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Characteristics of Toddlers at Elevated Likelihood of Autism: Language, Sensory Reactivity, and Autism Specific Symptoms

Poster · November 2019

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Sallie Nowell Michaela DuBay

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 Characteristics of Toddlers at Elevated Likelihood of Autism:
Language, Sensory Reactivity, and Autism-Specific Symptoms
Sallie Nowell, PhD CCC-SLP, Michaela DuBay, MA CCC-SLP, Elizabeth Choi, MS CCC-SLP, Rebecca Grzadzinski, PhD, Kelsey Thompson, MS CCC-SLP, Grace T. Baranek PhD OTR/L, Linda R. Watson, PhD CCC-SLP

Background Method Results

Participants: Aim 1:
Early Screening for ASD • Parents of children from 11-16 months of age were recruited through a research registry, social media, • Language: Toddlers in the EL-
childcare centers, healthcare practices, and direct mailings based on birth records to complete the First ASD group were significantly
• Early screening can identify children at 12 months or younger at Years Inventory (FYI) version 3.1b (Baranek et al. 2014). behind their LL-ASD peers on
elevated likelihood for ASD (EL-ASD). • The FYI 3.1b is a 25-item questionnaire asks parents to Sample EL-ASD LL-ASD expressive & receptive
• Infants and young toddlers rarely meet full criteria for diagnosis of ASD. report the frequency with which their child engages in Demographics (n=43) (n = 37) language and gestures.
• Parents may find themselves in a prolonged period of uncertainty about various behaviors; empirically established cut-off scores Age (months) 12.9(1.6) 13.3(1.5) • Sensory: EL-ASD group toddlers
identify children at EL-ASD Sex (% Female) 30% 35% demonstrated significantly
their child’s eventual developmental and diagnostic prognosis. • LL-ASD group was recruited by randomly selecting children more sensory seeking
Race (% non-white) 33% 9%
• More intense early interventions are available to children with whose scores are subthreshold on the FYI3.1b. responses to stimuli than
Ethnicity (% Hispanic) 5% 3%
confirmed ASD diagnosis. toddlers in the LL-ASD group.
Measures:
• Thus, research is needed to identify predictors of diagnosis in young • Mullen Scales of Early Learning (MSEL; Mullen, 1995)
• ASD: EL-ASD and LL-ASD
children at EL-ASD. • MacArthur-Bates Communicative Development Inventory, Words and Gestures (MBCDI; Fenson et al., 2007). toddler groups did not differ on
• Sensory Processing Assessment for Young Children (SPA; Baranek, 1999a). SC and RRBs.
Language and Communication • Brief Observation of Social-Communication Change (BOSCC; Grzadzinski et al., 2016).
Aim 2:
Data Analysis: • SC scores were significantly
• The most frequent early concerns of parents for children with ASD are Aim 1: Non-parametric Wilcoxon Signed Rank tests were run to compare LL-ASD and EL-ASD child performance on
correlated with Mullen
in the area of communication. standardized measures of communication, sensory features, and autism symptomatology. See Table 1.
Expressive Language but only in
• Toddlers with ASD have greater prevalence of receptive language Aim 2: Spearman’s Rho correlations were run on all measures for the LL-ASD and EL-ASD groups. See Table 2.
the EL-ASD Group.
weaknesses relative to expressive language skills than those without • For the EL-ASD group, RRB/I
ASD (e.g., Weismer, Lord & Esler, 2010; Seol et al., 2014). Table 1: Aim 1 Assessment Results by Group Table 2: Aim 2 Spearman’s Rho Correlations of scores were only significantly
Standardized Measures with ASD Symptoms by Group
• Prelinguistic social-communication skills also are associated LL-ASD BOSCC BOSCC Restricted
correlated with early gestures;
EL-ASD Group but for the LL-ASD group, RRB/I
concurrently and predictively with ASD diagnosis (Parlade & Iverson, Mean Social Repetitive
Mean (sd) Differences scores were significantly
2015; Watson et al., 2013; Wetherby et al., 2007) (sd) Communication Behaviors/Interests
correlated with receptive
Mullen Receptive Z=2.12, LL-ASD EL-ASD LL-ASD EL-ASD
Language t-score
44(14) 38(19)
p<.03*
language, early gestures, and
Sensory Features Mullen Receptive -.93, sensory hypo-reactivity.
-.10 -.33 -.15
Mullen Expressive Z=2.42, Language p<.01*
45(10) 35(11)
Language t-score p<.01* Mullen Expressive -.56
• Hyporeactivity, hyperreactivity, and sensory seeking behaviors predict Language
.33
p<05*
-.47 -.16 Conclusions
MCDI Early Z=4.58,
later ASD symptom severity and ASD diagnosis (e.g., Baranek et al., 12(4) 8(4)
MCDI Early -.84, -.58
Gestures p<.01*
-.02 -.35 • Young toddlers at EL-ASD are likely to use fewer gestures, understand fewer words, and
2018; Germani et al., 2014; Grzadzinski et al., under review; Wolff et al., MCDI Total Z=4.34, Gestures p<.01* p<.04*
say fewer words than their peers. They are also likely to have more repetitive/seeking
31(12) 18(10)
2019). Gestures p<.01* MCDI Total
.10 -.30 -.70 -.54 responses to sensory stimuli than peers.
Gestures
MCDI Total Words
130(115) 56(74)
Z=3.77, • Many of the toddlers at EL-ASD would not qualify for early intervention services based
Understood p<.01* MCDI Total Words on standardized measures, but research shows that their developmental trajectories
Research Aims: MCDI Total Words Z=4.05, Understood
-.07 .30 -.37 -.12
18(30) 6(13) may suffer for this lack of intervention.
Said p<.01* MCDI Total Words
1. Compare young toddlers at EL-ASD with their peers who are at lower .04 -.31 -.31 -.11 • Since these early symptoms of ASD may be observed during clinical language
Z=1.89, Said
SPA Hypo 1.8(.4) 2.1(.5) assessments by SLPs, it is important that clinicians refer families to resources, even if the
likelihood of later ASD (LL-ASD) on measures of receptive and p=.06 SPA Hypo-
-.11 -.50
.73,
.50 child does not yet qualify for services.
expressive language, gestures, sensory reactivity patterns, and ASD- Z=2.09, reactivity p<.04*
SPA Seeking .9(.9) 2(1) • We recommend advocating for and providing services to young children fitting this
p<.04*
specific symptoms in the social-communication and restricted and SPA Seeking .54 -.63 .45 -.32 symptom profile.
Z=-1.89,
repetitive behaviors (RRB) domains. BOSCC RRB 4(.9) 5(.9)
p=.06
Limitations:
2. Examine the intercorrelations of measures of language and sensory References Available Upon Request • Aim 2 analyses may be unstable due to only a subset of the sample having BOSCC data
BOSCC Social Z=-.51,
29(5) 31(5) Acknowledgements
• Distributions for many scores were non-normal; therefore, non-parametric analyses
reactivity with measures of more ASD-specific symptoms of social- Communication p=.61 This work was funded by the National Institute of Health NICHD (5R21HD091547-02) grant awarded to Linda R. Watson and Grace T. Baranek.
The work reported here was partially supported by the Institute of Education Sciences, U.S. Department of Education (Grant R324B160038)
awarded to UNC-Chapel Hill. The opinions expressed here represent those of the authors and do not represent the views of the Institute or
the U.S. Department of Education. were conducted for this preliminary presentation.
communication and restricted and repetitive behaviors. We would like to acknowledge the following students at USC for their contributions to this work: Yun-Ju Chen, MS., Emily Campi, BS, and Tsam
Ning, BA
• Results are not reported for the hyper-reactivity subscale of the SPA due to excessive
Author Contact:
Sallie Nowell (nowell@unc.edu)
missing data.
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