Communication Spontaneity in Response to Direct Social Prompts Predicts ASD Symptoms in High and Low Risk Infants
Title: Communication Spontaneity in Response to Direct Social Prompts Predicts ASD symptoms in High and Low Risk Infants
Background: Children with ASD demonstrate a unique profile of early communication behaviors. One aspect of early communication development that has received limited attention is Communication spontaneity (CS). CS has been conceptualized as the level of environmental support required for a child to initiate a communication act. CS has been identified as an important component of functional communication. However, there is limited consensus on how to best define and measure CS. Additional research is needed to understand the nature of CS (i.e., descriptive data across populations and ages) and its relevance to developmental outcomes.
Objectives: This study examined CS in a cohort of infants with an older sibling with ASD (high-risk; HR) and infants with typically developing older siblings (low-risk; LR). The purpose is to:
(1) provide the first descriptive data on CS in a longitudinal sample of children at 12 and 24 months, (2) describe the relationships between CS and language and developmental outcomes among 4 groups of children: HRNonASD, HRASD, LRNonASD, LRASD,
(3) determine if (a) 12-month CS predicts ASD symptoms at 24 months and (b) the relationship between CS and ASD symptoms differed by prompting condition, and
(4) examine whether CS changes between 12 and 24 months differ by group.
Methods: Participants are part of a larger, multi-site, prospective infant sibling study (NIH IBIS ACE Network) examining brain and behavioral development. We examined a subsample of HR (n=50) and LR (n=31) infants from the University of Washington. To measure CS, videos of the CSBS:DP were blindly coded using a newly-developed coding system capturing the level and type of prompting required for a child to initiate communication acts.
Results: CS was associated with language and social communication abilities. Social context, specifically, child response to direct, social prompts during the CSBS-DP at 12 months of age, was associated with ADOS diagnostic group and symptom severity at 24 months controlling for initial language abilities. Unaffected, HR siblings also demonstrated lower CS during the direct social prompt condition than LR siblings, at 24 months.
Conclusions: This study was the first to prospectively measure CS in infants at 12 and 24 months. Lower CS at 12 months was associated with increased symptoms of ASD and a greater likelihood of meeting ADOS criteria for ASD at 24 months. The context of social communication was found to be an important consideration. No group differences in CS were evident during free play or indirect environmental prompts. However, group differences in level of CS were found in response to direct social prompts. Thus, social prompt responsiveness (SPR) at 12 months uniquely predicted later ASD symptoms. Assessing SPR in HR infants may shed light on a new dimension of social communication deficits in ASD and lead to new intervention targets for very young children prior to the diagnosis of ASD.