0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Early Social-Communicative and Cognitive Development of Younger Siblings of Children With Autism Spectrum Disorders FREE

Wendy L. Stone, PhD; Caitlin R. McMahon, MS; Paul J. Yoder, PhD; Tedra A. Walden, PhD
[+] Author Affiliations

Author Affiliations: Kennedy Center (Dr Stone) and Departments of Pediatrics (Dr Stone), Psychology and Human Development (Ms McMahon and Dr Walden), and Special Education (Dr Yoder), Vanderbilt University, Nashville, Tenn.


Arch Pediatr Adolesc Med. 2007;161(4):384-390. doi:10.1001/archpedi.161.4.384.
Text Size: A A A
Published online

Objective  To compare the early social-communicative development of younger siblings of children with autism spectrum disorders (ASDs) with that of younger siblings of children with typical development, using parental report and child-based measures.

Design  Group comparison.

Setting  Vanderbilt University, between July 1, 2003, and July 31, 2006.

Participants  Younger siblings of children with ASD (n = 64) and younger siblings of children with typical development (n = 42) between the ages of 12 and 23 months (mean, 16 months).

Main Exposure  Having a sibling with an ASD.

Outcome Measures  Child-based measures included a cognitive assessment; an interactive screening tool assessing play, imitation, and communication; and a rating of autism symptoms. Parental report measures were an interview of social-communicative interactions and a questionnaire assessing language and communication skills.

Results  Younger siblings of children with ASD demonstrated weaker performance in nonverbal problem solving (mean difference [MD], 5.91; 95% confidence interval [CI], 2.48-9.34), directing attention (MD, 0.52; 95% CI, 0.07-0.97), understanding words (MD, 33.30; 95% CI, 3.11-63.48), understanding phrases (MD, 4.56; 95% CI, 1.85-7.27), gesture use (MD, 1.49; 95% CI, 0.51-2.47), and social-communicative interactions with parents (MD, 1.32; 95% CI, 0.27-2.37), and had increased autism symptoms (MD, 2.54; 95% CI, 1.05-4.03), relative to control siblings. A substantial minority of the ASD sibling group exhibited lower performance relative to controls. Significant correlations between child-based measures and parental reports assessing similar constructs were found (r = −0.74 to 0.53; P range, .000-.002).

Conclusion  The weaker performance found for children in the ASD sibling group may represent early-emerging features of the broader autism phenotype, thus highlighting the importance of developmental surveillance for younger siblings.

Figures in this Article

Twin and family studies support a strong genetic basis for autism.1 The genetic risk to parents and siblings extends not only to diagnosed autism spectrum disorders (ASDs) but also to milder variants, often referred to as the “broader autism phenotype.” The broader phenotype includes traits that are not necessarily associated with disability, but are conceptually similar to the core autism symptom domains.2,3 Multiple studies48 have demonstrated elevated rates of impairments (eg, social and communication impairments and language delays) in relatives of children with autism. Although these phenotypic features may be below the diagnostic threshold, they may still have an effect on early development and learning.

Estimates of the recurrence risk for ASD in younger siblings of children with ASD (Sibs-ASD) have ranged from 6% to 9%,1,9,10 although rates as high as 29% and 37% have been reported recently.11,12 In addition to those siblings who are diagnosed as having an ASD, others may demonstrate broader phenotypic features, particularly language delays.1214 These findings highlight the heterogeneity that characterizes Sibs-ASD and the unique opportunity they provide for studying the early development of autism and related disorders.

Much of our information about the early manifestations of autism derives from retrospective parental reports and home videotapes,1518 which may be limited by recall biases or unstandardized contexts.19 The prospective study19 of infant Sibs-ASD allows for longitudinal investigation of development using direct observations and standard assessments. This approach can provide information not only about the earliest signs of autism but also about the development, manifestation, and boundaries of specific behaviors that may represent the broader autism phenotype, such as social and communication skills.

Recent studies13,14,2022 have found that Sibs-ASD demonstrate differences in social and communicative development by the age of 14 to 18 months, such as less advanced levels of requesting, initiating and responding to joint attention, and language and gesture development, relative to siblings of typically developing children (Sibs-TD). Moreover, the latter differences exist even when children who are later diagnosed as having an ASD or language delays are excluded from analyses, suggesting the pervasiveness of early communicative differences in Sibs-ASD.13 Because children with autism often have learning delays compared with their low-risk peers, cognitive functioning is another area warranting investigation. Information about early performance on standardized cognitive measures is available only for the subgroup of Sibs-ASD who are later diagnosed as having an ASD, or for language subscales only.12,13 Thus, the extent to which differences in verbal and nonverbal cognitive abilities exist within the broader group of high-risk siblings, relative to control siblings, is not yet known.

The present study compares the early social-communicative and cognitive development of Sibs-ASD and Sibs-TD. This study extends our knowledge by using a relatively large sample to examine group differences and within-group patterns of performance for child-based and parental report measures.

PARTICIPANTS

This study included 106 participants: 64 Sibs-ASD and 42 Sibs-TD. Eligible participants had (1) a chronological age between 12 and 23 months, inclusive; (2) no severe sensory or motor impairments that would impede completion of research assessments; (3) no identified metabolic, genetic, or progressive neurological disorders; (4) English as the primary language; and (5) an older sibling. Eligibility for the Sibs-ASD group required that the older sibling (ie, proband) be diagnosed as having autism, pervasive developmental disorder not otherwise specified, or Asperger disorder; proband diagnoses and available supporting information were obtained from parents. Eligibility for the Sibs-TD group required that the older sibling have no developmental disorders and that there be no family history of autism or mental retardation in first-degree relatives; this information was obtained through a family history interview with parents.

Children were recruited between July 1, 2003, and July 31, 2006. The Sibs-ASD were recruited from university-based autism (n = 34) and speech-language (n = 16) programs, and community agencies (n = 14). The Sibs-TD were recruited through a birth record database (n = 18), university-based research programs (n = 13), and community agencies (n = 11). The research protocol received approval from the Vanderbilt University institutional review board, and all parents signed informed consent forms before beginning any research procedures.

The sample was 87% white and 57% male. Parental occupations ranged from semiskilled to professional,23 and nearly all mothers (99%) completed high school (Table 1). The groups differed significantly on maternal education (mean difference [MD], 0.42; 95% confidence interval [CI], 0.08-0.76), with mothers of Sibs-TD having a higher mean educational level than mothers of Sibs-ASD. The number of older siblings was comparable in the Sibs-ASD (mean, 1.8) and Sibs-TD (mean, 1.6) groups (MD, 0.23; 95% CI, −0.11 to 0.56). Of the probands, 40 (63%) had autism, 21 (33%) had pervasive developmental disorder not otherwise specified, and 2 (4%) had Asperger syndrome. (Number of probands does not add to 64 because 2 Sibs-ASD came from the same family.)

Table Graphic Jump LocationTable 1. Participant Characteristics*
PROCEDURES

All assessments and interviews were conducted or supervised by experienced licensed psychologists, in collaboration with reliably trained graduate students (C.R.M. and others) or research assistants. With the exception of the Childhood Autism Rating Scale (CARS), each measure was administered by a different member of the research team in a single 3-hour session. In rare cases, families were rescheduled for a second session because of child fatigue. Examiners were not blind to sibling group.

MEASURES
Mullen Scales of Early Learning

The Mullen Scales of Early Learning (MSEL)24 is a measure of cognitive function designed for children from birth through the age of 68 months. Cognitive subscales measure the domains of nonverbal problem solving (visual reception), fine motor skills, receptive language, and expressive language. The MSEL provides a t score (mean, 50; SD, 10) for each domain and an overall early learning composite (mean, 100; SD, 15). The MSEL has strong concurrent validity with other cognitive and language measures and is used commonly with young children with autism.24 The 4 t scores and the early learning composite were used to measure cognitive development.

Childhood Autism Rating Scale

The CARS25 is a 15-item scale used to assess autism symptoms (eg, social relating, communication, and body use). Items are rated on a 4-point scale (including midpoints) according to degree of abnormality. Total scores range from 15 to 60, with scores 30 and higher suggesting the presence of autism. The CARS has strong test-retest reliability and correlations with clinical ratings.25 This measure was completed collaboratively by the research team after observing the child's behaviors during the entire session. The total CARS score was used as a continuous measure of autism symptoms, consistent with previous research.26,27

Screening Tool for Autism in Two-Year-Olds

The Screening Tool for Autism in Two-Year-Olds (STAT)28,29 is an interactive screening tool developed to identify autism risk in children between the ages of 24 and 36 months. It consists of 12 activity-based items that are coded live and assess 4 social-communicative domains: play (2 items), requesting (2 items), directing attention (4 items), and motor imitation (4 items). Within each domain, items are scored as pass or fail according to specific behavioral criteria, and domain scores reflect the number of items passed. The total STAT score is calculated from the average number of failures across domains; this score ranges from 0 to 4 (in increments of 0.25). Higher total scores represent more impaired social-communicative performance, with scores of 2 or greater indicating autism risk. The STAT has strong screening properties for those aged 24 to 36 months, including sensitivity and specificity, interobserver agreement, test-retest reliability, and concurrent validity with the Autism Diagnostic Observation Schedule and clinical diagnosis.29 Prior research30 has used the STAT in children younger than 24 months, and preliminary data have revealed strong psychometric properties for children as young as 14 months, using a higher cutoff score (ie, 2.75) (W.L.S. and L. Henderson, PhD, unpublished data, 2006). In the present study, the total STAT score was used as a measure of overall social-communicative functioning, and the 4 individual domain scores were used to measure specific social-communicative skills.

MacArthur Communicative Development Inventories

The MacArthur Communicative Development Inventories (MCDI)30 is a parental report measure of child language and communication development commonly used with young children with ASD.31 Four scores from the Words and Gestures form were used: number of words understood, number of words used, number of phrases understood, and number of communicative gestures used. Vocabulary scores were derived by summing the number of words on a 396-item vocabulary checklist endorsed as understood (vocabulary comprehension) or understood and used (vocabulary production). The score for gestures used was derived from a 12-item scale with a 3-point response format (ie, not yet, sometimes, or often); the latter 2 responses were collapsed into a single category for analysis. The score for phrases understood was derived by summing the number of items endorsed from a list of 28 phrases.

Detection of Autism by Infant Sociability Interview

The Detection of Autism by Infant Sociability Interview (DAISI)32 is a semistructured parental interview developed to measure social engagement behaviors present before the age of 2 years. Items assess early dyadic (eg, turn taking) and triadic (eg, referential eye contact) interactions. Retrospective use of the DAISI with parents of undiagnosed 2- to 4-year-old children found that 15 key items differentiated children who were subsequently diagnosed as having autism from those diagnosed as having nonautistic developmental delay.32 In the present study, the 15-item version was used; scores range from 0 to 15, with higher scores reflecting more optimal social-communicative development.

PRELIMINARY ANALYSES

Preliminary analyses were conducted to examine the relationship between maternal education and chronological age and the other variables of interest. When appropriate, maternal education, chronological age, or both were entered as covariates in subsequent analyses. Mean differences and 95% CIs are reported for analyses of covariance and multivariate analyses of covariance. Results from χ2 analyses are presented as odds ratios (ORs) (Sibs-ASD/Sibs-TD) with 95% CIs.

CHILD-BASED MEASURES

Children in the Sibs-ASD group obtained significantly lower mean cognitive scores than those in the Sibs-TD group on the MSEL early learning composite (MD, 6.95; 95% CI, 1.45-12.45) and the MSEL visual reception domain (MD, 5.91; 95% CI, 2.48-9.34) (Table 2). Autism symptoms on the CARS were greater for Sibs-ASD than Sibs-TD (MD, 2.54; 95% CI, 1.05-4.03). In addition, social-communicative performance was lower for Sibs-ASD on the STAT total (MD, 0.31; 95% CI, 0.01-0.61) and the directing attention domain (MD, 0.52; 95% CI, 0.07-0.97).

Table Graphic Jump LocationTable 2. Data for Child-Based Measures

The pattern of scores within each group suggested that the lower performance of the Sibs-ASD characterized a substantial subgroup of this sample, rather than a few outlying low performers. For example, 34 (53%) of Sibs-ASD (vs 12 [29%] of Sibs-TD) had 1 or more below-average MSEL domain scores (ie, <40) (χ2 = 6.22; OR, 2.83 [95% CI, 1.24-6.50]), and 23 (36%) Sibs-ASD (vs 6 [14%] Sibs-TD) obtained total STAT scores in the at-risk range (ie, ≥2.75) (χ2 = 5.98; OR, 0.30 [95% CI, 0.11-0.81]).

PARENTAL REPORT MEASURES

Significant group differences were found for the DAISI (MD, 1.32; 95% CI, 0.27-2.37), with parents of Sibs-ASD reporting fewer social-communicative behaviors. On the MCDI, significant differences were found for vocabulary comprehension (MD, 33.30; 95% CI, 3.11-63.48), phrases understood (MD, 4.56; 95% CI, 1.85-7.27), and gestures used (MD, 1.49; 95% CI, 0.51-2.47) (Table 3).

Table Graphic Jump LocationTable 3. Data for Parental Report Measures

Again, a substantial minority of Sibs-ASD were in the lower-performing subgroup. For example, 19 (30%) Sibs-ASD (vs 1 [2%] Sibs-TD) reportedly understood fewer than 10 phrases (χ2 = 12.61; OR, 17.71 [95% CI, 2.27-138.27]), 10 (16%) (vs 0) used fewer than 5 gestures (χ2 = 7.00; OR, undefined), 35 (55%) (vs 14 [33%]) understood fewer than 100 words (χ2 = 5.00; OR, 2.50 [95% CI, 1.11-5.63]), and 9 (14%) (vs 0) obtained DAISI scores lower than those previously reported for children with developmental delay (χ2 = 6.45; OR, undefined).32

Correlations between child-based and parental report variables measuring similar constructs revealed significant agreement. Parental report on the DAISI was correlated with children's total STAT and CARS scores, and MSEL language scores were correlated with MCDI scores (Table 4).

Table Graphic Jump LocationTable 4. Correlations Between Child-Based and Parental Report Measures
DISTRIBUTIONS OF SCORES

Scatterplots were used to examine patterns of scores within and between groups. Figure 1 illustrates patterns of performance on the STAT and CARS, both of which measure autism symptoms. For most Sibs-TD (36 [86%] of 42 children), scores clustered in the lower left quadrant, indicating few or no signs of autism symptoms. Scores for the Sibs-ASD showed more variability; whereas most (41 [64%] of 64) children demonstrated a pattern similar to the Sibs-TD, a substantial minority of the Sibs-ASD obtained scores in the at-risk range (ie, ≥2.75) on the STAT (23 [36%] of 64 children), 3 of whom also had clinical scores (ie, ≥30) on the CARS. Six of the Sibs-TD also obtained scores in the at-risk range on the STAT; however, 5 of these children were younger than 14 months, which is below the age for which it is recommended. None of the Sibs-TD scored in the clinical range on the CARS.

Place holder to copy figure label and caption
Figure 1.

Distribution of scores on the Screening Tool for Autism in Two-Year-Olds (STAT) vs the Childhood Autism Rating Scale (CARS). The line at x = 2.75 indicates the autism spectrum disorder (ASD) risk cutoff for children younger than 24 months on the STAT, and the line at y = 30.0 indicates the ASD cutoff on the CARS. Higher scores on both scales indicate increased autism symptoms. Sibs-ASD indicates siblings of children with ASD; and Sibs-TD, siblings of typically developing children.

Graphic Jump Location

Figure 2 provides a comparison of patterns across parental report (DAISI) and child-based (STAT) measures of social-communicative behaviors. Again, many of the Sibs-TD (36 [86%] of 42 children) demonstrated well-developed social-communicative skills (ie, higher DAISI scores and lower STAT scores). The Sibs-ASD demonstrated more variable performance, with higher proportions obtaining suboptimal scores on 1 (16 [25%] of 64 children) or both (8 [12%] of 64 children) measures.

Place holder to copy figure label and caption
Figure 2.

Distribution of scores on the Screening Tool for Autism in Two-Year-Olds (STAT) vs the Detection of Autism by Infant Sociability Interview (DAISI). The line at x = 2.75 indicates the autism spectrum disorder (ASD) risk cutoff for children younger than 24 months on the STAT, and the line at y = 10 indicates the point below which only children with autism scored in the original DAISI sample. Higher scores on the STAT and lower scores on the DAISI indicate greater social-communicative impairment. Sibs-ASD indicates siblings of children with an autism spectrum disorder; and Sibs-TD, siblings of typically developing children.

Graphic Jump Location

The results of this study revealed that Sibs-ASD demonstrated significantly lower performance across measures of social-communicative development, cognitive functioning, and autism symptoms, relative to their low-risk peers. Weaker social-communicative performance for Sibs-ASD was found on the STAT, an interactive measure assessing play, imitation, and communication; the DAISI, a parent interview assessing early social, affective, and communication behaviors; and the MCDI, a parental questionnaire assessing verbal and nonverbal understanding and expression. The consistency of results obtained across different methods highlights the robustness of these findings.

Results of cognitive testing with the MSEL revealed group differences for the composite score and for the scale assessing nonverbal problem solving (ie, visual reception). However, mean scores for both groups were well within the average range. The weaker performance on visual reception demonstrated by the Sibs-ASD was somewhat surprising, given that nonverbal ability is often described as a relative strength for young children with ASD.33 However, several items on this scale involve the presentation of verbal instructions and/or require a gestural response (eg, pointing). It is, thus, possible that these findings are related to the lower language understanding and gesture use demonstrated by Sibs-ASD. Significant positive correlations between the MSEL and MCDI support this interpretation.

Our failure to find expressive language differences between the sibling groups, either for parental report or cognitive measures, was also unexpected. Language impairments, including early delays in spoken language, are a prominent feature of autism and an important behavioral marker for early identification.34,35 This finding may be explained by the young ages of the children in this study. Similar results with young ASD group siblings were obtained by Mitchell et al,13 who concluded that gestural deficits may be apparent earlier than language deficits and may, therefore, represent more sensitive markers for early detection.

Group differences for directing attention (ie, initiating joint attention), which represents a core feature of autism,3638 were found on the STAT. This result is consistent with findings from other recent studies14,21,39,40 demonstrating differences in initiating joint attention for Sibs-ASD on the Early Social Communication Scale. Joint attention is a key developmental skill that has been associated with language acquisition in children with typical development and in those with autism.4146 The implications of early developmental differences in joint attention for subsequent language development in Sibs-ASD are not yet known, because normative data are not available for many social-communicative behaviors, including joint attention. As a result, the point at which behavioral differences represent delayed or disordered development (or risk for such) is not known.

One important question regarding group comparisons between siblings of children with ASD and siblings of children with typical development is the extent to which group differences may be attributable to a few Sibs-ASD whose performance may be particularly impaired. Our results suggest that a substantial proportion of Sibs-ASD—rather than a few “outliers”—demonstrated weaker performance relative to the Sibs-TD. For example, more than half of the Sibs-ASD obtained 1 or more below-average MSEL subtest scores and more than one third obtained STAT scores in the “at-risk” range. Moreover, scatterplots illustrated the clustering of scores within the optimal range for the Sibs-TD, whereas the Sibs-ASD demonstrated considerable variability in performance. These results are consistent with those of Goldberg et al,21 who found a wide distribution of Early Social Communication Scale scores in a young sample of Sibs-ASD.

Because the study of infant siblings is a fairly new area of research, follow-up diagnostic evaluations have extended only to the age of 24 months. Thus, we have little information about long-term developmental pathways or trajectories. It could be the case that mild behavioral differences in this group resolve on their own over time, without intervention and with no ill effects. On the other hand, it is possible that slight differences in social-communicative behavior may limit a young child's exposure to crucial social input and result in a cascade of developmental sequelae.47 Conceptualizations of brain development suggest that atypical early experiences may have a significant effect on brain growth and later neuropsychological functioning.4750 Therefore, understanding the early development of these high-risk siblings may suggest treatment (or prevention) strategies for attenuating early developmental differences and optimizing outcomes. Longitudinal follow-up of these high-risk siblings is under way, and will clarify the implications of early behavioral differences. Meanwhile, however, developmental surveillance is important to ensure that any needed assessment or intervention referrals are made as early as possible.

In sum, the study of infant siblings of children with ASD offers an important opportunity to learn about the earliest signs of autism and/or broader phenotypic features, and to understand normative and disrupted patterns of early social-communicative development. This research has the potential to increase our knowledge about the early development of autism and to develop tailored intervention and prevention strategies for promoting optimal outcomes in this group of at-risk children.

Correspondence: Wendy L. Stone, PhD, Vanderbilt University, Peabody Box 74, 230 Appleton Pl, Nashville, TN 37203 (wendy.stone@vanderbilt.edu).

Accepted for Publication: November 15, 2006.

Author Contributions:Study concept and design: Stone, Yoder, and Walden. Acquisition of data: Stone, McMahon, and Walden. Analysis and interpretation of data: Stone, McMahon, Yoder, and Walden. Drafting of the manuscript: Stone and McMahon. Critical revision of the manuscript for important intellectual content: Stone, McMahon, Yoder, and Walden. Statistical analysis: Stone, McMahon, and Yoder. Obtained funding: Stone, Yoder, and Walden. Administrative, technical, and material support: Stone, McMahon, and Walden. Study supervision: Stone and Walden.

Financial Disclosure: The STAT will soon be published and available commercially. Dr Stone will be receiving a royalty share under the Vanderbilt technology policy.

Funding/Support: This study was supported by grant R01 HD043292 and in part by grants P30 HD15052 and T32 HD07226 from the National Institute of Child Health and Human Development; a Mentor-Based Postdoctoral Fellowship from the National Alliance for Autism Research; and in part by the Vanderbilt University Kennedy Center Marino Autism Research Institute.

Role of the Sponsor: The funding bodies had no role in data extraction and analyses, in the writing of the manuscript, or in the decision to submit the manuscript for publication.

Acknowledgment: We thank Anne Osberger, BS, and Meredith Martin, BS, for initial development of materials and procedures; Lauren Turner, PhD, Stacie Pozdol, MS, Lynnette Henderson, PhD, Teresa Ulman, MS, Evon Lee, PhD, Vanessa Elliott, PhD, and Linda Ashford, PhD, for contributions to the assessment process; Justin Lane, BA, Kelly Wendel, MEd, Helki Crowder, BS, Holly Breece, BS, Joanna Mussey, BS, and Eric Esters, BS, for project and data management; and the families who participated in this research project.

Szatmari  PJones  MZwaigenbaum  LMacLean  J Genetics of autism: overview and new directions. J Autism Dev Disord 1998;28351- 368
PubMed Link to Article
Folstein  SEPiven  J Etiology of autism: genetic influences. Pediatrics 1991;87 ((pt 2)) 767- 773
PubMed
Wassink  THBrzustowicz  LMBartlett  CWSzatmari  P The search for autism disease genes. Ment Retard Dev Disabil Res Rev 2004;10272- 283
PubMed Link to Article
Bailey  APalferman  SHeavey  LLe Couteur  A Autism: the phenotype in relatives. J Autism Dev Disord 1998;28369- 392
PubMed Link to Article
Le Couteur  ABailey  AGoode  S  et al.  A broader phenotype of autism: the clinical spectrum in twins. J Child Psychol Psychiatry 1996;37785- 801
PubMed Link to Article
Piven  JGayle  JChase  G  et al.  A family history study of neuropsychiatric disorders in the adult siblings of autistic individuals. J Am Acad Child Adolesc Psychiatry 1990;29177- 183
PubMed Link to Article
Smalley  SLMcCracken  JTanguay  P Autism, affective disorders, and social phobia. Am J Med Genet 1995;6019- 26
PubMed Link to Article
Szatmari  PMacLean  JJones  M  et al.  The familial aggregation of the lesser variant in biological and nonbiological relatives of PDD probands: a family history study. J Child Psychol Psychiatry 2000;41579- 586
PubMed Link to Article
Piven  JPalmer  PJacobi  DChildress  DArndt  S Broader autism phenotype: evidence from a family history study of multiple-incidence autism families. Am J Psychiatry 1997;154185- 190
PubMed
Ritvo  ERJorde  LBMason-Brothers  A  et al.  The UCLA–University of Utah epidemiologic survey of autism: recurrence risk estimates and genetic counseling. Am J Psychiatry 1989;1461032- 1036
PubMed
Zwaigenbaum  LBryson  SRogers  TRoberts  WBrian  JSzatmari  P Behavioral manifestations of autism in the first year of life. Int J Dev Neurosci 2005;23143- 152
PubMed Link to Article
Landa  RGarrett-Mayer  E Development in infants with autism spectrum disorders: a prospective study. J Child Psychol Psychiatry 2006;47629- 638
PubMed Link to Article
Mitchell  SBrian  JZwaigenbaum  L  et al.  Early language and communication development of infants later diagnosed with autism spectrum disorder. J Dev Behav Pediatr 2006;27 ((suppl)) S69- S78
PubMed Link to Article
Yirmiya  NGamliel  IPilowsky  TFeldman  RBaron-Cohen  SSigman  M The development of siblings of children with autism at 4 and 14 months: social engagement, communication, and cognition. J Child Psychol Psychiatry 2006;47511- 523
PubMed Link to Article
Dahlgren  SOGillberg  C Symptoms in the first two years of life: a preliminary population study of infantile autism. Eur Arch Psychiatry Neurol Sci 1989;238169- 174
PubMed Link to Article
Ohta  MNagai  YHara  HSasaki  M Parental perception of behavioral symptoms in Japanese autistic children. J Autism Dev Disord 1987;17549- 563
PubMed Link to Article
Baranek  GT Autism during infancy: a retrospective video analysis of sensory-motor and social behaviors at 9-12 months of age. J Autism Dev Disord 1999;29213- 224
PubMed Link to Article
Osterling  JADawson  GMunson  JA Early recognition of 1-year-old infants with autism spectrum disorder versus mental retardation. Dev Psychopathol 2002;14239- 251
PubMed Link to Article
Zwaigenbaum  LThurm  AStone  W  et al.  Studying the emergence of autism spectrum disorders in high-risk infants: methodological and practical issues [published online ahead of print August 4, 2006]. J Autism Dev Disord doi:10.1007/s /0803-006-0179-x
Cassel  TDMessinger  DSIbanez  LVHaltigan  JDAcosta  SIBuchman  AC Early social and emotional communication in the infant siblings of children with autism spectrum disorders: an examination of the broad phenotype [published online ahead of print December 21, 2006]. J Autism Dev Disord doi:10.1007/s /0803-006-0337-1
Goldberg  WAJarvis  KLOsann  K  et al.  Brief report: early social communication behaviors in the younger siblings of children with autism. J Autism Dev Disord 2005;35657- 664
PubMed Link to Article
Presmanes  AGWalden  TAStone  WLYoder  PJ Effects of different attentional cues on responding to joint attention in younger siblings of children with autism spectrum disorders [published online ahead of print December 21, 2006]. J Autism Dev Disord
PubMeddoi:10.1007/s/10803-006-0338-0
Hollingshead  A Four Factor Index of Social Status.  New Haven, Conn Dept of Sociology, Yale University1975;
Mullen  E Mullen Scales of Early Learning.  Circle Pines, Minn American Guidance Service1995;
Schopler  EReichler  RRenner  B The Childhood Autism Rating Scale.  Los Angeles, Calif Western Psychological Services1990;
Perry  ACondillac  RFreeman  NDunn-Geier  JBelair  J Multi-site study of the Childhood Autism Rating Scale (CARS) in five clinical groups of young children. J Autism Dev Disord 2005;35625- 634
PubMed Link to Article
Coplan  JJawad  A Modeling clinical outcome of children with autistic spectrum disorders. Pediatrics 2005;116117- 122
PubMed Link to Article
Stone  WLCoonrod  EEOusley  OY Brief report: Screening Tool for Autism in Two-Year-Olds (STAT): development and preliminary data. J Autism Dev Disord 2000;30607- 612
PubMed Link to Article
Stone  WLCoonrod  EETurner  LMPozdol  SL Psychometric properties of the STAT for early autism screening. J Autism Dev Disord 2004;34691- 701
PubMed Link to Article
Fenson  LDale  PReznick  J  et al.  The MacArthur Communicative Development Inventories: User's Guide and Technical Manual.  San Diego, Calif Singular Publishing Group1993;
McDuffie  AYoder  PStone  W Prelinguistic predictors of vocabulary in young children with autism spectrum disorders. J Speech Lang Hear Res 2005;481080- 1097
Link to Article
Wimpory  DCHobson  RPWilliams  JMNash  S Are infants with autism socially engaged? a study of recent retrospective parental reports. J Autism Dev Disord 2000;30525- 536
PubMed Link to Article
Joseph  RMTager-Flusberg  HLord  C Cognitive profiles and social-communicative functioning in children with autism spectrum disorder. J Child Psychol Psychiatry 2002;43807- 821
PubMed Link to Article
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.  Washington, DC American Psychiatric Association2000;
Filipek  PAAccardo  PJAshwal  S  et al.  Practice parameter: screening and diagnosis of autism: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology 2000;55468- 479
PubMed Link to Article
Mundy  PThorp  DCharman  TedStone  WLed The neural basis of early joint-attention behavior. Social and Communication Development in Autism Spectrum Disorders: Early Identification, Diagnosis, and Intervention. New York, NY Guilford Press2006;296- 336
Wetherby  ACharman  TedStone  WLed Understanding and measuring social communication in children with autism spectrum disorders. Social and Communication Development in Autism Spectrum Disorders: Early Identification, Diagnosis, and Intervention. New York, NY Guilford Press2006;3- 34
Coonrod  EStone  WVolkmar  FRedPaul  RedKlin  AedCohen  Ded Screening for autism in young children. Handbook of Autism and Pervasive Developmental Disorders Vol 23rd ed New York, NY John Wiley & Sons Inc2005;707- 729
Seibert  JHogan  AMundy  P Assessing interactional competencies: the Early Social-Communication Scales. Infant Ment Health J 1982;3244- 258
Link to Article
Mundy  PDelgado  CBlock  JVenezia  MHogan  ASeibert  J A Manual for the Abridged Early Social Communication Scales (ESCS).  Coral Gables, Fla Dept of Psychology, University of Miami2003;
Carpenter  MNagell  KTomasello  M Social cognition, joint attention, and communicative competence from 9 to 15 months of age. Monogr Soc Res Child Dev 1998;63i- vi, 1-143
Link to Article
Mundy  PFox  NCard  J EEG coherence, joint attention and language development in the second year. Dev Sci 2003;648- 54
Link to Article
Charman  TSwettenham  JBaron-Cohen  SBaird  GDrew  ACox  A Predicting language outcomes in infants with autism and pervasive developmental disorder. Int J Lang Commun Disord 2003;38265- 285
PubMed Link to Article
Dawson  GToth  KAbbott  R  et al.  Early social attention impairments in autism: social orienting, joint attention, and attention to distress. Dev Psychol 2004;40271- 283
PubMed Link to Article
Sigman  MRuskin  EArbeile  S  et al.  Continuity and change in the social competence of children with autism, Down syndrome, and developmental delays. Monogr Soc Res Child Dev 1999;641- 114
Link to Article
Stone  WLYoder  PJ Predicting spoken language level in children with autism spectrum disorders. Autism 2001;5341- 361
PubMed Link to Article
Mundy  PNeal  RGlidden  LM Neural plasticity, joint attention, and a transactional social-orienting model of autism. International Review of Research in Mental Retardation: Autism Vol 23 San Diego, Calif Academic Press2001;139- 168
Johnson  MH Functional brain development in humans. Nat Rev Neurosci 2001;2475- 483
PubMed Link to Article
Klin  ASchultz  RCohen  DBaron-Cohen  SedTager-Flusberg  HedCohen  Ded Theory of mind in action: developmental perspectives on social neuroscience. Understanding Other Minds: Perspectives From Developmental Neuroscience. 2nd ed. Oxford, England Oxford University Press2000;357- 388
Knudsen  EI Sensitive periods in the development of the brain and behavior. J Cogn Neurosci 2004;161412- 1425
PubMed Link to Article

Figures

Place holder to copy figure label and caption
Figure 1.

Distribution of scores on the Screening Tool for Autism in Two-Year-Olds (STAT) vs the Childhood Autism Rating Scale (CARS). The line at x = 2.75 indicates the autism spectrum disorder (ASD) risk cutoff for children younger than 24 months on the STAT, and the line at y = 30.0 indicates the ASD cutoff on the CARS. Higher scores on both scales indicate increased autism symptoms. Sibs-ASD indicates siblings of children with ASD; and Sibs-TD, siblings of typically developing children.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Distribution of scores on the Screening Tool for Autism in Two-Year-Olds (STAT) vs the Detection of Autism by Infant Sociability Interview (DAISI). The line at x = 2.75 indicates the autism spectrum disorder (ASD) risk cutoff for children younger than 24 months on the STAT, and the line at y = 10 indicates the point below which only children with autism scored in the original DAISI sample. Higher scores on the STAT and lower scores on the DAISI indicate greater social-communicative impairment. Sibs-ASD indicates siblings of children with an autism spectrum disorder; and Sibs-TD, siblings of typically developing children.

Graphic Jump Location

Tables

Table Graphic Jump LocationTable 1. Participant Characteristics*
Table Graphic Jump LocationTable 2. Data for Child-Based Measures
Table Graphic Jump LocationTable 3. Data for Parental Report Measures
Table Graphic Jump LocationTable 4. Correlations Between Child-Based and Parental Report Measures

References

Szatmari  PJones  MZwaigenbaum  LMacLean  J Genetics of autism: overview and new directions. J Autism Dev Disord 1998;28351- 368
PubMed Link to Article
Folstein  SEPiven  J Etiology of autism: genetic influences. Pediatrics 1991;87 ((pt 2)) 767- 773
PubMed
Wassink  THBrzustowicz  LMBartlett  CWSzatmari  P The search for autism disease genes. Ment Retard Dev Disabil Res Rev 2004;10272- 283
PubMed Link to Article
Bailey  APalferman  SHeavey  LLe Couteur  A Autism: the phenotype in relatives. J Autism Dev Disord 1998;28369- 392
PubMed Link to Article
Le Couteur  ABailey  AGoode  S  et al.  A broader phenotype of autism: the clinical spectrum in twins. J Child Psychol Psychiatry 1996;37785- 801
PubMed Link to Article
Piven  JGayle  JChase  G  et al.  A family history study of neuropsychiatric disorders in the adult siblings of autistic individuals. J Am Acad Child Adolesc Psychiatry 1990;29177- 183
PubMed Link to Article
Smalley  SLMcCracken  JTanguay  P Autism, affective disorders, and social phobia. Am J Med Genet 1995;6019- 26
PubMed Link to Article
Szatmari  PMacLean  JJones  M  et al.  The familial aggregation of the lesser variant in biological and nonbiological relatives of PDD probands: a family history study. J Child Psychol Psychiatry 2000;41579- 586
PubMed Link to Article
Piven  JPalmer  PJacobi  DChildress  DArndt  S Broader autism phenotype: evidence from a family history study of multiple-incidence autism families. Am J Psychiatry 1997;154185- 190
PubMed
Ritvo  ERJorde  LBMason-Brothers  A  et al.  The UCLA–University of Utah epidemiologic survey of autism: recurrence risk estimates and genetic counseling. Am J Psychiatry 1989;1461032- 1036
PubMed
Zwaigenbaum  LBryson  SRogers  TRoberts  WBrian  JSzatmari  P Behavioral manifestations of autism in the first year of life. Int J Dev Neurosci 2005;23143- 152
PubMed Link to Article
Landa  RGarrett-Mayer  E Development in infants with autism spectrum disorders: a prospective study. J Child Psychol Psychiatry 2006;47629- 638
PubMed Link to Article
Mitchell  SBrian  JZwaigenbaum  L  et al.  Early language and communication development of infants later diagnosed with autism spectrum disorder. J Dev Behav Pediatr 2006;27 ((suppl)) S69- S78
PubMed Link to Article
Yirmiya  NGamliel  IPilowsky  TFeldman  RBaron-Cohen  SSigman  M The development of siblings of children with autism at 4 and 14 months: social engagement, communication, and cognition. J Child Psychol Psychiatry 2006;47511- 523
PubMed Link to Article
Dahlgren  SOGillberg  C Symptoms in the first two years of life: a preliminary population study of infantile autism. Eur Arch Psychiatry Neurol Sci 1989;238169- 174
PubMed Link to Article
Ohta  MNagai  YHara  HSasaki  M Parental perception of behavioral symptoms in Japanese autistic children. J Autism Dev Disord 1987;17549- 563
PubMed Link to Article
Baranek  GT Autism during infancy: a retrospective video analysis of sensory-motor and social behaviors at 9-12 months of age. J Autism Dev Disord 1999;29213- 224
PubMed Link to Article
Osterling  JADawson  GMunson  JA Early recognition of 1-year-old infants with autism spectrum disorder versus mental retardation. Dev Psychopathol 2002;14239- 251
PubMed Link to Article
Zwaigenbaum  LThurm  AStone  W  et al.  Studying the emergence of autism spectrum disorders in high-risk infants: methodological and practical issues [published online ahead of print August 4, 2006]. J Autism Dev Disord doi:10.1007/s /0803-006-0179-x
Cassel  TDMessinger  DSIbanez  LVHaltigan  JDAcosta  SIBuchman  AC Early social and emotional communication in the infant siblings of children with autism spectrum disorders: an examination of the broad phenotype [published online ahead of print December 21, 2006]. J Autism Dev Disord doi:10.1007/s /0803-006-0337-1
Goldberg  WAJarvis  KLOsann  K  et al.  Brief report: early social communication behaviors in the younger siblings of children with autism. J Autism Dev Disord 2005;35657- 664
PubMed Link to Article
Presmanes  AGWalden  TAStone  WLYoder  PJ Effects of different attentional cues on responding to joint attention in younger siblings of children with autism spectrum disorders [published online ahead of print December 21, 2006]. J Autism Dev Disord
PubMeddoi:10.1007/s/10803-006-0338-0
Hollingshead  A Four Factor Index of Social Status.  New Haven, Conn Dept of Sociology, Yale University1975;
Mullen  E Mullen Scales of Early Learning.  Circle Pines, Minn American Guidance Service1995;
Schopler  EReichler  RRenner  B The Childhood Autism Rating Scale.  Los Angeles, Calif Western Psychological Services1990;
Perry  ACondillac  RFreeman  NDunn-Geier  JBelair  J Multi-site study of the Childhood Autism Rating Scale (CARS) in five clinical groups of young children. J Autism Dev Disord 2005;35625- 634
PubMed Link to Article
Coplan  JJawad  A Modeling clinical outcome of children with autistic spectrum disorders. Pediatrics 2005;116117- 122
PubMed Link to Article
Stone  WLCoonrod  EEOusley  OY Brief report: Screening Tool for Autism in Two-Year-Olds (STAT): development and preliminary data. J Autism Dev Disord 2000;30607- 612
PubMed Link to Article
Stone  WLCoonrod  EETurner  LMPozdol  SL Psychometric properties of the STAT for early autism screening. J Autism Dev Disord 2004;34691- 701
PubMed Link to Article
Fenson  LDale  PReznick  J  et al.  The MacArthur Communicative Development Inventories: User's Guide and Technical Manual.  San Diego, Calif Singular Publishing Group1993;
McDuffie  AYoder  PStone  W Prelinguistic predictors of vocabulary in young children with autism spectrum disorders. J Speech Lang Hear Res 2005;481080- 1097
Link to Article
Wimpory  DCHobson  RPWilliams  JMNash  S Are infants with autism socially engaged? a study of recent retrospective parental reports. J Autism Dev Disord 2000;30525- 536
PubMed Link to Article
Joseph  RMTager-Flusberg  HLord  C Cognitive profiles and social-communicative functioning in children with autism spectrum disorder. J Child Psychol Psychiatry 2002;43807- 821
PubMed Link to Article
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.  Washington, DC American Psychiatric Association2000;
Filipek  PAAccardo  PJAshwal  S  et al.  Practice parameter: screening and diagnosis of autism: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology 2000;55468- 479
PubMed Link to Article
Mundy  PThorp  DCharman  TedStone  WLed The neural basis of early joint-attention behavior. Social and Communication Development in Autism Spectrum Disorders: Early Identification, Diagnosis, and Intervention. New York, NY Guilford Press2006;296- 336
Wetherby  ACharman  TedStone  WLed Understanding and measuring social communication in children with autism spectrum disorders. Social and Communication Development in Autism Spectrum Disorders: Early Identification, Diagnosis, and Intervention. New York, NY Guilford Press2006;3- 34
Coonrod  EStone  WVolkmar  FRedPaul  RedKlin  AedCohen  Ded Screening for autism in young children. Handbook of Autism and Pervasive Developmental Disorders Vol 23rd ed New York, NY John Wiley & Sons Inc2005;707- 729
Seibert  JHogan  AMundy  P Assessing interactional competencies: the Early Social-Communication Scales. Infant Ment Health J 1982;3244- 258
Link to Article
Mundy  PDelgado  CBlock  JVenezia  MHogan  ASeibert  J A Manual for the Abridged Early Social Communication Scales (ESCS).  Coral Gables, Fla Dept of Psychology, University of Miami2003;
Carpenter  MNagell  KTomasello  M Social cognition, joint attention, and communicative competence from 9 to 15 months of age. Monogr Soc Res Child Dev 1998;63i- vi, 1-143
Link to Article
Mundy  PFox  NCard  J EEG coherence, joint attention and language development in the second year. Dev Sci 2003;648- 54
Link to Article
Charman  TSwettenham  JBaron-Cohen  SBaird  GDrew  ACox  A Predicting language outcomes in infants with autism and pervasive developmental disorder. Int J Lang Commun Disord 2003;38265- 285
PubMed Link to Article
Dawson  GToth  KAbbott  R  et al.  Early social attention impairments in autism: social orienting, joint attention, and attention to distress. Dev Psychol 2004;40271- 283
PubMed Link to Article
Sigman  MRuskin  EArbeile  S  et al.  Continuity and change in the social competence of children with autism, Down syndrome, and developmental delays. Monogr Soc Res Child Dev 1999;641- 114
Link to Article
Stone  WLYoder  PJ Predicting spoken language level in children with autism spectrum disorders. Autism 2001;5341- 361
PubMed Link to Article
Mundy  PNeal  RGlidden  LM Neural plasticity, joint attention, and a transactional social-orienting model of autism. International Review of Research in Mental Retardation: Autism Vol 23 San Diego, Calif Academic Press2001;139- 168
Johnson  MH Functional brain development in humans. Nat Rev Neurosci 2001;2475- 483
PubMed Link to Article
Klin  ASchultz  RCohen  DBaron-Cohen  SedTager-Flusberg  HedCohen  Ded Theory of mind in action: developmental perspectives on social neuroscience. Understanding Other Minds: Perspectives From Developmental Neuroscience. 2nd ed. Oxford, England Oxford University Press2000;357- 388
Knudsen  EI Sensitive periods in the development of the brain and behavior. J Cogn Neurosci 2004;161412- 1425
PubMed Link to Article

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 41

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles