Loss of Social-Communication Skills and Outcomes during Childhood in a Large General Population Cohort

Oral Presentation
Friday, May 11, 2018: 2:21 PM
Willem Burger Hal (de Doelen ICC Rotterdam)
A. Havdahl1,2, S. Bishop3, C. Farmer4, S. Schjolberg5, M. Bresnahan6,7, D. Hirtz8, M. Hornig9, C. Lord10, T. Reichborn-Kjennerud11,12, P. Suren13, A. S. Oyen14,15, P. Magnus13, E. Susser6,7, W. I. Lipkin9, C. Stoltenberg13,16, G. Davey Smith17 and A. Thurm4, (1)MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom, (2)Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway, (3)University of California San Francisco, San Francisco, CA, (4)National Institute of Mental Health, Bethesda, MD, (5)Norwegian Institute of Public Health, Oslo, NORWAY, (6)Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, (7)New York State Psychiatric Institute, New York, NY, (8)National Institutes of Health, Bethesda, MD, (9)Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY, (10)University of California Los Angeles, Los Angeles, CA, (11)Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway, (12)Institute of Clinical Medicine, University of Oslo, Oslo, Norway, (13)Norwegian Institute of Public Health, Oslo, Norway, (14)Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway, (15)Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway, (16)Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway, (17)Population Health Sciences, Bristol Medical School, MRC Integrative Epidemiology Unit, Bristol, United Kingdom

Developmental regression, especially the loss of previously acquired social-communication skills, is often described as specific to autism spectrum disorder (ASD). However, studies of regression have largely been conducted in samples ascertained for diagnosed or suspected ASD. Therefore, little is known about the prevalence and correlates of regression in the general population. Furthermore, while studies have primarily relied on retrospective reporting, parental recall may be unreliable (Ozonoff et al., 2017). Prospective studies of regression as a predictor of longer-term neurodevelopmental outcomes has been limited by study periods restricted to the early developmental period.


We examined whether prospectively-reported loss of social-communication skills is associated with 1) parental recall of regression, and 2) concurrent and later neurodevelopmental functioning.


Data were from the Norwegian Mother and Child Cohort Study (MoBa) and the Autism Birth Cohort, a study nested within MoBa. Preliminary analyses included 48,550 children (49% girls, born 1999-2009) with parent ratings of 15 social-communication skills at age 18 months (SD=0.55, range 15-29) and 36 months (SD=0.76, range 34-47). We included early-emerging skills (i.e., expected to be attained by 18 months) such as pointing and showing, from screeners for social-communication deficits in children. Prospectively-reported loss was defined as the reported absence at 36 months of any skills that were reported as attained at 18 months. Parents were also asked at 36 months to generally recall if their child had lost any social abilities. Follow-up questionnaire data were available for n=29,928 at 5 years and n=23,586 at 8 years. ASD diagnosis was available from the nationwide patient registry.


The majority of children (n=33,565, 69.13%) attained all social-communication skills by 18 months and maintained all at 36 months, while 17.67% (n=8,577) showed delayed attainment of at least one skill without any loss. Loss of at least one skill was observed in 13.20% (n=6,408). In contrast, few parents recalled any social loss (“yes”:n=400, 0.83%; “not sure”:n=590, 1.22%; missing n=83).

Correspondence between prospectively-reported and recalled loss was very low (kappa 0.02). Among parents who prospectively reported loss, only 2.03% (n=130) recalled a loss (an additional 3.16%, n=202, reported being “not sure”). Conversely, prospectively-reported loss was observed in 32.50% (n=130) of those who recalled a loss (34.24%, n=202, in the “not sure” group).

Prospectively-reported loss was associated with higher odds of a range of concurrent and later developmental delays (Fig.1-2), epilepsy (Fig.3), emotional and behavioral problems (Fig.4-5), functional impairments (Fig.6), and ASD symptoms and diagnosis (Fig.7).


Loss of previously attained social-communication skills was prospectively reported for a substantial minority of children. However, these parents rarely recalled a general loss of social abilities, suggesting that rates of loss in retrospective studies may be underestimated.

Prospectively-reported loss was associated with later ASD symptoms and diagnosis, but also with neurodevelopmental problems not specific to ASD, highlighting the need to consider social-communication regression in a broader perspective. Repeated parent ratings of the same skill in prospective population-based cohorts may be valuable in increasing our understanding of the emergence of social-communication deficits in neurodevelopmental disorders.