Early identification of Autism Spectrum Disorders

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Early identification of Autism Spectrum Disorders

• Catherine Lord
• University of Michigan Autism and Communication
  Disorders Center (UMACC)

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Collaborators

• Pamela C. DiLavore
• Susan Risi
• Cory Shulman
• Audrey Thurm
• Families and children in the Early Diagnosis
  project

• Deborah Anderson
• Rosalind Oti
• Michael Rutter
• Andrew Pickles
• Rebecca Niehus
• Rhiannon Luyster

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Can autism and ASD be reliably diagnosed at age 2?
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Is there a reason to distinguish narrowly defined
autism from more broadly defined ASD in young
children?
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What are the trajectories associated with early
development in ASD?
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Autism as a developmental disorderWhat is
manifested as autism changes with
developmentDevelopment is affected by having
autism
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• Both positive (abnormal) behaviors, and negative
  (the absence of normal) behaviors are required to
  make a diagnosis of ASD.
• This means that developmental level and
  contextual effects (in what kind of circumstances
  does the child or adult function?) can both have
  significant effects on diagnostic judgments.

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Information from earlier studies

• Conflicting information from treatment versus
  epidemiological/longitudinal studies
• Empirical studies of preschool children
• Joint attention response to/initiation
• Looking at faces gaze
• Response to name
• Pretending

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• Canadian follow-up study (N 30)
• Clearest discriminators at age two from parent
  report (ADI)
• Attention to voice
• Child spontaneously directing others attention
  (in any way)
• Understands no words out of context

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• Clearest discriminators at age three
• Attention to voice
• Pointing to express interest
• Hand and finger mannerisms
• Use of others body as a tool
• Uses no meaningful words spontaneously

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North Carolina/Chicago Early Diagnosis Study

• Multiple measures
• Parent report and direct observations
• Larger sample
• Greater diversity

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Participants with 9 Year-Old Data
s.
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Can autism and ASD be reliably diagnosed at age 2?
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Percent of age two diagnostic combinations and
best-estimate judgments accurately predicting
diagnosis at 9
(Age 2 best-estimate autism prevalence based on
N214) Age 9 best-estimate autism prevalence
based on N172
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Best Estimate Diagnoses at 2 and 9 (NC and
Chicago)
At 9 years
At 2 years
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Using Best Estimate Diagnoses Overall diagnoses
of autism were very stable from 2-9 Of children
who had a diagnosis of autism at 2 84 had
autism diagnoses at 9 15 had PDD-NOS dx at 9
1 had nonspectrum dx
Of children who had a diagnosis of autism at
9 71 had autism diagnoses at 2 27 had PDD-NOS
dx at 2 2 had nonspectrum dx at 2
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Is there a reason to distinguish narrowly defined
autism from more broadly defined ASD in young
children?
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Two Year-old Measures Predicting ASD at 9,
including Best Estimate Diagnosis (est. R2
.63 TPV 92)
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Two Year-old Measures Predicting ASD at 9,
excluding Best Estimate Diagnosis (est. R2
.52 TPV 89)
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PDD-NOS as a category was much less stable Of
children with PDD-NOS at 2 61 autism at 9 25
PDD-NOS at 9 14 nonspectrum at 9
Of children with PDD-NOS at 9 39 autism at
2 33 PDD-NOS at 9 27 nonspectrum at 9
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More diagnostic changes were between 2 and
5. Between 25 21 more severe 13 less
severe 65 same
Between 59 11 more severe 8 less
severe 81 same
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What are the trajectories associated with early
development in ASD?
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Patterns of Change in VIQ From Age 2- to 9-Years
N17
N18
N40
N62
VIQ
N36
N78
N93
Age in Months
Age in Months
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Patterns of Change in NVIQ From Age 2- to 9-Years
N61
NVIQ
N68
N43
Age in Months
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Patterns of Change in ADOS Algorithm Totals From
Age 2- to 9-Years

ADOS TOT
N91
N91
N19
N46
N28
N35
N34
Age in Months
Age in Months
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Mullen Ratio IQ(7/29/05) VIQ 55 NVIQ
95Younger sibling minimal intervention
ADOS Social Scores
ADOS Repetitive Scores
Age (mos)
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Mullen Ratio IQ(5/26/05) VIQ 112 NVIQ
98Younger sibling intensive intervention
(Verbal Behavior)
ADOS Social Scores
ADOS Repetitive Scores
Age (mos)
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What would you tell professionals about giving
early diagnoses?

• At age 9
• Dont give too much information too soon
• Dont stress negative prognoses
• Present all options
• Provide written information

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Summary

• Autism can be reliably diagnosed at 2 years.
• Diagnoses of milder cases of ASD with less
  clinician certainty were less reliable over time.
  

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Conclusions Most diagnostic change occurred
before 5. Most common outcome for children with
PDD-NOS at 2 was autism, but there was great
variation. Little evidence of complete
recovery (1). A significant minority (1 in 6) is
doing quite well.
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Conclusions (cont)
Considerable improvement in verbal IQs from 2 to
5 and 5 to 9. Repetitive behavior was not
crucial for diagnosis at age 2, but was an
important predictor of diagnosis at 9. Small
differences in development made large differences
in prognosis.
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Estimates of Expressive Language Level at Age 9
-- Percent of 151 Participants
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University of Michigan Autism and Communication
Disorders Center (UMACC)