Trajectories of Symptom Severity in Children with Autism: Variability and Turning Points through the Transition to School

This study examined the trajectories of autistic symptom severity in an inception cohort of 187 children with ASD assessed across four time points from diagnosis to age 10. Trajectory groups were derived using multivariate cluster analysis. A two trajectory/cluster solution was selected. Change in trajectory slopes revealed a turning point marked by plateauing in symptom reduction during the period of transition to school (age 6) for one of the two trajectories. Trajectories were labelled: Continuously Improving (27%) and Improving then Plateauing (73% of sample). Children in the two trajectories differed in levels of symptom severity, language, cognitive, and adaptive functioning skills. Study findings can inform the development of more personalized services for children with ASD transitioning into the school system.

Ten years of evidence for the diagnostic assessment of preschoolers with prenatal alcohol exposure

The assessment of preschoolers with prenatal alcohol exposure (PAE) is challenging for many diagnostic teams and clinicians. The 2016 Canadian Fetal Alcohol Spectrum Disorder (FASD) diagnostic guidelines describe the assessments recommended for individuals with PAE in various age groups. Interpretation of brain domains constituting global impairment in preschoolers is not well described in the literature, and there has been clinical reluctance to consider the interpretation of clinical assessments as definitively diagnostic in this age group. This study describes the results of 10-year retrospective clinical data of over 300 preschoolers with PAE referred to the Manitoba FASD Centre for assessment of FASD. Preschoolers who met the criteria for a diagnosis of FASD showed significantly greater global developmental impairment, compared with those with PAE alone. They also demonstrated poorer receptive and expressive language abilities when compared with preschoolers who were not diagnosed. Preschoolers with FASD were rated as having more difficulties with executive functioning skills and adaptive functioning skills, compared to their counterparts. Significant deficits were found in fine-motor, visual-motor, and components of gross-motor skills. Importantly, significant sensory processing differences are particularly evident in preschoolers and are important in understanding behavior and in intervention planning. Together, standardized assessment of motor and sensory processing skills, with a comprehensive assessment of language, are significant predictors of FASD diagnosis for preschoolers with PAE.

Temperament influences the relationship between symptom severity and adaptive functioning in children with autism spectrum disorder

Temperament is a construct that is relatively stable over time but varies between individuals. Research suggests that children with autism spectrum disorder have a ‘reactive’ temperament profile when compared to peers with or without disabilities. However, our understanding of how temperament varies within children with autism and how it relates to child symptoms and outcomes is limited. This study aimed to (a) explore the variation of individual temperament traits within a sample of school-aged children with autism to determine whether subgroups of children with similar trait profiles emerge and (b) examine whether temperament influences the relationship between autism symptoms and adaptive functioning outcomes. Results revealed that children with autism can be classified empirically into two distinct profiles – ‘Even’ and ‘Reactive’ temperaments. Correlational and hierarchical regression analyses indicated that both temperament profiles and baseline symptom severity predicted adaptive functioning outcomes 1 year later. There was a significant interaction between temperament and symptom severity, suggesting temperament can influence the impact of increasing symptom severity on adaptive functioning skills in children with autism. Study findings highlight the importance of considering temperament in understanding the individual differences that influence the development of daily functioning and developmental outcomes in children with autism. Lay Abstract Temperament is often thought of as behavioural traits that are relatively stable over time but can vary between individuals. Children diagnosed with autism spectrum disorder are often characterized as having ‘reactive’ and ‘negative’ temperaments when compared to same-aged peers with or without disabilities, which can negatively impact the development of adaptive functioning skills but little is known about variations of temperament between individual children diagnosed with autism spectrum disorder. This study aimed to (a) explore the variation of individual temperament traits within a sample of school-aged children with autism spectrum disorder to determine whether subgroups with similar trait profiles emerge and (b) examine whether temperament influences the relationship between autism symptoms and adaptive functioning outcomes. Results from our dataset suggest that children diagnosed with autism spectrum disorder fit under two profiles: ‘even’ and ‘reactive’. Furthermore, our analysis shows that temperament can influence the impact of increasing symptom severity on adaptive functioning skills in children with autism spectrum disorder. Study findings highlight the importance of considering temperament when trying to understand the individual differences that influence the development of functioning and developmental outcomes in children with autism spectrum disorder.