The association between social emotional development and symptom presentation in autism spectrum disorder.

Wendy Roberts,Kyle B Reid,Susan Bryson,Sarah Raza,Peter Szatmari,Lonnie Zwaigenbaum,Caroline Roncadin,Lori-Ann R Sacrey,Tracy Vaillancourt,Isabel M Smith,Vickie Armstrong,Jessica Brian

doi:10.1017/s0954579420000711

Abstract

Understanding differences in social-emotional behavior can help identify atypical development. This study examined the differences in social-emotional development in children at increased risk of an autism spectrum disorder (ASD) diagnosis (infant siblings of children diagnosed with the disorder). Parents completed the Brief Infant-Toddler Social-Emotional Assessment (BITSEA) to determine its ability to flag children with later-diagnosed ASD in a high-risk (HR) sibling population. Parents of HR (n = 311) and low-risk (LR; no family history of ASD; n = 127) children completed the BITSEA when their children were 18 months old and all children underwent a diagnostic assessment for ASD at age 3 years. All six subscales of the BITSEA (Problems, Competence, ASD Problems, ASD Competence, Total ASD Score, and Red Flags) distinguished between those in the HR group who were diagnosed with ASD (n = 84) compared to non-ASD-diagnosed children (both HR-N and LR). One subscale (BITSEA Competence) differentiated between the HR children not diagnosed with ASD and the LR group. The results suggest that tracking early social-emotional development may have implications for all HR children, as they are at increased risk of ASD but also other developmental or mental health conditions.

Highlights

Social-emotional development includes the ability to express and manage positive and negative emotions, develop interpersonal relationships, as well as explore the environment to learn about one’s surroundings (Pontoppidan, Niss, Pejtersen, Julian, & Vaever, 2017)
Three groups were identified for comparison based on the 36-month diagnostic assessments: (1) HR infant siblings who received a diagnosis of autism spectrum disorder (ASD) (‘HR-ASD’; n = 84; 61 boys and 23 girls); (2) HR infant siblings who did not receive a diagnosis of ASD (‘HR-N’; n = 227; 115 boys and 112 girls); and (3) LR controls who did not receive a diagnosis of ASD (‘LR’; n = 128; 67 boys and 61 girls)
There were three main results: (1) socialemotional development, as indexed by Brief Infant-Toddler Social-Emotional Assessment (BITSEA) subscales, differentiated children with ASD from children without ASD at 18 months of age, with only one subscale (BITSEA Competence) differentiating between the HR-N and LR groups; (2) socialemotional development was associated with clinical presentation at age three, as indexed by significant associations between BITSEA subscales and Autism Diagnostic Interview-Revised (ADI-R) algorithm scores in both HR groups; and (3) screening cut-off thresholds for social-emotional development, as indexed by the BITSEA, did not meet recommended criteria for screening of ASD (Zwaigenbaum et al, 2015)

Summary

Introduction

Social-emotional development includes the ability to express and manage positive and negative emotions, develop interpersonal relationships, as well as explore the environment to learn about one’s surroundings (Pontoppidan, Niss, Pejtersen, Julian, & Vaever, 2017). The BITSEA developers have added scales specific to autism spectrum disorder (ASD) in an attempt to support its use as an early detection tool for ASD (Briggs-Gowan et al, 2006; Gardner et al, 2013; Giserman Kiss & Carter, 2017). They reported acceptable levels of sensitivity (>.70) for distinguishing children with ASD from children without ASD children under 4 years old (Giserman Kiss, Feldman, Sheldrick, & Carter, 2017; Kruizinga et al, 2014). We predicted that parents of children diagnosed with ASD at age 3 years would report more socialemotional atypicalities at 18 months compared to parents of children who would not be diagnosed with ASD

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