Developmental Profiles of Preschool Children Diagnosed with Co-Occurring Autism and Epilepsy Using the Communication Deall Developmental Checklist

Background: Epilepsy co-occurs frequently in autism spectrum disorder (ASD). Language deficits are common in both ASD and epilepsy. Understanding if there is a different phenotype in developmental domains, including motor and cognitive-linguistic domains, in children with Autism with and without epilepsy will help further research efforts towards targeted intervention.

Objectives: (1)To compare developmental profiles of preschool children diagnosed with ASD only (ASD) to those with ASD and Epilepsy (ASD+Epi) (2)To evaluate predictors of motor, language and cognitive abilities in the two groups

Methods: A total of 89 (63-ASD, 26-ASD+Epi) 3-6-year-old pre-school children were assessed on The Communication DEALL Developmental Checklist (CDDC; Karanth et al., 2010). CDDC is a well validated developmental tool that is sensitive to the socio-cultural-linguistic needs of India. CDDC assesses child’s development in eight domains: Gross Motor(GM), Fine Motor(FM), Activities of Daily Living(ADL), Receptive Language(RL), Expressive Language(EL), Cognition, Social and Emotional skills - for children between 0-6 years. Each subject received a total ratio score of observed skills/expected skills per domain. Whenever possible clinicians corroborate CDDC scores via direct observation during a 1-hour play session. The study subjects were also assessed for autism severity on the Childhood Autism Rating Scale and for a proxy for cognitive abilities via the social quotient (SQ) on the Vineland Social Maturity Scale. Subjects received a clinical best estimate diagnosis for Epilepsy, ASD and for associated comorbidities.

Analysis: (1) To determine if domain scores differed between groups, an ANCOVA testing for main effects of subject diagnostic group were employed, adjusting for age, sex and SQ. (2) Robust linear regression was used to predict motor, language and cognitive scores from other domain scores, autism severity score, age, sex, SQ, socio-economic status(SES), comorbidity and presence/absence of regression, by groups.

Results: Across groups, subjects did not differ by age, sex, SES, SQ scores, regression and co-morbidities (Table-1). ASD+Epi had significantly higher autism severity (t=3.42,p=0.001)

Only FM, RL, EL, Cognitive and Emotional skills were significantly different between groups (F = 12.17,9.22,7.4,4.10,6.58 and p=<0.001,0.037,0.036,0.001,0.041 respectively). Further, comparing different developmental domains within a group, EL and Social were most affected in comparison to e.g. motor domains (Fig-1A, 1B-for varying autism severity). Mean total ratio scores were lower than optimal of 1 indicating clear developmental nature of the disorder (Fig-1A). All domain scores were significantly negatively correlated with Autism severity scores but not for group*severity interaction - ranging from: EL-F=18.68,p<0.001 to GM-F=5.83,p< 0.007 (Fig-1C).

Cognitive scores predicted GM and FM skills in both groups (GM-ASD:b=0.594,p=<0.0001; GM-ASD+Epi:b=0.979,p=0.004; FM-ASD:b=0.667,p=0.001; FM-ASD+Epi:b=1.236,p=0.043). Age, autism severity, Social, RL-EL differences, Motor (b=0.002,-0.008,0.459,0.643,0.490; p=0.0285,0.001,0.001,<0.0001,<0.0001 respectively) predicted RL skills in the ASD group. RL-EL differences (b=0.467,p=0.03) and motor (b=0.452,p=0.006) predicted RL in the ASD+Epi group. Model convergence was not achieved for Cognitive Scores.

Conclusions: All developmental domains were affected in both groups on the CDDC, with poorer scores in the ASD+Epilepsy group. The profiles obtained using this checklist and domain specific predictors, help streamline current practices in India of providing intervention within the developmental model as it is eminently suitable to monitor progress in intervention/therapy.