0.001)

11

(< 0.001)

7.5

(0.002)

4.4

(< 0.001)

  1. In parenthesis: P value (comparison with the ASD group)
  2. ASD autism spectrum disorder, DI developmental impairment, TD typical development, N number of children

18 months level

Group

Age performed

(Months)

Language communication milestone

Motor milestone

Vocabulary of more than ten words

Gives a kiss

Builds a tower

Eats with a spoon

Walks without support

Climbs the stairs

ASD (N = 295)

18.4

69.8

35.4

24.9

24.6

13.7

18.9

DI

(N = 308)

18.9

37.3

(< 0.001)

12.9

(< 0.001)

11.9

(< 0.001)

5.8

(< 0.001)

5.4

(0.01)

4.1

(< 0.001)

TD (N = 310)

18.9

26.5

(< 0.001)

7.4

(< 0.001)

7.4

(< 0.001)

1.3

(< 0.001)

0

(< 0.001)

1.7

(< 0.001)

  1. In parenthesis: P value (comparison with the ASD group)
  2. ASD autism spectrum disorder, DI developmental impairment, TD typical development, N number of children

24 months level

Group

Age performed

(Months)

Language communication milestone

Motor milestone

Builds a sentence of three word or more

Uses grammatical first biases

Imitates a circle

Climbs up and down the stairs without support

Runs without falling

ASD (N = 263)

27.4

69.6

73.5

35.2

13

8.7

DI

(N = 286)

27.6

26.5

(< 0.001)

39.6

(< 0.001)

9.5

(< 0.001)

5.8

(0.004)

3.6

(0.01)

TD (N = 272)

28.3

13.7

(< 0.001)

24.3

(< 0.001)

6.1

(< 0.001)

1.9

(< 0.001)

1.5

(< 0.001)

  1. In parenthesis: P value (comparison with the ASD group)
  2. ASD autism spectrum disorder, DI developmental impairment, TD typical development, N number of children

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Davidovitch, M., Stein, N., Koren, G. et al. Deviations from Typical Developmental Trajectories Detectable at 9 Months of Age in Low Risk Children Later Diagnosed with Autism Spectrum Disorder. J Autism Dev Disord 48, 2854–2869 (2018). https://doi.org/10.1007/s10803-018-3549-2

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