Response to Name: Increasing the Sensitivity of This Very Specific Sign of ASD

Background: Response to name (or rather, the failure to respond to one’s name) is one of the most consistently documented behaviors that distinguishes autism at a young age.  However, despite its very high specificity to ASD, and its clinical relevance, it has not yet been a useful measure of autism, severity, or response to treatment.  This is likely because we have misconceptualized it as a dichotomous variable; as if children either always respond or always fail to respond, when a closer look at the evidence suggests that children with autism show a decrease in, not an absence of, responding. Measured as a quantitative variable, or as a rate of responding rather than a dichotomous summary judgment, response to name may be a powerful indicator of ASD and perhaps a clinical measure that could be sensitive to change. 

Objectives:  To characterize and measure both the child’s behavior and adult’s behavior around Response to Name, including determining the different kinds of “bids” adults use during a clinical interaction, and the child’s rate of responding to each type of bid.  Secondary objectives were to compare results to the more categorical measures of Response to Name currently used (ADOS, ADI-R, M-CHAT, ITC, Mullen, and Vineland).

Methods:  We rated children’s responses to their own name during 20 minutes of free play and structured activities (two 10-minutes segments from the ADOS).  Participants (11 with ASD; 12 with speech or other delays, and 11 typically developing controls) included children who had been screened as part of a highly comprehensive screening study within a large community practice, and thus are highly representative of the types of children presenting to pediatricians for screening.   Ratings were conducted by two blind raters, and percent exact agreement was 90%. 

Results:  

Adults used three types of name calls (Name, Name with Command, and Name within a social game).  Children who responded less than 50% of the time were considered to show weak responding.  In the ASD group, 63% of children showed weak responding to Name, compared to 25% of children with delays, and 36% of typically developing children.  In contrast, only 18% of children with ASD were weak responders to Name with Command, with 8% and 0% weak responders in the other groups (respectively).  Our quantitative measures showed almost no correspondence with ADOS, ADI-R or questionnaire items completed by parents.  On questionnaires and interviews, parents virtually always rated their children as good responders.  On the ADOS, only 36% of children with ASD obtained a score of 2 or 3 on the Response to Name activity, and of those, half were good responders otherwise.

Conclusions:

Among children screened in pediatric practice, actual rates of responding to name showed little correspondence to current clinical and research measures. As a simple behavior with high specificity to ASD and high ecological validity, Response to Name may have more clinical and research utility as a quantitative variable, rather than a categorical judgment.