Abstract
This study was designed to track the developmental trajectory, during the first 24 months of life, of 335 low-risk infants later diagnosed with Autism Spectrum Disorder and identify early deviations observed in routine Well Care checkups. We compared their achievements to typically developing children and to children later diagnosed with non-autistic developmental impairments. The results show that in the first 6 months, the children with autism showed normal acquisition of milestones, whereas by 9 months of age they began to fail the language/communication, as well as motor items when compared to typical and delayed non-autistic children. Regular check-up visits may be useful in detecting early failure in achieving milestones, leading to earlier referral for further evaluation and treatment.
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Acknowledgments
The authors thank Lior Ganor and Diana Kogan for editing the manuscript.
Author Contributions
MD made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data and was involved in drafting the manuscript. NS made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data. GK made substantial contributions to analysis and interpretation of data, and was involved and revising it critically for important intellectual content. BCF made substantial contributions to analysis and interpretation of data and was involved in drafting the manuscript.
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All authors are employees of Maccabi Healthcare Services.
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The study was approved by the Ethics Review Board of Maccabi Healthcare Services.
Appendix: Percentages of Children Who Failed Each Milestone in the Different Developmental Ages
Appendix: Percentages of Children Who Failed Each Milestone in the Different Developmental Ages
6 weeks | ||||||
---|---|---|---|---|---|---|
Group | Age performed (Months) | Language communication milestone | Motor milestone | |||
Response to loud noise (changing activity) | Social smile | Makes noises in response to stimulation | Elevates head—prone position | Follows a moving object | ||
ASD (N = 324) | 2.1 | 2.8 | 5.6 | 4.3 | 12.3 | 9.2 |
DI (N = 297) | 2.2 | 2 | 2.7 | 2 | 12.5 | 5.7 |
TD (N = 311) | 2 | 2.6 | 2.9 | 3.5 | 11.3 | 9.7 |
3 months level | |||||||
---|---|---|---|---|---|---|---|
Group | Age performed (Months) | Language communication milestone | Motor milestone | ||||
Laughs | Makes sounds | Turning head toward sound | Reaching for an object | Elevates head and chest—prone position | Crosses fingers of the two hands | ||
ASD (N = 320) | 3.9 | 7.8 | 13.4 | 11.3 | 19.1 | 8.4 | 7.2 |
DI (N = 295) | 3.9 | 3.7 (0.03) | 11.2 | 9.5 | 13.6 | 6.4 | 5.1 |
TD (N = 306) | 3.9 | 4.2 | 9.2 | 7.2 | 10.5 (0.002) | 5.5 | 4.2 |
6 months Level | ||||||
---|---|---|---|---|---|---|
Group | Age performed (Months) | Language communication milestone | Motor milestone | |||
Reacts differently to familiar and strangers | Makes repetitive syllables | Lifts head—supine | Transfers objects between hands | Rolls over | ||
ASD (N = 319) | 6.2 | 7.2 | 12.9 | 6.3 | 7.2 | 19.1 |
DI (N = 289) | 6.3 | 9.7 | 15.6 | 8 | 5.5 | 24.6 |
TD (N = 317) | 6.3 | 3.8 | 9.8 | 3.8 | 0.6 (< 0.001) | 14.5 |
9 months level | |||||||
---|---|---|---|---|---|---|---|
Group | Age performed (Months) | Language communication milestone | Motor milestone | ||||
Says one word or meaningful syllable | Understands simple command | Imitates sounds | Stands up | Sits | Pincer grasp | ||
ASD (N = 234) | 9.4 | 38.1 | 30.8 | 15.8 | 41.4 | 39.7 | 18.9 |
DI (N = 196) | 9.7 | 27.7 (0.02) | 18.1 (0.002) | 8.8 (0.009) | 33.8 | 29.3 (0.02) | 11.5 (0.03) |
TD (N = 205) | 9.3 | 26.6 (0.01) | 12.7 (< 0.001) | 10.2 | 25.5 (< 0.001) | 22.1 (< 0.001) | 8.2 (0.001) |
12 months level | ||||||
---|---|---|---|---|---|---|
Group | Age performed (Months) | Language communication milestone | Motor milestone | |||
Says 2–3 words | Knows body part | Points | Rolls a ball | Walks with support | ||
ASD (N = 322) | 12.6 | 44.8 | 46.4 | 36 | 15.3 | 15.3 |
DI (N = 320) | 12.9 | 28.7 (< 0.001) | 28 (< 0.001) | 15.3 (< 0.001) | 9.4 (0.02) | 12.1 |
TD (N = 332) | 12.6 | 21.7 (< 0.001) | 25.4 (< 0.001) | 11 (< 0.001) | 7.5 (0.002) | 4.4 (< 0.001) |
18 months level | |||||||
---|---|---|---|---|---|---|---|
Group | Age performed (Months) | Language communication milestone | Motor milestone | ||||
Vocabulary of more than ten words | Gives a kiss | Builds a tower | Eats with a spoon | Walks without support | Climbs the stairs | ||
ASD (N = 295) | 18.4 | 69.8 | 35.4 | 24.9 | 24.6 | 13.7 | 18.9 |
DI (N = 308) | 18.9 | 37.3 (< 0.001) | 12.9 (< 0.001) | 11.9 (< 0.001) | 5.8 (< 0.001) | 5.4 (0.01) | 4.1 (< 0.001) |
TD (N = 310) | 18.9 | 26.5 (< 0.001) | 7.4 (< 0.001) | 7.4 (< 0.001) | 1.3 (< 0.001) | 0 (< 0.001) | 1.7 (< 0.001) |
24 months level | ||||||
---|---|---|---|---|---|---|
Group | Age performed (Months) | Language communication milestone | Motor milestone | |||
Builds a sentence of three word or more | Uses grammatical first biases | Imitates a circle | Climbs up and down the stairs without support | Runs without falling | ||
ASD (N = 263) | 27.4 | 69.6 | 73.5 | 35.2 | 13 | 8.7 |
DI (N = 286) | 27.6 | 26.5 (< 0.001) | 39.6 (< 0.001) | 9.5 (< 0.001) | 5.8 (0.004) | 3.6 (0.01) |
TD (N = 272) | 28.3 | 13.7 (< 0.001) | 24.3 (< 0.001) | 6.1 (< 0.001) | 1.9 (< 0.001) | 1.5 (< 0.001) |
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Davidovitch, M., Stein, N., Koren, G. et al. Deviations from Typical Developmental Trajectories Detectable at 9 Months of Age in Low Risk Children Later Diagnosed with Autism Spectrum Disorder. J Autism Dev Disord 48, 2854–2869 (2018). https://doi.org/10.1007/s10803-018-3549-2
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DOI: https://doi.org/10.1007/s10803-018-3549-2