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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 l.jpg

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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Is there a reason to distinguish narrowly defined autism

from more broadly defined ASD in young children?



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Autism as a developmental disorder: in ASD?What 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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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


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  • Canadian follow-up study (N = 30) epidemiological/longitudinal studies

  • 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


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  • Clearest discriminators at age three epidemiological/longitudinal studies

    • Attention to voice

    • Pointing to express interest

    • Hand and finger mannerisms

    • Use of other’s body as a tool

    • Uses no meaningful words spontaneously


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North Carolina/Chicago epidemiological/longitudinal studies Early Diagnosis Study

  • Multiple measures

  • Parent report and direct observations

  • Larger sample

  • Greater diversity


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Participants with 9 Year-Old Data epidemiological/longitudinal studies

s.


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Can autism and ASD be reliably diagnosed at age 2? epidemiological/longitudinal studies


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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 N=214)

[Age 9 best-estimate autism prevalence based on N=172]


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Best Estimate Diagnoses at judgments accurately predicting diagnosis at 9

2 and 9 (NC and Chicago)

At 9 years

At 2 years


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  • Using Best Estimate Diagnoses: judgments accurately predicting diagnosis at 9

  • 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 judgments accurately predicting diagnosis at 9

from more broadly defined ASD in young children?


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Two Year-old Measures Predicting ASD at 9, judgments accurately predicting diagnosis at 9

including Best Estimate Diagnosis

(est. R2 = .63; TPV = 92%)


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Two Year-old Measures Predicting ASD at 9, judgments accurately predicting diagnosis at 9

excluding Best Estimate Diagnosis

(est. R2 = .52; TPV = 89%)


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  • Of children with PDD-NOS at 9:

  • 39% autism at 2

  • 33% PDD-NOS at 9

  • 27% nonspectrum at 9


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  • Between 5–9 11% more severe

  • 8% less severe

  • 81% same



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Patterns of Change in VIQ in ASD?

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


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Patterns of Change in NVIQ in ASD?

From Age 2- to 9-Years

N=61

NVIQ

N=68

N=43

Age in Months


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Patterns of Change in ADOS Algorithm Totals in ASD?

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


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Mullen Ratio IQ(7/29/05): VIQ – 55; NVIQ – 95 in ASD?Younger sibling; minimal intervention

ADOS

Social Scores

ADOS

Repetitive

Scores

Age (mos)


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Mullen Ratio IQ(5/26/05): VIQ – 112; NVIQ – 98 in ASD?Younger sibling; intensive intervention (Verbal Behavior)

ADOS

Social Scores

ADOS

Repetitive

Scores

Age (mos)


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At age 9 in ASD?

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?


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Autism can be reliably diagnosed at 2 years. in ASD?

Diagnoses of milder cases of ASD with less clinician certainty were less reliable over time.

Summary


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Conclusions: in ASD?

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): in ASD?

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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