Skip to main content

Advertisement

SpringerLink
Log in

Autism Spectrum Disorders and Low Mental Age: Diagnostic Stability and Developmental Outcomes in Early Childhood

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

Abstract

Some children with autism spectrum disorders (ASDs) exhibit low mental age (Low-MA; i.e., cognitive functioning below 12 months). We examined diagnosis, symptom severity, and development in children with ASD-low MA (n = 25), autistic disorder (n = 111), and PDD-NOS (n = 82) at ages two and four. We predicted that some ASD-low MA children would demonstrate just intellectual impairment and not autism symptoms on follow-up, with social deficits at age two attributable to global delays. Instead, most ASD-low MA children (96%) had an ASD at follow-up, compared to children initially diagnosed with autistic disorder (86.5%) or PDD-NOS (73.2%). They showed the least developmental progress and highest symptom severity. Results support diagnosing ASDs in children functioning below a 12-month level.

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

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

    Google Scholar 

  • Anderson, D. K., Liang, J. W., & Lord, C. (2014). Predicting young adult outcome among more and less cognitively able individuals with autism spectrum disorders. Journal of Child Psychology and Psychiatry, 55(5), 485–494.

    Article  PubMed  Google Scholar 

  • Bagnato, S. J., & Neisworth, J. T. (1980). The intervention efficiency index: An approach to preschool program accountability. Exceptional Children, 46(4), 264–269.

    Article  Google Scholar 

  • Bagnato, S. J., & Neisworth, J. T. (1985). Efficacy of interdisciplinary assessment and treatment for infants and preschoolers with congenital and acquired brain injury. Analysis and Intervention in Developmental Disabilities, 5, 107–128.

    Article  Google Scholar 

  • Baron-Cohen, S., Cox, A., Baird, G., Swettenham, J., Drew, A., Nightingale, N., Morgan, K., & Charman, T. (1996). Psychological markers of autism at 18 months of age in a large population. British Journal of Psychiatry, 168(2), 158–163.

    Article  PubMed  Google Scholar 

  • Baron-Cohen, S., Wheelwright, S., Cox, A., Baird, G., Charman, T., Swettenham, J., Drew, A., & Doehring, P. (2000). Early identification of autism by the checklist for autism in toddlers (CHAT). Journal of the Royal Society of Medicine, 93(10), 521.

    Article  PubMed  PubMed Central  Google Scholar 

  • Barton, M. L., Robins, D. L., Jashar, D., Brennan, L., & Fein, D. (2013). Sensitivity and specificity of proposed DSM-5 criteria for autism spectrum disorder in toddlers. Journal of Autism and Developmental Disorders, 43(5), 1184–1195.

    Article  PubMed  PubMed Central  Google Scholar 

  • Berry, L. N. (2009). Early treatments associated with optimal outcome in children with autism spectrum disorders. Storrs: University of Connecticut.

    Google Scholar 

  • Chakrabarti, S., & Fombonne, E. (2001). Pervasive developmental disorders in preschool children. Journal of the American Medical Association, 285(24), 3093–3099.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Chasson, G. S., Harris, G. E., & Neely, W. J. (2007). Cost comparison of early intensive behavioral intervention and special education for children with autism. Journal of Child and Family Studies, 16(3), 401–413.

    Article  Google Scholar 

  • Chlebowski, C., Green, J. A., Barton, M. L., & Fein, D. (2010). Using the childhood autism rating scale to diagnose autism spectrum disorders. Journal of Autism and Developmental Disorders, 40(7), 787–799.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cohen, D. J., Paul, R., & Volkmar, F. R. (1986). Issues in the classification of pervasive and other developmental disorders: Toward DSM-IV. Journal of the American Academy of Child Psychiatry, 25, 213–220.

    Article  PubMed  Google Scholar 

  • DiLavore, P. C., Lord, C., & Rutter, M. (1995). The pre-linguistic autism diagnostic observation schedule. Journal of Autism and Developmental Disorders, 25(4), 355–379.

    Article  PubMed  Google Scholar 

  • Eikeseth, S., Klintwall, L., Jahr, E., & Karlsson, P. (2012). Outcome for children with autism receiving early and intensive behavioral intervention in mainstream preschool and kindergarten settings. Research in Autism Spectrum Disorders, 6, 829–835.

    Article  Google Scholar 

  • Fombonne, E. (2003). The prevalence of autism. Journal of the American Medical Association, 289(1), 87–89.

    PubMed  Google Scholar 

  • Helt, M., Kelley, E., Kinsbourne, M., Pandey, J., Boorstein, H., Herbert, M., et al. (2008). Can children with autism recover? If So, How? Neuropsychology Review, 18(4), 339–366.

    Article  PubMed  Google Scholar 

  • Howard, J., Sparkman, C., Cohen, H., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26, 359–383.

    Article  PubMed  Google Scholar 

  • Inada, N., Kamio, Y., & Koyama, T. (2010). Developmental chronology of preverbal social behaviors in infancy using the M-CHAT: Baseline for early detection of atypical social development. Research in Autism Spectrum Disorders, 4(4), 605–611.

    Article  Google Scholar 

  • Kanne, S. M., Gerber, A. J., Quirmbach, L. M., Sparrow, S. S., Cicchetti, D. V., & Saulnier, C. A. (2011). The role of adaptive behavior in autism spectrum disorders: Implications for functional outcome. Journal of Autism and Developmental Disorders, 41(8), 1007–1018.

    Article  PubMed  Google Scholar 

  • Klin, A., Carter, A. S., & Sparrow, S. S. (1997). Psychological assessment of children with autism. In D. J. Cohen & F. R. Volkmar (Eds.), Handbook of autism and pervasive developmental disorders (2nd ed.) (pp. 418–427). New York: Wiley.

    Google Scholar 

  • Klintwall, L., Eldevik, S., & Eikeseth, S. (2015). Narrowing the gap: Effects of intervention on developmental trajectories in autism. Autism: The International Journal of Research and Practice, 19(1), 53–63.

    Article  Google Scholar 

  • Lord, C. (1995). Follow-up of 2-year-olds referred for possible autism. Journal of Child Psychology and Psychiatry, 36(8), 1365–1382.

    Article  PubMed  Google Scholar 

  • Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, A., & Pickles, A. (2006). Autism from 2 to 9 years of age. Archive of General Psychiatry, 63, 694–701.

    Article  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., & Schopler, E. (1989a). The role of age at assessment, developmental level, and test in the stability of intelligence scores in young autistic children. Journal of Autism and Developmental Disorders, 19(4), 483–499.

    Article  PubMed  Google Scholar 

  • Lord, C., & Schopler, E. (1989b). Stability of assessment results of autistic and non-autistic language-impaired children from preschool years to early school age. Journal of Child Psychology and Psychiatry, 30(4), 575–590.

    Article  PubMed  Google Scholar 

  • Luyster, R., Guthrie, W., Gotham, K., Risi, S., DiLavore, P., & Lord, C. (2009). The autism diagnostic observation schedule–toddler module: preliminary findings using a modified version of the ADOS, (pp. 15–17). West Hartford: International Meeting for Autism Research.

    Google Scholar 

  • Matson, J. L., & Shoemaker, M. (2009). Intellectual disability and its relationship to autism spectrum disorders. Research in Developmental Disabilities, 30(6), 1107–1114.

    Article  PubMed  Google Scholar 

  • Moore, V., & Goodson, S. (2003). How well does early diagnosis of autism stand the test of time? Follow-up study of children assessed for autism at age 2 and development of an early diagnostic service. Autism: The International Journal of Research and Practice, 7(1), 47–63.

    Google Scholar 

  • Mullen, E. M. (1995). Mullen scales of early learning. Circle Pines, MN: American Guidance Service, Inc.

    Google Scholar 

  • Oliver, C., Petty, J., Ruddick, L., & Bacarese-Hamilton, M. (2012). The association between repetitive, self-injurious and aggressive behavior in children with severe intellectual disability. Journal of Autism and Developmental Disorders, 42(6), 910–919.

    Article  PubMed  Google Scholar 

  • Osterling, J. A., Dawson, G., & Munson, J. A. (2002). Early recognition of 1-year-old infants with autism spectrum disorder versus mental retardation. Development and Psychopathology, 14(02), 239–251.

    Article  PubMed  Google Scholar 

  • Reznick, J. S., Baranek, G. T., Reavis, S., et al. (2007). A parent-report instrument for identifying 1-year-olds at risk for an eventual diagnosis of autism: The first year inventory. Journal of Autism and Developmental Disorders, 37, 1691–1710.

    Article  PubMed  Google Scholar 

  • Robins, D. L., Casagrande, K., Barton, M., Chen, C.-M. A., 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 

  • Robins, D. L., Fein, D., Barton, M. L., & Green, J. A. (2001). The modified checklist for autism in toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders, 31(2), 131–144.

    Article  PubMed  Google Scholar 

  • Rutter, M., Le Couteur, A., Lord, C., & Faggioli, R. (2005). ADI-R: Autism diagnostic interview–revised: Manual. OS, Organizzazioni speciali. Torrance: Western Psychological Services

    Google Scholar 

  • Sallows, G. O., & Graupner, T. D. (2005). Intensive behavioral treatment for children with autism: 4-year outcome and predictors. American Journal on Mental Retardation, 110(6), 417–438.

    Article  PubMed  Google Scholar 

  • Schopler, E., Reichler, R. J., DeVellis, R. F., & Daly, K. (1980). Toward objective classification of childhood autism: Childhood autism rating scale (CARS). Journal of Autism and Developmental Disorders, 10(1), 91–103.

    Article  PubMed  Google Scholar 

  • Schopler, E., Short, A., & Mesibov, G. (1989). Relation of behavioral treatment to “normal functioning”: Comment on Lovaas. Journal of Consulting and Clinical Psychology, 57, 162–164.

    Article  PubMed  Google Scholar 

  • Sevin, J. A., Matson, J. L., Williams, D., & Kirkpatrick-Sanchez, S. (1995). Reliability of emotional problems with the diagnostic assessment for the severely handicapped (DASH). British Journal of Clinical Psychology, 34, 93–94.

    Article  PubMed  Google Scholar 

  • Shonkoff, J. P., Hauser-Cram, P., Krauss, M. W., & Upshur, C. C. (1992). Development of infants with disabilities and their families. Monographs of the Society for Research in Child Development, 57(6), 230.

    Article  Google Scholar 

  • Sigman, M., & Ruskin, E. (1999). Change and continuity in the social competence of children with autism, down syndrome, and developmental delays. Monographs of the Society for Research in Child Development, 64(1), 1–114.

    Article  PubMed  Google Scholar 

  • Sparrow, S. S., Balla, D. A., & Cicchetti, D. V. (1984). The Vineland adaptive behavior scales-interview edition. Circle Pines, MN: American Guidance Service.

    Google Scholar 

  • Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland adaptive behavior scales (2nd edn.). Circle Pines, MN: American Guidance Services.

    Google Scholar 

  • Stone, W. L., Lee, E. B., Ashford, L., Brissie, J., Hepburn, S. L., Coonrod, E. E., & Weiss, B. H. (1999). Can autism be diagnosed accurately in children under 3 years? Journal of Child Psychology and Psychiatry, 40(2), 219–226.

    Article  PubMed  Google Scholar 

  • Stone, W. L., McMahon, C. R., & Henderson, L. M. (2008). Use of the screening tool for autism in 2-Year-olds (STAT) for children under 24 months: An exploratory study. Autism: The International Journal of Research and Practice, 12(5), 557–573.

    Article  Google Scholar 

  • Sutera, S., Pandey, J., Esser, E. L., Rosenthal, M. A., Wilson, L. B., Barton, M., Green, J., Hodgson, S., Robins, D. L., Dumont-Mathieu, T., & Fein, D. (2007). Predictors of optimal outcome in toddlers diagnosed with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37(1), 98–107.

    Article  PubMed  Google Scholar 

  • Swinkels, S. H., Dietz, C., Van Daalen, E., et al. (2006). Screening for autistic spectrum in children aged 14 to 15 months: The development of the early screening of autistic traits questionnaire (ESAT). Journal of Autism and Developmental Disorders, 36(6), 723–732.

    Article  PubMed  Google Scholar 

  • Wetherby, A. M., Brosnan-Maddox, S., Peace, V., et al. (2008). Validation of the infant-toddler checklist as a broadband screener for autism spectrum disorders from 9 to 24 months of age. Autism: The International Journal of Research and Practice, 12(5), 487–511.

    Article  Google Scholar 

  • Wolery, M., & Dyk, L. (1985). The evaluation of two levels of a center based early intervention project. Topics in Early Childhood Special Education, 5(2), 66–77.

    Article  Google Scholar 

Download references

Acknowledgments

The authors wish to thank the families and clinicians who participated in the current study, as well as the Early Detection Study research team at the University of Connecticut for their assistance with data collection.

Funding

This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Grant number R01HD039961) and the Maternal and Child Health Bureau (Grant number R40MC00270).

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, University of Michigan Health System, 325 East Eisenhower Parkway, Suite 100, Ann Arbor, MI, 48108, USA

    Alexander J. Hinnebusch

  2. Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA

    Lauren E. Miller & Deborah A. Fein

Authors
  1. Alexander J. Hinnebusch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lauren E. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deborah A. Fein
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AH participated in conception of the study design, data collection, performance of statistical analyses, and drafting of the manuscript; LM participated in performance of statistical analyses, interpretation of the data, and revising of the manuscript; DF participated in conception of the study design, data collection, interpretation of the data, and revising of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Lauren E. Miller.

Ethics declarations

Conflict of interest

Deborah Fein is part owner of M-CHAT-R, LLC, which receives royalties from companies that incorporate the M-CHAT-R into commercial products and charge for its use. Data reported in the current paper is from the freely available paper versions of the M-CHAT and M-CHAT-R. Alexander Hinnebusch and Lauren Miller declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Appendix

Appendix

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hinnebusch, A.J., Miller, L.E. & Fein, D.A. Autism Spectrum Disorders and Low Mental Age: Diagnostic Stability and Developmental Outcomes in Early Childhood. J Autism Dev Disord 47, 3967–3982 (2017). https://doi.org/10.1007/s10803-017-3278-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-017-3278-y

Keywords

Search

Navigation