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J Neurodev Disord. 2018 Oct 22;10(1):29. doi: 10.1186/s11689-018-9247-8.

Language delay aggregates in toddler siblings of children with autism spectrum disorder.

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Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave, Box 8504, St Louis, MO, 63110, USA.
Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 740, Memphis, TN, 38105, USA.
Department of Psychology, Temple University, 1801 N. Broad St, Philadelphia, PA, 19122, USA.
Institute of Child Development, University of Minnesota, 51 East River Parkway, Minneapolis, MN, 55455, USA.
Department of Educational Psychology, University of Minnesota, 56 East River Road, Minneapolis, MN, 55455, USA.
Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC, 27514, USA.
Children's Hospital of Philadelphia, University of Pennsylvania, Civic Center Blvd, Philadelphia, PA, 19104, USA.
Mallinckrodt Institute of Radiology, Washington University School of Medicine, 660 S. Euclid Ave, St Louis, MO, 63110, USA.
Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave, Box 8504, St Louis, MO, 63110, USA.
Department of Pediatrics, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada.
Department of Radiology, University of Washington, Seattle, 1410 NE Campus Parkway, Seattle, WA, 98195, USA.
Department of Speech and Hearing Sciences, University of Washington, Seattle, 1701 NE Columbia Rd, Seattle, WA, 98195-7920, USA.



Language delay is extremely common in children with autism spectrum disorder (ASD), yet it is unclear whether measurable variation in early language is associated with genetic liability for ASD. Assessment of language development in unaffected siblings of children with ASD can inform whether decreased early language ability aggregates with inherited risk for ASD and serves as an ASD endophenotype.


We implemented two approaches: (1) a meta-analysis of studies comparing language delay, a categorical indicator of language function, and language scores, a continuous metric, in unaffected toddlers at high and low familial risk for ASD, and (2) a parallel analysis of 350 unaffected 24-month-olds in the Infant Brain Imaging Study (IBIS), a prospective study of infants at high and low familial risk for ASD. An advantage of the former was its detection of group differences from pooled data across unique samples; an advantage of the latter was its sensitivity in quantifying early manifestations of language delay while accounting for covariates within a single large sample.


Meta-analysis showed that high-risk siblings without ASD (HR-noASD) were three to four times more likely to exhibit language delay versus low-risk siblings without ASD (LR-noASD) and had lower mean receptive and expressive language scores. Analyses of IBIS data corroborated that language delay, specifically receptive language delay, was more frequent in the HR-noASD (n = 235) versus LR-noASD group (n = 115). IBIS language scores were continuously and unimodally distributed, with a pathological shift towards decreased language function in HR-noASD siblings. The elevated inherited risk for ASD was associated with lower receptive and expressive language scores when controlling for sociodemographic factors. For receptive but not expressive language, the effect of risk group remained significant even when controlling for nonverbal cognition.


Greater frequency of language delay and a lower distribution of language scores in high-risk, unaffected toddler-aged siblings support decreased early language ability as an endophenotype for ASD, with a more pronounced effect for receptive versus expressive language. Further characterization of language development is warranted to refine genetic investigations of ASD and to elucidate factors influencing the progression of core autistic traits and related symptoms.


Autism spectrum disorder; Development; Endophenotype; Infant sibling; Language

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