Parent and Clinician Agreement in Early Behavioural Signs in 12-Month-Old Infants at-Risk of Autism Spectrum Disorder: A High-Risk Sibling Cohort
Objectives: The purpose of this study was to examine parent and clinician agreement at 12 months of age for the clinician observational assessment, the Autism Observation Scale for Infants (AOSI; Bryson et al., 2008), and the parent-report questionnaire, the Autism Parent Screen for Infants (APSI; Sacrey et al., 2016), which was modeled in content from the AOSI.
Participants: High-risk infants (HR; have an older sibling diagnosed with ASD) were divided into two groups based on an independent expert clinical assessment using the ADOS and ADI-R at 36 months of age: HR siblings who did not receive an ASD diagnosis (HR-N; n = 155) and HR siblings who didreceive a diagnosis of ASD (HR-ASD; n = 68).
Assessments: The APSI (Sacrey et al., 2016) is a 26-item parent-report questionnaire that complements the AOSI observational assessment (Bryson et al., 2008). These assessment tools share 19 items that cover early symptomatology of ASD. Parents completed the APSI and clinicians completed the AOSI at 12 months of age.
Statistical Analyses: Performance on the APSI and AOSI was compared between the two HR groups using independent t-test analyses. Agreement between parents and clinicians for the shared 19 items was analyzed using intraclass correlations.
Results: Intraclass correlations of AOSI and APSI items indicated poor agreement between parents and clinicians, ranging from -.06 to .23 for the combined group, -.06 to .30 for the HR-ASD group, and -.05 to 19 for the HR-N group. Item-level comparisons using independent t-tests indicated: (1) six items were informative in predicting diagnostic outcomes on both the AOSI and APSI, including responding to name, eye contact, hand-eye coordination, unusual sensory behaviours, engagement of attention, and shared interest (ps< .05), (2) six items were informative on the APSI only, including visual fixation, anticipating a social interaction, back-and-forth vocalizations, social smiling, reactivity, and repetitive motor behaviour (ps< .05), and (3) seven of the items were not informative on either assessment, including visual tracking, reacting to change in facial expression, imitation, showing interest and pleasure, transitions, difficulty using hands, and insistence on same object.
Conclusions: Prospective parent report is informative for early signs of ASD by 12 months and complements what may be elicited / observed during an interactive assessment. Some clinically informative behaviour may be more likely detected by parents based on their day-to-day observations than during a brief clinical visit.