Early Identification of Autistic Spectrum Disorders: A Retrospective Analysis of Early Social-Emotional and Communicative Indicators

Background: It is imperative to identify children at risk of developing autistic spectrum disorders (ASD) as early as possible, given the evidence that early intervention mitigates the downstream consequences of ASD. This spectrum of complex neurobiological disorders can affect a child’s ability to communicate, both verbally and nonverbally, to engage in social interactions and form relationships with others. The screening approaches most widely used for identification do not allow for reliable assessment until the age of 18 months. In fact, a reliable diagnosis generally does not occur prior to 2 years. Despite the age of diagnosis, many parents express serious concerns regarding their infants’ level of development within the first year of life. 

Objectives: This retrospective study investigated the early emergence of social-emotional and communicative markers associated with ASD in the framework of infant-caregiver interactions as they occurred on home videos.

Methods: Twenty-three children diagnosed with ASD and 22 typically developing (TD) children participated via previously recorded home videotapes. Infants were engaged in a series of typical daily activities with primary caregivers (e.g., feeding and changing). Videos were analyzed to determine whether deficits in social-emotional and communicative development were evident within the first 13 months of life. The aim of the study was two-fold. One, to investigate the developmental profiles of both groups by observing age of onset pertaining to several developmental milestones (i.e., cooing, reduplicative babbling, variegated babbling, first words, social and pointing) from birth to 13 months. The second objective was to examine communication trends in each group via caregiver-infant interactions, from 1 ½ to 4 months and from 4 to 8 months, with a focus on infant communicative behaviours.

Results: The onset of developmental milestones occurred significantly earlier in the TD group. Infants with ASD did not evidence variegated babbling, first words, and pointing in the first 13 months. In relation to infant communication, between 6 weeks and 4 months of age there were significant differences between the groups with respect to the coordination of eye contact and (1) nonverbal behaviours, and (2) vocalizations and nonverbal behaviours. The ASD group showed a significantly lower proportion of both forms of cross-modal communication. Between 4 to 8 months of age there was a significant difference between groups in relation to coordination of eye contact with (1) vocalizations, and (2) vocalizations and nonverbal behaviours, whereby infants with ASD showed a significantly lower proportion of both forms of cross-modal communication. The ASD group displayed a significantly higher frequency of eye contact as an independent response at the first age point and a significantly lower frequency at the second age point. The frequency of initiations towards the caregiver was higher for the TD group at both age points. Initiations were not evidenced by the ASD group.

Conclusions: The findings suggest that the onsets of significant social-emotional and communicative milestones are delayed in infants with ASD. In relation to dyadic communication, these infants are less likely to implement cross-modal communication but may rely on uni-modal communication, such as gaze, very early on.