Self-Regulation and Attention from 1-Week to 2-Months of Age in Infants at High- and Low-Risk for ASD

Background: Infant self-regulation, in the face of highly stimulating or distressing events, emerges in the first months of life. This ability is critical for maintaining alertness, interacting with a caregiver, and attending to the environment. Toddlers with autism spectrum disorder (ASD) experience difficulty with self-regulation, which could interfere with social interaction, communication, and learning (Dodge, 1989; Gomez & Baird, 2005). Previous studies suggest a link between decreased self-regulatory capacities in early infancy and later medical and behavioral problems, including ASD (Liu et al., 2016; Gomez & Baird, 2005). For this reason, high-risk infant siblings of children with ASD may demonstrate a decreased ability to self-regulate in the first few months of life compared to low-risk infants.

Objectives: This exploratory study compared abnormalities in self-regulatory abilities in the first months of life for infants at high- and low-risk for ASD. Specifically, we investigated very early developmental trajectories of 1) excitability, 2) self-regulation, and 3) attention in high-risk and low-risk infants between 1-week and 2-months of age.

Methods: As part of a large, longitudinal, federally funded study, participants included low-risk (LR, N=20) and high-risk (HR, N=19) infants seen at 1-week, 1-month, and 2-months of age. Measures of excitability, regulation, and attention (response to visual and auditory stimuli) were obtained from the NICU Network Neurobehavioral Scale (NNNS; Lester & Tronick, 2004) and differences between HR and LR infants were explored. Given the documented relationship between regulation and learning, the Bayley Scales of Infant and Toddler Development was administered and associations between Bayley cognitive scores and NNNS regulation scores were also investigated.

Results: Repeated measures two-way ANOVAs were used to analyze trajectories of excitability, self-regulation, and attention across HR and LR infants. There were no differences in excitability between groups at any time point. However, there was a marginally significant interaction (p=.125, see Fig 1a) in which LR infants showed a significant decrease in excitability across time (p=.05), while HR infants remained stable. In regard to self-regulation, both HR and LR infants made very little change from 1-week to 2-months, however there was a marginally significant difference across groups at 1-month: HR infants demonstrated fewer self-regulatory abilities compared to LR infants (p=.09). In contrast to HR infants, LR infants showed steadily increasing attention scores from 1-week to 2-months, resulting in a marginally significant interaction across time and risk group (p=.122, see Fig 1b). HR infants showed significantly lower attention scores at 2-months (p=.010). Finally, Pearson correlations revealed a positive association between self-regulation ability and Bayley cognitive standard scores at 2-months (r= .421, p<.05).

Conclusions: Very few studies to date have investigated neurobehavioral differences in HR and LR infants as young as 1-week-old. These preliminary findings provide novel evidence suggesting differences in trajectories of excitability, self-regulation, and attention. Further, these results suggest that self-regulation could be important for early cognitive development. Finally, results reveal that HR infants as a group may be more vulnerable to difficulties in self-regulation and attention when compared to LR infants.