Early Language and Gesture Profiles of Toddlers with ASD As Measured By Developmental Screeners

Background: Parent-report measures identifying early concerns and Autism Spectrum Disorders (ASD) red-flags are critical for informing appropriate referrals to diagnostic evaluations and services. One of the most salient early concerns related to ASD leading to early evaluation is language delay (Coonrod & Stone, 2004). The Ages and Stages Questionnaire (ASQ-3) is a broadband developmental screener that includes a Communication domain, focusing on receptive and expressive language skills as well as early social communication and gesture use. Prior studies on the ASQ-3 suggest that the Communication domain is sensitive to ASD red-flags, with a significant number of children falling in the “fail” range of concern receiving a diagnosis of ASD (Hardy et al., 2015). The MacArthur-Bates Communicative Development Inventory (MCDI) is a parent-report measure of early language and social communication that focuses on children’s larger inventory of the same skills measured by the ASQ-3 Communication domain. Our study assesses the MCDI profiles of children who do not screen in the concern range on the ASQ-3 Communication domain.

Objectives: Understand the relationship between broadband developmental screeners and parent-report measures of early language and gesture inventory in an ASD evaluation.

Methods: Our sample includes 59 children (81.4% male) all of whom received an ASD diagnosis following a gold-standard evaluation. Out of 59 children, 9 individuals (15.3%) did not come up in the concern range on the ASQ-3 Communication domain. Children were between the ages of 16-31 months (mean=24.8, SD=3.91) and referred based on parental concerns and/or referrals from pediatricians or early interventionists. Parents completed the ASQ-3 and MCDI, and children were evaluated with the Mullen Scales of Early Learning and Autism Diagnostic Observation Schedule, Second Edition (ADOS-2, Toddler Module). Comparisons between groups were analyzed using independent t-tests. Data from 50 additional participants is expected to be collected before May 2018.

Results: Significant differences were observed in MCDI scores by the ASQ-3 “concern” and “no concern” groups, with parents of individuals who did not screen in the concern range on the ASQ-3 Communication domain as per scoring guidelines outlined in the ASQ-3 manual reporting larger gesture inventory and stronger receptive and expressive language skills (t(55)=4.8, t(57)=7.3, t(57)=2.9, all p’s<.005) on the MCDI. When measures of gesture inventory were divided into early gestures (such as reaching, pointing, waving and routine based games like peek-a-boo) and late gestures (such as complex imitation and pretend play), differences between screening groups remained significant at the p<.001 level.

Conclusions: Consistent with previous research, this study revealed that the ASQ-3 Communication domain was sensitive to red-flags of ASD in early social communication and language development. In addition, the results show strong agreement between communication concerns as picked up by broadband developmental screeners and metrics of early word and gesture inventory. These results provide further support for the utility of parent-report screeners specific to language use in ASD diagnostic assessments, as the brief communication survey aligned with a much larger and nuanced measure of word inventory and social communication skills.