18-Month Predictors of Later Outcomes in Younger Siblings of Children With Autism Spectrum Disorder: A Baby Siblings Research Consortium Study
18-Month Predictors of Later Outcomes in Younger Siblings of Children With Autism Spectrum Disorder: A Baby Siblings Research Consortium Study
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DOI：
10.1016/j.jaac.2014.09.015
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发表时间：
2014-12-01
影响因子：
13.3
通讯作者：
Bryson, Susan
中科院分区：
文献类型：
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作者：
Chawarska, Katarzyna;Shic, Frederick;Bryson, Susan
目的：患有自闭症谱系障碍（ASD）的儿童的年幼兄弟姐妹处于发展ASD以及更广泛的自闭症表型特征的高风险（HR）中。虽然这使该队列的早期诊断考虑复杂化，但它也提供了一个机会来检查与其他发育结果相比与ASD特别相关的行为模式。方法：我们对719名HR兄弟姐妹的自闭症诊断观察表（ADOS）的单个项目应用分类和回归树（CART）分析，以确定18个月时的行为特征，这些行为特征可预测36个月时的诊断结果（ASD，非典型发育和典型发育）。结果如下：18个月时，三种不同的特征组合可预测ASD的结局：眼神接触不良，缺乏交流手势和给予;眼神接触不良，缺乏想象力游戏;缺乏给予，存在重复行为，但眼神接触完整。这些18个月的行为特征预测了36个月时的ASD与非ASD状态，初始测试样本的准确率为82.7%，验证样本的准确率为77.3%。ASD儿童3岁时的临床特征因其18个月的症状特征而异。在18个月时被错误分类的ASD儿童功能更高，他们的自闭症症状在18至36个月之间增加。结论：这些结果表明，存在不同的发展途径，房间隔缺损的HR同胞。了解这些途径将为神经和遗传研究提供更清晰的目标，并确定ASD的发育特异性治疗方法。
Objective: Younger siblings of children with autism spectrum disorder (ASD) are at high risk (HR) for developing ASD as well as features of the broader autism phenotype. Although this complicates early diagnostic considerations in this cohort, it also provides an opportunity to examine patterns of behavior associated specifically with ASD compared to other developmental outcomes. Method: We applied Classification and Regression Trees (CART) analysis to individual items of the Autism Diagnostic Observation Schedule (ADOS) in 719 HR siblings to identify behavioral features at 18 months that were predictive of diagnostic outcomes (ASD, atypical development, and typical development) at 36 months. Results: Three distinct combinations of features at 18 months were predictive of ASD outcome: poor eye contact combined with lack of communicative gestures and giving; poor eye contact combined with a lack of imaginative play; and lack of giving and presence of repetitive behaviors, but with intact eye contact. These 18-month behavioral profiles predicted ASD versus non-ASD status at 36 months with 82.7% accuracy in an initial test sample and 77.3% accuracy in a validation sample. Clinical features at age 3 years among children with ASD varied as a function of their 18-month symptom profiles. Children with ASD who were misclassified at 18 months were higher functioning, and their autism symptoms increased between 18 and 36 months. Conclusion: These findings suggest the presence of different developmental pathways to ASD in HR siblings. Understanding such pathways will provide clearer targets for neural and genetic research and identification of developmentally specific treatments for ASD.