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JAMA Psychiatry. 2015 Mar;72(3):276-83. doi: 10.1001/jamapsychiatry.2014.2463.

Developmental trajectories of symptom severity and adaptive functioning in an inception cohort of preschool children with autism spectrum disorder.

Author information

1
Centre for Addiction and Mental Health, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
2
Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada.
3
IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
4
Department of Psychiatry, Oregon Health & Science University, Portland.
5
Department of Educational and Counselling Psychology and Special Education, University of British Columbia, Vancouver, Canada.
6
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
7
Faculty of Education, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
8
Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
9
Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada.
10
Department of Pediatrics, University of Alberta, Edmonton, Canada.
11
Department of Psychiatry, McGill University, Montreal, Quebec, Canada.

Abstract

IMPORTANCE:

Symptom severity and adaptive functioning are fundamental domains of the autism spectrum disorder (ASD) phenotype. To date, the longitudinal association between these 2 domains has not been examined.

OBJECTIVE:

To describe the developmental trajectories of autistic symptom severity and adaptive functioning in a large inception cohort of preschool children with ASD.

DESIGN, SETTING, AND PARTICIPANTS:

The sample consisted of 421 newly diagnosed preschool children with ASD 2 to 4 years old (355 boys; mean age at study enrollment, 39.87 months) participating in a large Canadian multisite longitudinal study (Pathways in ASD Study). Prospective data collected at 4 points from time of diagnosis to age 6 years were used to track the developmental trajectories of children.

MAIN OUTCOMES AND MEASURES:

Autistic symptom severity was indexed using the Autism Diagnostic Observation Schedule. Adaptive functioning was indexed using the Vineland Adaptive Behavior Scales, Second Edition.

RESULTS:

Two distinct trajectory groups provided the best fit to the autistic symptom severity data. Group 1 (11.4% of the sample) had less severe symptoms and an improving trajectory (P < .05), whereas group 2 (88.6% of the sample) had more severe symptoms and a stable trajectory. Three distinct trajectory groups provided the best fit to the adaptive functioning data. Group 1 (29.2% of the sample) showed lower functioning and a worsening trajectory, group 2 (49.9% of the sample) had moderate functioning and a stable trajectory, and group 3 (20.9% of the sample) had higher functioning and an improving trajectory (P < .05). Cross-trajectory overlap between the autistic symptom severity and adaptive functioning groups was low (φ = 0.13, P < .05). Sex was a significant predictor of autistic symptom severity group membership and age at diagnosis, and language and cognitive scores at baseline predicted membership in adaptive functioning trajectories. Trajectories of both symptom severity and adaptive functioning predicted several different outcomes at age 6 years.

CONCLUSIONS AND RELEVANCE:

Findings confirm the heterogeneous nature of developmental trajectories in ASD. Change in adaptive functioning suggests that improvement is possible in roughly 20% of the sample. Autistic symptom severity appears to be more stable, with roughly 11% of the sample showing a marked decrease in symptom severity. During the preschool years, there appears to be only a small amount of "yoking" of developmental trajectories in autistic symptom severity and adaptive functioning. It is imperative that a flexible suite of interventions that target both autistic symptom severity and adaptive functioning should be implemented and tailored to each child's strengths and difficulties.

[Indexed for MEDLINE]

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