This study investigated early posture development prospectively in infants at heightened (HR) vs. low risk (Low Risk; LR) for ASD. Fourteen HR infants diagnosed with ASD (HR-ASD), 17 HR infants with language delay (HR-LD), 29 HR infants with no diagnosis (HR-ND), and 25 LR infants were videotaped at home for 25 min during everyday activities and play at 6, 8, 10, 12, and 14 months. All postures were coded and the sustainment source was identified for supported postures. Relative to LR infants, HR-ASD infants and to a lesser extent HR-LD infants exhibited distinct postural trajectories that revealed slower development of more advanced postures. In addition, subtle differences in posture sustainment differentiated HR-ASD from HR-LD infants.
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Although the MSEL is not specifically a tool for assessing posture development, the Gross Motor subscale includes items such as the ability to sit, stand, and squat.
One HR-ND infant demonstrated nonspecific developmental delays (“other delay”) as indicated by MSEL standard scores at or below 1.5 SD from the mean on the non-language subscales of the Mullen (i.e., Visual Reception, Fine Motor) at 36 months. This infant’s parents did not report any concerns about her development, and she never received early intervention services. Further, visual inspection of the data suggested that posture development for this infant was not substantially different from other HR-ND infants; thus, the decision was made to retain this infant in this category.
Before conducting analyses all percentage data were arcsine transformed (2 × arcsin[sqrt(x)]) to correct for nonnormality that typically results from percentage data (Cohen et al., 2013). Models were run with both the arcsine transformed and non-transformed data. In all cases, normality improved with the arcsine transformation but results remained unchanged (although significance values may have attenuated or strengthened). Thus, for ease of interpretation, descriptive data (e.g., mean percentages) as well as the coefficients and standard errors for the HLM models reported below are those for the untransformed percentages.
There were 15 missing sessions at 6 months (14 HR, 1 LR); 10 missing sessions at 8 months (9 HR, 1 LR); 3 missing sessions at 10 months (2 HR, 1 LR); 2 missing sessions at 12 months (1 HR, 1 LR); and 2 missing sessions at 14 months (both HR).
Sex was included as a grand-mean centered covariate at Level 2 in light of evidence that boys may show a slight advantage over girls in gross motor performance (Thomas and French 1985).
Although the HR-ND group exhibited a pattern of sitting development that was similar to the other HR groups, they did not differ significantly from the LR group on any growth parameters.
While motor development can be an agent of change for the developing language and communication system, the acquisition of language draws on a complex array of multiple skills from multiple domains. In addition, there are likely alternative pathways for accessing similar language learning contexts that, in normative development, are provided by gains in motor skills (Iverson 2010).
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This article is based on a dissertation submitted to the University of Pittsburgh in partial fulfillment of the requirements for the degree of Doctor of Philosophy by the first author Nina B. Leezenbaum. The research was supported by Autism Speaks and the National Institutes of Health (R01 HD41607 and R01 HD54979 to JMI) and an Autism Science Foundation Predoctoral Fellowship to NBL. Additional support was provided by NIH HD35469 and HD055748 to N. Minshew. We thank members of the Infant Communication Lab at the University of Pittsburgh for assistance with data collection and coding, Dr. Elizabeth Votruba-Drzal for statistical advice, and Drs. Nancy Minshew, Diane Williams, and Susan B. Campbell, Celia Brownell, and Michael Pogue-Geile for valuable contributions at various stages of the project. A special thanks to the families and infants who participated in the research.
This study was funded by Autism Speaks and the National Institutes of Health (R01 HD41607 and R01 HD54979) with additional support form an Autism Science Foundation Predoctoral Fellowship.
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The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Leezenbaum, N.B., Iverson, J.M. Trajectories of Posture Development in Infants With and Without Familial Risk for Autism Spectrum Disorder. J Autism Dev Disord 49, 3257–3277 (2019). https://doi.org/10.1007/s10803-019-04048-3
- Infant siblings
- Autism spectrum disorder
- Motor development