Early Detection for Risk of Autism Spectrum Disorder Using the Infant-Toddler Social and Emotional Assessment (ITSEA): A Prospective High-Risk Cohort Study
Objectives: The objective of the present study was to examine the relationship between parent-reported ITSEA scores at 18 months, and ASD symptomatology and diagnostic outcomes at 36 months in a cohort of toddlers at high-risk of developing ASD (HR; have older sibling diagnosed with ASD).
Methods: Three groups of toddlers participated: (1) HR siblings who did not receive an ASD diagnosis at 36 months (HR-N; n=238), (2) HR siblings who did receive an ASD diagnosis at 36 months (HR-ASD; n=93), and (3) low-risk toddlers with no family history of ASD (LR; n=133). Parents completed the ITSEA at 18 months. ITSEA domain scores (Externalizing, Internalizing, Dysregulation, and Competence domains), subdomain scores, and indices (Maladaptive, Social Relatedness, and Atypical indices) were calculated. At 36 months, an independent blinded diagnostic ASD assessment was conducted for all toddlers using the ADI-R and the ADOS. ITSEA scores were compared using a series of one-way ANOVAs with Group (HR-ASD, HR-N, LR) as the independent measure and Domain scores and Indices as the dependent measures. Group effects were explored using Benjamini & Hochberg (1995) corrections for multiple comparisons. Predictive contributions of the ITSEA were assessed using correlations between domain scores and indices at 18 months, and ADI-R and ADOS scores at 36 months.
Results: Parents of HR-ASD toddlers reported higher ITSEA scores on the Internalizing (q ≤ 0.001) and Dysregulation (q ≤ 0.025) domains, and Maladaptive (q ≤ 0.024) and Atypical (q ≤ 0.001) indices, as well as lower scores on the Competency (q ≤ 0.001) domain and Social Relatedness (q ≤ 0.001) index compared to parents of HR-N and LR groups. These results indicate greater impairment in social-emotional functioning at 18 months among HR toddlers later diagnosed with ASD. With respect to prediction, all ITSEA domain scores (with the exception of Externalizing in the HR-ASD group) and indices were significantly correlated with ASD symptomatology in both HR groups on the ADI-R (p’s < 0.05). The Externalizing, Internalizing, and Dysregulation domains were correlated with the ADOS in the HR-ASD group (p’s < 0.01), but not in the HR-N group.
Conclusions: Parental ratings on the ITSEA provide valuable information about the relation between early social-emotional functioning and later developmental outcomes in children who will and will not receive an ASD diagnosis. Specifically, HR siblings with ASD displayed marked social-emotional difficulties at 18 months, which predicted later ASD symptomatology and diagnostic outcomes at 36 months. These findings highlight the importance of considering social-emotional regulation when assessing the risk for ASD.