The Vocabulary of Infants with an Elevated Likelihood and Diagnosis of Autism Spectrum Disorder: A Systematic Review and Meta-Analysis of Infant Language Studies Using the CDI and MSEL.

Zsofia Belteki,Raquel Lumbreras,Caroline Junge,Ewa Haman,Kloe Fico

doi:10.3390/ijerph19031469

Abstract

Diagnoses of autism spectrum disorder (ASD) are typically accompanied by atypical language development, which can be noticeable even before diagnosis. The siblings of children diagnosed with ASD are at elevated likelihood for ASD diagnosis and have been shown to have higher prevalence rates than the general population. In this paper, we systematically reviewed studies looking at the vocabulary size and development of infants with autism. One inclusion criterion was that infants were grouped either pre-diagnostically as elevated or typical likelihood or post-diagnostically as ASD or without ASD. This review focused on studies that tested infants up to 24 months of age and that assessed vocabulary either via the parent-completed MacArthur–Bates Communicative Developmental Inventory (CDI) or the clinician-administered Mullen Scales of Early Learning (MSEL). Our systematic search yielded 76 studies. A meta-analysis was performed on these studies that compared the vocabulary scores of EL and TL infants pre-diagnostically and the scores of ASD and non-ASD infants post-diagnostically. Both pre- and post-diagnostically, it was found that the EL and ASD infants had smaller vocabularies than their TL and non-ASD peers, respectively. The effect sizes across studies were heterogenous, prompting additional moderator analyses of age and sub-group analyses of the language measure used (CDI or MSEL) as potential moderators of the effect size. Age was found to be a moderator both in the pre- and post-diagnostical groups, however, language measure was not a moderator in either diagnostic group. Interpretations and future research directions are discussed based on these findings.

Highlights

Introduction iationsAutism spectrum disorder (ASD) is a developmental condition accompanied by impairments in social communication and interaction, as well as restrictive and repetitive behaviours or interests [1]
We focused on studies that compare the vocabularies of the infant groups using the Communicative Developmental Inventory (CDI) and the Mullen Scales of Early Learning (MSEL) as their language measures
Post-diagnostically, the lower confidence limits indicated large effect sizes. This means that larger differences were observed between the post-diagnostic (ASD vs. nonASD) and the pre-diagnostic (EL vs. typical likelihood (TL)) group classifications

Summary

Introduction

Autism spectrum disorder (ASD) is a developmental condition accompanied by impairments in social communication and interaction, as well as restrictive and repetitive behaviours or interests [1]. This includes differences in how the vocabularies of ASD infants develop compared to their non-ASD peers [2,3]. Some aspects of social communication and interaction are shown to be affected in ASD infants even prior to diagnosis. Infants who have an older sibling with ASD have an increased probability of receiving a diagnosis by approximately 20%, relative to the general population [4]. While some studies have classified infants solely on the basis of their genetic background (i.e., prospectively), other studies

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