ATLANTA ― Multiple repetitive behaviors observed in infants at 12 months of age are associated with a highly significant risk for a diagnosis of autism spectrum disorder (ASD) at the age of 2 years, new research shows.
Investigators at the University of North Carolina in Chapel Hill found that infants with 3 or more types of repetitive behavior at 12 months of age were 4 times more likely to meet diagnostic criteria for ASD at age 2 years compared with low-risk infants and, importantly, high-risk infants who were not diagnosed with ASD at 2 years of age.
Infants who were diagnosed with ASD at 24 months also not only had higher levels of motor movements at 12 months but had higher levels of self-injurious behavior, higher levels of insistence on sameness, and higher levels of a requirement to engage in complex routines.
"Even our best clinicians are only able to diagnose autism reliability at around 18 months, so 12 months of age is really pushing the lower limit of what we can currently do," lead investigator Jason Wolff, PhD, assistant professor of psychiatry, said in a press conference.
"And it's not an onerous task for parents, it's the kind of behavior parents are able to observe and report on, so it gives us great hope in terms of thinking about next steps and how we might improve our screening tools to assess for autism risk in a very young child."
The study was presented here at the 13th Annual International Meeting for Autism Research.
Red Flag
In partnership with colleagues from the National Institutes of Health–funded Infant Brain Imaging Study, Dr. Wolff and colleagues followed 184 toddlers at high risk for ASD and 59 low-risk control infants out to 24 months of age.
Parents were asked to document the presence of different types of repetitive behavior at 12 and 24 months of age.
Behaviors included stereotypical motor behaviors (hand and arm flapping); self-injurious behaviors; compulsive behaviors (in which things have to be done in a certain order); ritualistic behaviors (toys lined up in a certain way, eating only certain colored foods at mealtime), and restrictive behavior (limited activities of interest).
Children who were diagnosed with autism averaged between 4 and 8 types of repetitive parent-reported behaviors at 12 months, Dr. Wolff told Medscape Medical News.
In contrast, infants with the same high risk of developing ASD who were not diagnosed with the disorder at 24 months as well as low-risk infants had only 1 or 2 parent-reported repetitive behaviors.
Differences between the groups also became more pronounced with age so that by the time infants were 24 months of age, "there was an even bigger gap between groups," he added.
Furthermore, having more repetitive behaviors at the age of 12 months significantly predicted how severe the child's social deficits were at the age of 24 months — "and the more repetitive behaviors they had, the less adept a child would be in engaging in social interaction," said Dr. Wolff.
Unlike other studies, repetitive behaviors in this study were not related to general cognitive ability in this sample of toddlers.
"There's always going to be some repetitive behavior in infants and toddlers, it's part of how a child negotiates with their environment and become more goal-directed in their behavior," Dr. Wolff said. "But there's a level where you see too much repetitive behavior, and it becomes a possible red flag for developing autism. And if we can do a good job of identifying and screening those children who exhibit a high-risk level of repetitive behavior early on and get that child outside of their locked patterns of behavior, we may be able to improve outcomes."
Potential for Earlier Diagnosis
Asked to comment on the study, Laura Klinger, PhD, University of North Carolina TEACCH Autism Program, Chapel Hill, told Medscape Medical News that this is another study showing that recognition of early symptoms of ASD could lead to earlier diagnosis and hopefully improved outcomes in these children.
"We know that most patients approach their family practitioner by around 18 months to say that they think there is something not quite right with their child's development," she said.
"So parents have concerns and have historically asked physicians for guidance, and I think that some of the tools we discussed at this year's conference give us a way to measure and see what is developing atypically in these young children."
Dr. Klinger also said that it is also difficult for clinicians to recognize whether the presence of repetitive behaviors are typical or atypical because young children normally engage in all sorts of repetitive behaviors, including wanting to watch a movie over and over again or jumping up and down with their hands flapping when they get excited.
"Those are very normal behaviors," she emphasized. "But what we see from this study when we have problems with ASD is that parents see so much more of these behaviors, so it's the amount that is different, not the behavior itself."
Dr. Wolff and Dr. Klinger have disclosed no relevant financial relationships.
13th Annual International Meeting for Autism Research (IMFAR). Abstract 169.006. Presented May 17, 2014.
Medscape Medical News © 2014 WebMD, LLC
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