Preschool Staff Spot Social Communication Difficulties, but Not Restricted and Repetitive Behaviors in Young Autistic Children

Background: Clinicians sometimes visit the preschool as part of the assessment of autism spectrum disorder (ASD) in children. This could be the case when clinical findings and information from parents are insufficient for a diagnostic decision. A less costly and time-consuming source of information could be ratings of the child´s autistic behaviors by preschool staff. It has been found that preschool staff rate general autistic symptoms in children more accurately than parents. However, it is not known what kind of autistic behaviors, whether difficulties of social communication and interaction (SCI) and/or restricted and repetitive behaviors (RRBs), that preschool staff identify.

Objectives: The objective of the study was to investigate how accurate preschool staff are at reporting difficulties in SCI and RRBs in young children. The first aim was to investigate if preschool ratings of SCI and RRBs would discriminate between children with and without ASD at three years of age. We expected that ratings of both SCI and RRBs would contribute uniquely to the differentiation between the groups. The second aim was to investigate if there was a specific association between preschool ratings on SCI behavior and clinical assessment of social behavior, and between preschool ratings on RRBs and clinical assessment of RRBs. We expected a positive correlation between the corresponding measures.

Methods: Preschool staff’s ratings on the SCI and RRB subscales from the Social Responsiveness Scale – 2 and the Repetitive Behavior Scale-R were compared between three-year-old siblings, having an older brother or sister with ASD, either diagnosed (n = 12; six girls) or not diagnosed (n = 36; 20 girls) with ASD, and typically developing control siblings with no family history of ASD (n = 16; seven girls). Ratings were investigated from a categorical (group status) and dimensional (preschool ratings relative to clinical assessment of autistic symptoms) perspective. All preschool staff were blind to diagnostic status and the diagnostic assessment took place independent of rating results.

Results: In line with our expectations, we found that preschool staff differentiated between the ASD group and the two other groups for SCI behaviors and that the preschool SCI ratings were significantly associated with clinical assessment of social deficits in the high-risk group. However, against our expectations, ratings of the preschool RRB subscale showed no differentiation between the ASD group relative to the two other groups. Moreover, the preschool RRB ratings did not correlate with clinical assessment of RRBs in the high-risk group.

Conclusions: Ratings of SCI behaviors by preschool staff are in line with clinical assessment and can be a valuable source in differentiating children with ASD from those who have not. However, results indicate that preschool ratings of RRBs should be interpreted with caution. More research is needed within the RRB rating field.