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Autism Res. 2017 May;10(5):757-768. doi: 10.1002/aur.1739. Epub 2017 Feb 9.

Infant muscle tone and childhood autistic traits: A longitudinal study in the general population.

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Erasmus Medical Centre Rotterdam, The Generation R Study Group, the Netherlands.
Department of Child and Adolescent Psychiatry, Erasmus Medical Centre-Sophia Children's Hospital Rotterdam, the Netherlands.
Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
Department of Radiology, Erasmus Medical Centre Rotterdam, the Netherlands.
Department of Epidemiology, Erasmus Medical Centre Rotterdam, the Netherlands.
Department of Pediatrics, Erasmus Medical Centre-Sophia Children's Hospital Rotterdam, the Netherlands.
Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands.


In a longitudinal population-based study of 2,905 children, we investigated if infants' neuromotor development was associated with autistic traits in childhood. Overall motor development and muscle tone were examined by trained research assistants with an adapted version of Touwen's Neurodevelopmental Examination between ages 2 and 5 months. Tone was assessed in several positions and items were scored as normal, low, or high tone. Parents rated their children's autistic traits with the Social Responsiveness Scale (SRS) and the Pervasive Developmental Problems (PDP) subscale of the Child Behavior Checklist at 6 years. We defined clinical PDP if scores were >98th percentile of the norm population. Diagnosis of autism spectrum disorder (ASD) was clinically confirmed in 30 children. We observed a modest association between overall neuromotor development in infants and autistic traits. Low muscle tone in infancy predicted autistic traits measured by SRS (adjusted beta = 0.05, 95% CI for B: 0.00-0.02, P = 0.01), and PDP (adjusted beta = 0.08, 95% CI for B: 0.04-0.10, P < 0.001). Similar results emerged for the association of low muscle tone and clinical PDP (adjusted OR = 1.36, 95% CI: 1.08-1.72, P = 0.01) at age 6 years. Results remained unchanged if adjusted for child intelligence. There was no association between high muscle tone and SRS or PDP. Exclusion of children with ASD diagnosis did not change the association. This large study showed a prospective association of infant muscle tone with autistic traits in childhood. Our findings suggest that early detection of low muscle tone might be a gateway to improve early diagnosis of ASD. Autism Res 2017, 10: 757-768.


autism spectrum disorder; autistic traits; infant muscle tone; prospective

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