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

Stelios Georgiades,Isabel M Smith,Peter A Tait,Stephen Gentles,Anat Zaidman-Zait,Connor M Kerns,Eric Duku,Pat Mirenda,Paul D Mcnicholas,Joanne Volden,Lonnie Zwaigenbaum,Wendy J Ungar,Teresa Bennett,Tracy Vaillancourt,Mayada Elsabbagh,Charlotte Waddell,Peter Szatmari

doi:10.1007/s10803-021-04949-2

Abstract

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.

Highlights

Autism Spectrum Disorder (ASD or autism) is a heterogeneous neurodevelopmental condition that affects the way a person communicates and relates to the people and the world around them
This study examined the trajectories of autistic symptom severity in a large inception cohort of children with ASD assessed across four time points from diagnosis to age 10
A two-group clustering solution was selected based on Bayesian information criterion (BIC) criteria (2 clusters: − 11,977; 3 clusters: − 12,115; 4 clusters: − 12,345), in which smaller values are preferred (Schwarz, 1978)

Summary

Introduction

Autism Spectrum Disorder (ASD or autism) is a heterogeneous neurodevelopmental condition that affects the way a person communicates and relates to the people and the world around them. A small number of ‘person-centered’ studies has used trajectory analyses that combine three or more data points to capture variation among children with ASD in level and rate of change (Gotham et al, 2012; Kim et al, 2018; Szatmari et al, 2015; Venker et al, 2014). Verbal IQ predicted trajectory membership and adaptive behavior declined in all but the improving trajectory, with consistent impairment in all trajectories These findings have since been replicated by Venker et al (2014) in a sample of 129 children with ASD evaluated annually from ages 21⁄2 to 51⁄2. Sex was the only significant correlate of trajectory membership, with boys more likely to be in the more severe and stable trajectory

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Discussion

Conclusion