Skip to main content
SpringerLink
Log in

Screening for Behavioral Signs of Autism Spectrum Disorder in 9-Month-Old Infant Siblings

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

Despite considerable progress in characterizing the early signs of autism spectrum disorder (ASD), more remains to be learned about how symptoms emerge in the first year of life. Parents with a new baby who already had at least one biological child diagnosed with ASD (high-risk) or no family history of ASD (low-risk) completed two measures when their baby was 9 months of age, the Autism Parent Screen for Infants (APSI) questionnaire and the interview-based Parent Concerns Form. Children underwent a blinded independent diagnostic assessment for ASD at age 3 years. Total scores on the APSI and the Parent Concerns Form were both able to independently differentiate high-risk children who were later diagnosed with ASD from other high-risk and low-risk children who were not. Using logistic regression, we found that the total score on the APSI predicted ASD outcomes at age 3 with 70% accuracy, but the Parent Concerns Form did not contribute any unique variance when the APSI was already in the model. The results suggest that the APSI identifies early features predictive of ASD in high-risk infants and can be used to flag them for targeted follow-up and screening.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Akobeng, A. K. (2007). Understanding diagnostic tests 3: Receiver operating characteristic curves. Acta Paediatricia, 96, 644–647.

    Article  Google Scholar 

  • Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society, Series B (Methodological), 57, 289–300.

    Article  Google Scholar 

  • Bosl, W. J., Tager-Flusberg, H., & Nelson, C. A. (2018). EEG analytics for early detection of autism spectrum disorder: A data-driven approach. Scientific Reports, 8, 6828. https://doi.org/10.1038/s41598-018-24318-x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brian, J., Doyle-Thomas, K., Baribeau, D., & Anagnostou, E. (2016). Novel mechanisms and treatment approaches in autism spectrum disorder. Discovery Medicine, 22(119), 47–54.

    PubMed  Google Scholar 

  • Bryson, S.E., Zwaigenbaum, L., Brian, J., & Roberts, W. (2006). Autism Parent Screen for Infants (APSI).

  • Bryson, S. E., Zwaigenbaum, L., McDermott, C., & Roberts, W. (2008). The autism observation scale for infants: Scale development and reliability data. Journal of Autism and Developmental Disorders, 38(4), 731–738.

    Article  PubMed  Google Scholar 

  • Chakrabarti, S., & Fombonne, E. (2005). Pervasive developmental disorders in preschool children: Confirmation of high prevalence. American Journal of Psychiatry, 162, 1133–1141.

    Article  Google Scholar 

  • Cicchetti, D. V., Volkmar, F., Klin, A., & Showalter, D. (1995). Diagnosing autism using ICD-10 criteria: A comparison of neural networks and standard multivariate procedures. Child Neuropsychology, 1(1), 26–37.

    Article  Google Scholar 

  • Cohen, J. (1988). Statistical power analyses for the behavioral sciences (2nd ed.). Mahwah: L. Earlbaum Associated.

    Google Scholar 

  • Daniels, A. M., & Mandell, D. S. (2014). Explaining differences in age at autism spectrum disorder diagnosis: A critical review. Autism, 18(5), 583–597.

    Article  PubMed  Google Scholar 

  • Durkin, M. S., Elsabbagh, M., Barbaro, J., Gladstone, M., Happe, F., Hoekstra, R. A., et al. (2015). Autism screening and diagnosis in low resource settings: Challenges and opportunities to enhance research and services worldwide. Autism Research, 8(5), 473–476.

    Article  PubMed  PubMed Central  Google Scholar 

  • Elsabbagh, M., Mercure, E., Hudry, K., Chandler, S., Pasco, G., Charman, T., et al. (2012). Infant neural sensitivity to dynamic eye gaze is associated with later emerging autism. Current Biology, 22(4), 338–342. https://doi.org/10.1016/j.cub.2011.12.056.

    Article  PubMed  PubMed Central  Google Scholar 

  • Emerson, R. W., Adams, C., Nishino, T., Hazlett, H. C., Wolff, J. J., Zwaigenbaum, L., et al. (2017). Functional neuroimaging of high-risk 6-month-old infants predicts a diagnosis of autism at 24 months. Science Translational Medicine, 9(393), eaag2882. https://doi.org/10.1126/scitranslmed.aag2882.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fischer, J. E., Bachmann, L. M., & Jaeschke, R. (2003). A readers’ guide to the interpretation of diagnostic test properties: Clinical example of sepsis. Intensive Care Medicine, 29, 1043–1051.

    Article  PubMed  Google Scholar 

  • Flanagan, J. E., Landa, R., Bhat, A., & Bauman, M. (2012). Head lag in infants at risk for autism: A preliminary study. American Journal of Occupational Therapy, 66(5), 577–585.

    Article  Google Scholar 

  • Fleiss, J. L. (1981). Statistical methods for rates and proportions (2nd ed.). New York: Wiley. ISBN 0-471-26370-2.

    Google Scholar 

  • Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS severity scores for a measure of severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(5), 693–705.

    Article  PubMed  Google Scholar 

  • Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007). The autism diagnostic observation schedule: Revised algorithms for improved diagnostic validity. Journal of Autism and Developmental Disorders, 37(4), 613–627.

    Article  PubMed  Google Scholar 

  • Hazlett, H. C., Gu, H., Munsell, B. C., Kim, S. H., Styner, M., Wolff, J. J., et al. (2017). Early brain development in infants at high risk for autism spectrum disorder. Nature, 542(7641), 348–351. https://doi.org/10.1038/nature21369.

    Article  PubMed  PubMed Central  Google Scholar 

  • Johnson, C. P., Myers, S. M., & American Academy of Pediatrics Council on Children with Disabilities. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120(5), 1183–1215.

    Article  PubMed  Google Scholar 

  • Klin, A., & Jones, W. (2018). An agenda for 21st century neurodevelopmental medicine: Lessons from autism. Reviews in Neurology, 66(S01), S3–S15.

    Google Scholar 

  • Klin, A., Klaiman, C., & Jones, W. (2015). Reducing age of autism diagnosis: Developmental social neuroscience meets public health challenge. Reviews in Neurology, 60(S1), S3–11.

    Google Scholar 

  • LeBarton, E. S., & Landa, R. J. (2018). Infant motor skill predicts later expressive language and autism spectrum disorder diagnosis. Infant Behavior and Development, 54, 37–47.

    Article  PubMed  Google Scholar 

  • Lewis, J. D., Evans, A. C., Pruett, J. R. Jr, Botteron, K. N., McKinstry, R. C., Zwaigenbaum, L., et al. (2017). The emergence of network inefficiencies in infants with autism spectrum disorder. Biological Psychiatry, 82(3), 176–185. https://doi.org/10.1016/j.biopsych.2017.03.006.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Jr., 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.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., Goode, S., Heemsbergen, J., Jordan, H., Mawhood, L., et al. (1989). Autism diagnostic observation schedule: A standardized observation of communicative and social behavior. Journal of Autism and Developmental Disorders, 19(2), 185–212.

    Article  PubMed  Google Scholar 

  • Lord, C., Rutter, M., & LeCouteur, A. (1994). Autism diagnostic interview-revised: A revised version of time diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659–685.

    Article  PubMed  Google Scholar 

  • Manfredonia, J., Bangerter, A., Manyakov, N. V., Ness, S., Lewin, D., Skalkin, A., et al. (2018). Automatic recognition of posed facial expression of emotion in individuals with autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(1), 75–89.

    Google Scholar 

  • Miller, M., Iosif, A. M., Hill, M., Young, G. S., Schwichtenberg, A. J., & Ozonoff, S. (2017). Response to name in infants developing autism spectrum disorder: A prospective study. Journal of Pediatrics, 183, 141–146.

    Article  Google Scholar 

  • Pierce, K., Carter, C., Weinfeld, M., Desmond, J., Hazin, R., Bjork, R., et al. (2011). Detecting, studying, and treating autism early: the one-year well-baby check-up approach. Journal of Pediatrics, 159(3), 458–465.

    Article  Google Scholar 

  • Piven, J., Elison, J. T., & Zylka, M. J. (2017). Toward a conceptual framework for early brain and behavior development in autism. Molecular Psychiatry, 22(10), 1385–1394.

    Article  PubMed  PubMed Central  Google Scholar 

  • Public Health Agency of Canada. (2018). Autism Spectrum Disorder among children and youth in Canada 2018: A report of the national Autism Spectrum Disorder surveillance system. Ottawa, ON.

  • Robins, D. L., Casagrande, K., Barton, M., Chen, C. M., Dumont-Mathieu, T., & Fein, D. (2014). Validation of the modified checklist for autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics, 133(1), 37–45.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rogers, S. J., Vismara, L., Wagner, A. L., McCormick, C., Young, G., & Ozonoff, S. (2014). Autism treatment in the first year of life: A pilot study of infant start, a parent-implemented intervention for symptomatic infants. Journal of Autism and Developmental Disorders, 44(12), 2981–2995.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sacrey, L. R., Bryson, S., Zwaigenbaum, L., Brian, J., Smith, I. M., Roberts, W., et al. (2018a). The autism parent screen for infants: Predicting risk of ASD based on parent-reported behavior observed at 6 to 24 months of age. Autism, 54(6), 470–478.

    Google Scholar 

  • Sacrey, L. R., Zwaigenbaum, L., Bryson, S., Brian, J., Smith, I. M., Roberts, W., et al. (2015). Can parents’ concerns predict autism spectrum disorder? A prospective study of high-risk siblings from 6 to 36 months of age. Journal of the American Academy of Child and Adolescent Psychiatry, 54(6), 470–478.

    Article  PubMed  Google Scholar 

  • Sacrey, L. R., Zwaigenbaum, L., Bryson, S., Brian, J., Smith, I. M., Roberts, W., et al. (2018b). Parent and clinician agreement regarding early behavioral signs in 12- and 18-month-old infants at-risk of autism spectrum disorder. Autism Research, 11, 539–547.

    Article  PubMed  Google Scholar 

  • Schertz, H. H., Odom, S. L., Baggett, K. M., et al. (2016). Parent-reported repetitive behavior in toddlers on the autism spectrum. Journal of Autism and Developmental Disorders, 46, 3308–3316.

    Article  PubMed  Google Scholar 

  • Schreibman, L., Dawson, G., Stahmer, A., Landa, R., Rogers, S. J., McGee, G. G., et al. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorder, 45(8), 2411–2428. https://doi.org/10.1007/s10803-015-2407-8.

    Article  Google Scholar 

  • Shen, M. D., & Piven, J. (2017). Brain and behavior development in autism from birth to infancy. Dialogues in Clinical Neuroscience, 19(4), 325–333.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stadnick, N., Chlebowski, C., Baker-Ericzen, M., et al. (2016). Psychiatric comorbidity in autism spectrum disorder: Correspondence between mental health clinical report and structured parent interview. Autism, 21(7), 841–851.

    Article  PubMed  PubMed Central  Google Scholar 

  • Steiner, A. M., Gengoux, G. W., Klin, A., & Chawarska, K. (2013). Pivotal response treatment for infants at-risk for autism spectrum disorders: A pilot study. Journal of Autism and Developmental Disorders, 43(1), 91–102.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wan, M. W., Green, J., & Scott, J. (2018). A systematic review of parent-infant interaction in infants at risk of autism. Autism, ePub. https://doi.org/10.1177/1362361318777484.

    Article  Google Scholar 

  • Wetherby, A. M., Brosnan-Maddox, S., Peace, V., & Newton, L. (2008). Validation of the Infant-Toddler Checklist as a broadband screener for autism spectrum disorders from 9 to 24 months of age. Autism, 12(5), 487–511.

    Article  PubMed  PubMed Central  Google Scholar 

  • Williams, K. (2016). Timely identification of children with autism: Are we asking the right question? Developmental Medicine and Child Neurology, 58, 321–331.

    Article  Google Scholar 

  • Zwaigenbaum, L., Bauman, M. L., Fein, D., Pierce, K., Buie, T., Davis, P. A., et al. (2015). Early screening of autism spectrum disorder: Recommendations for practice and research. Pediatrics, 136, S41–S59.

    Article  PubMed  Google Scholar 

  • Zwaigenbaum, L., & Penner, M. (2018). Autism spectrum disorder: Advances in diagnosis and evaluation. BMJ, 361, k1674.

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

The authors would like to thank the research assistants at each site for their help with data collection and the parents and children who participated in our study. The study was funded by Canadian Institutes of Health Research (CIHR) and Kids Brain Health Network.

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Alberta, Edmonton, AB, Canada

    Lori-Ann R. Sacrey & Lonnie Zwaigenbaum

  2. Department of Pediatrics, Autism Research Centre – E209, Glenrose Rehabilitation Hospital, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada

    Lori-Ann R. Sacrey & Lonnie Zwaigenbaum

  3. Dalhousie University/IWK Health Centre, Halifax, NS, Canada

    Susan Bryson & Isabel M. Smith

  4. Bloorview Research Institute, Toronto, ON, Canada

    Jessica Brian

  5. University of Toronto, Toronto, ON, Canada

    Jessica Brian, Peter Szatmari & Caroline Roncadin

  6. ISAND, Toronto, ON, Canada

    Wendy Roberts

  7. The Hospital for Sick Children, Toronto, ON, Canada

    Peter Szatmari

  8. Centre for Addiction and Mental Health, Toronto, ON, Canada

    Peter Szatmari

  9. University of Ottawa, Ottawa, ON, Canada

    Tracy Vaillancourt

  10. McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, ON, Canada

    Caroline Roncadin

  11. Mount Allison University, Sackville, NB, Canada

    Nancy Garon

Authors
  1. Lori-Ann R. Sacrey
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lonnie Zwaigenbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Susan Bryson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jessica Brian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Isabel M. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wendy Roberts
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peter Szatmari
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tracy Vaillancourt
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Caroline Roncadin
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Nancy Garon
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LRS made substantial contributions to conception and design, collected and analyzed the data and prepared the first draft of the paper, and approved the final draft. LZ, SB, JB, IMS, WR, PS, TV, CR, and NG contributed to the conception of the project, provided a critical review of the manuscript, and approved the final draft.

Corresponding author

Correspondence to Lori-Ann R. Sacrey.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sacrey, LA.R., Zwaigenbaum, L., Bryson, S. et al. Screening for Behavioral Signs of Autism Spectrum Disorder in 9-Month-Old Infant Siblings. J Autism Dev Disord 51, 839–848 (2021). https://doi.org/10.1007/s10803-020-04371-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-020-04371-0

Keywords

Search

Navigation