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Early identification of Autism Spectrum Disorders

Early identification of Autism Spectrum Disorders. Catherine Lord University of Michigan Autism and Communication Disorders Center (UMACC). Collaborators. Pamela C. DiLavore Susan Risi Cory Shulman Audrey Thurm Families and children in the Early Diagnosis project. Deborah Anderson

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Early identification of Autism Spectrum Disorders

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  1. Early identification of Autism Spectrum Disorders Catherine Lord University of Michigan Autism and Communication Disorders Center (UMACC)

  2. 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

  3. Can autism and ASD be reliably diagnosed at age 2?

  4. Is there a reason to distinguish narrowly defined autism from more broadly defined ASD in young children?

  5. What are the trajectories associated with early development in ASD?

  6. Autism as a developmental disorder:What is manifested as autism changes with developmentDevelopment is affected by having autism

  7. 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.

  8. 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 Information from earlier studies

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

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

  11. North Carolina/Chicago Early Diagnosis Study • Multiple measures • Parent report and direct observations • Larger sample • Greater diversity

  12. Participants with 9 Year-Old Data s.

  13. Can autism and ASD be reliably diagnosed at age 2?

  14. Percent of age two diagnostic combinations and best-estimate judgments accurately predicting diagnosis at 9 (Age 2 best-estimate autism prevalence based on N=214) [Age 9 best-estimate autism prevalence based on N=172]

  15. Best Estimate Diagnoses at 2 and 9 (NC and Chicago) At 9 years At 2 years

  16. 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

  17. Is there a reason to distinguish narrowly defined autism from more broadly defined ASD in young children?

  18. Two Year-old Measures Predicting ASD at 9, including Best Estimate Diagnosis (est. R2 = .63; TPV = 92%)

  19. Two Year-old Measures Predicting ASD at 9, excluding Best Estimate Diagnosis (est. R2 = .52; TPV = 89%)

  20. 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

  21. More diagnostic changes were between 2 and 5. • Between 2–5 21% more severe • 13% less severe • 65% same • Between 5–9 11% more severe • 8% less severe • 81% same

  22. What are the trajectories associated with early development in ASD?

  23. Patterns of Change in VIQ From Age 2- to 9-Years N=17 N=18 N=40 N=62 VIQ N=36 N=78 N=93 Age in Months Age in Months

  24. Patterns of Change in NVIQ From Age 2- to 9-Years N=61 NVIQ N=68 N=43 Age in Months

  25. Patterns of Change in ADOS Algorithm Totals From Age 2- to 9-Years ADOS TOT N=91 N=91 N=19 N=46 N=28 N=35 N=34 Age in Months Age in Months

  26. Mullen Ratio IQ(7/29/05): VIQ – 55; NVIQ – 95Younger sibling; minimal intervention ADOS Social Scores ADOS Repetitive Scores Age (mos)

  27. Mullen Ratio IQ(5/26/05): VIQ – 112; NVIQ – 98Younger sibling; intensive intervention (Verbal Behavior) ADOS Social Scores ADOS Repetitive Scores Age (mos)

  28. At age 9 Don’t give too much information too soon Don’t stress negative prognoses Present all options Provide writteninformation What would you tell professionals about giving early diagnoses?

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

  30. 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.

  31. 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.

  32. Estimates of Expressive Language Level at Age 9 -- Percent of 151 Participants

  33. University of Michigan Autism and Communication Disorders Center (UMACC)

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