A prospective study of associations between early fearfulness and perceptual sensitivity and later restricted and repetitive behaviours in infants with typical and elevated likelihood of autism.

Mark H Johnson,Virginia Carter Leno,Nisha Narvekar,Greg Pasco,Tony Charman,Emily JH Jones

doi:10.1177/13623613211068932

Abstract

Autism is diagnosed based on social and communication difficulties, restricted and repetitive behaviours and sensory anomalies. Existing evidence indicates that anxiety and atypical sensory features are associated with restricted and repetitive behaviours, but cannot clarify the order of emergence of these traits. This study uses data from a prospective longitudinal study of infants with and without a family history of autism (N = 247; Elevated Likelihood N = 170 and Typical Likelihood N = 77). Longitudinal cross-lag models tested bidirectional pathways between parent-rated infant fear/shyness and perceptual sensitivity at 8, 14 and 24 months, and associations between these domains and parent-rated restricted and repetitive behaviours and social communication scores at 36 months. In addition to within-domain continuity, higher levels of fear/shyness at 14 months were associated with higher levels of perceptual sensitivity at 24 months. Higher levels of both fear/shyness and perceptual sensitivity at 24 months were associated with greater restricted and repetitive behaviours and social communication scores at 36 months. Results demonstrate the directionality of developmental pathways between fear/shyness and perceptual sensitivity in infancy and toddlerhood, but question theories that argue that these domains specifically underlie restricted and repetitive behaviours rather than autism. Identifying how early emerging anxiety and sensory behaviours relate to later autism is important for understanding pathways and developing targeted support for autistic children.Lay abstractRestricted interests and repetitive behaviours are central to the diagnosis of autism and can have profound effects on daily activities and quality of life. These challenges are also linked to other co-occurring conditions such as anxiety and sensory sensitivities. Here, we looked at whether early emerging signs of anxiety and sensory problems appear before symptoms of autism by studying infants with a family history of autism, as these infants are more likely to develop autism themselves. Studying infant siblings provides an opportunity for researchers to focus on early developmental markers of autism as these infants can be followed from birth. This study found that early infant signs of anxiety (e.g. fear/shyness) predicted later perceptual sensitivity, and those infants who scored higher on fear/shyness and sensitivity were more likely to experience more persistent repetitive behaviours, but also social and communication difficulties in toddlerhood. Early signs of anxiety and perceptual sensitivity may thus relate to both later social difficulties and repetitive behaviours. These findings support the importance of further research exploring the causal links between these domains in relation to autism, resulting in increased understanding of children who go onto develop autism in the future and guiding early interventions and supports.

Highlights

Autism spectrum disorder (ASD) is a neurodevelopmental condition with a childhood prevalence of ~1.5% (Maenner et al, 2020) which is typically diagnosed approximately around 6 years of age (Brett et al, 2016)
While sensory processing atypicalities are included as a subdomain of restrictive and repetitive behaviours (RRBs) symptoms in autism (APA, 2013), some suggest that sensory processing differences may themselves directly contribute to individual differences in other aspects of the RRB domain (Boyd et al, 2010; Grzadzinski et al, 2020; Schulz & Stevenson, 2019)
Infants in the EL group (n = 170; 85 male; 85 female) had at least one older sibling with a community clinical diagnosis of autism, which was confirmed based on parent report: using the Development and Wellbeing Assessment (DAWBA; Goodman et al, 2000), the Social Communication Questionnaire (SCQ; Berument et al, 1999) or parent confirmed community clinical autism diagnosis

Summary

Introduction

Autism spectrum disorder (ASD) ( referred to as autism) is a neurodevelopmental condition with a childhood prevalence of ~1.5% (Maenner et al, 2020) which is typically diagnosed approximately around 6 years of age (Brett et al, 2016). Children with OCD and autistic children are found to have comparable levels of sameness behaviours such as ritualistic habits and adherence to routines, and repetitive movements (Jiujias et al, 2017; Zandt et al, 2007), the drivers of RRB may differ between the two groups One interpretation of these findings is that certain types of RRB could be useful for managing anxiety levels by allowing the child to impose control over their environment (Lidstone et al, 2014; Rodgers et al, 2012). This may be possible within prospective studies of infants with a family history of autism, which enable the measurement of particular phenotypes before diagnosis occurs (Constantino et al, 2021; Jones et al, 2014). Less is known about normative developmental patterns of sensory processing and manifestations of atypical perceptual processing in early infancy, perceptual sensitivity has been conceptualised as a core component of models of infant temperament and appears to be stable between infancy and toddlerhood (Gartstein & Rothbart, 2003; Putnam et al, 2006)

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