Low Rates of Pointing in 18-Month-Olds at Risk for Autism Spectrum Disorder and Extremely Preterm Infants: A Common Index of Language Delay?

Alessandra Sansavini,Annalisa Guarini,Giacomo Faldella,Jana Marie Iverson,Jessica Zong Lee,Mariagrazia Zuccarini

doi:10.3389/fpsyg.2019.02131

Alessandra Sansavini, Annalisa Guarini + Show 4 more

Open Access

https://doi.org/10.3389/fpsyg.2019.02131

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Abstract

Infants with an older sibling with an Autism Spectrum Disorder diagnosis (Sibs ASD) are at high risk for language delay (LD) as well as infants born preterm, especially those with an extremely low gestational age (ELGA, GA ≤ 28 weeks). Gestures play a crucial role in language development and delays in gesture production may have negative cascading effects on it. The present exploratory study examined gesture production in 18-month-old infants with different underlying risks for LD. Seventy monolingual United States infants (41 Sibs ASD with no eventual ASD diagnosis and 29 infants with a typically developing older sibling -Sibs TD) and 40 monolingual Italian infants (20 ELGA without major cerebral damages, congenital malformations or sensory impairments and 20 full-term - FT infants, GA ≥ 37 weeks) were included. Both groups were followed longitudinally from 18 to 24, 30, and 36 months (corrected for ELGA infants). A 30-minute mother-infant play session with age-appropriate toys was video recorded at 18 months of age. Deictic (requesting, pointing, showing and giving), conventional, and representational gestures spontaneously produced by infants were coded; rate per 10 min was calculated. LD was defined as a score ≤10th percentile on the American English or Italian version of the MacArthur-Bates CDI on at least two time points between 18 and 36 months. Fifteen Sibs ASD and 9 ELGA infants were identified as infants with LD. Sibs ASD-LD and Sibs ASD-no LD produced fewer pointing gestures compared to Sibs TD (p = 0.038; p = 0.004); ELGA-LD infants produced significantly fewer pointing gestures than ELGA-no LD (p = 0.024) and FT (p = 0.006) infants. Low rates of pointing at 18 months are a marker of LD in Sibs ASD and ELGA infants. The potential implications of reduced pointing production and characteristics of different populations at risk for LD should be considered for understanding the emergence of LD.

Highlights

Language development is considered a reliable indicator of development and is related to later school achievements (Nelson et al, 2006)
The present exploratory study intends to address this issue focusing on these two populations characterized by different underlying biological and environmental risks for language delay (LD), i.e., infants who have an older sibling with ASD (Sibs ASD) and infants born extremely preterm, compared to typically developing (TD) comparison groups, i.e., infants with a typically developing older sibling and no family history of ASD (Sibs TD) and full-term infants (FT), respectively
This study demonstrates that a low rate of pointing gesture at 18 months may be a reliable and common marker of LD across different populations of infants with enhanced LD risk

Summary

Introduction

Language development is considered a reliable indicator of development and is related to later school achievements (Nelson et al, 2006). The risk of exhibiting LD is greater in populations characterized by perinatal risk factors (infants born preterm; Law et al, 2000; Nelson et al, 2006) or by genetic factors (younger siblings of children with autism spectrum disorder; ASD; e.g., Ozonoff et al, 2014). These two at-risk populations are characterized by high interindividual variability, with about 30– 40% of infants developing a LD (Ozonoff et al, 2014; Sansavini et al, 2014; Iverson et al, 2018).

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