King's College London, Institute of Psychiatry, UK.
J Am Acad Child Adolesc Psychiatry. 2012 Mar;51(3):249-260.e25. doi: 10.1016/j.jaac.2011.12.009. Epub 2012 Feb 3.
To chart the emergence of precursors and early signs of autism spectrum disorder (ASD) and autistic traits in the Avon Longitudinal Study of Parents and Children, a prospective longitudinal cohort study of the surviving offspring of 14,541 pregnant women from southwestern England with an expected delivery date between April 1991 and December 1992.
Parents' contemporaneous reports of their infant's development (241 questionnaire responses collected up to 30 months of age) were examined in relation to the diagnosis of autism spectrum disorder by age 11 years (n = 86) and a measure of autistic traits, derived by factor analysis.
Among the children later diagnosed with ASD, concerns about vision and hearing were more often reported in the first year, and differences in social, communication, and fine motor skills were evident from 6 months of age. Repetitive behaviors and differences in play, imitation, and feeding habits were reported in the second year. Differences in temperament emerged at 24 months of age and bowel habit by 30 months. All of these early signs were strongly associated with the presence of autistic traits in the rest of the population and these differences were often evident in the first year of development. Over the first 30 months of development, the best predictors of both later ASD and autistic traits included the Social Achievement and Communication scores from the Denver Developmental Screening Test, measures of communicative skills (Vocabulary and Combines Words) from the MacArthur Infant Communicative Development Inventories, and a repetitive behavior score.
Precursors, early signs, and other developmental differences were reported in the first year of development among children from the general population who later developed autism spectrum disorder and subtler autistic traits. Other differences emerged and unfolded as development progressed. The findings confirm the long-held suspicion that early differences underscore the multifaceted nature of autism spectrum disorder and the broader autism phenotype, and highlight the centrality of impairments in social communication skills.
描绘自闭症谱系障碍（ASD）和自闭症特征的前驱症状和早期迹象，该研究是一项针对英格兰西南部 14541 名孕妇所生育存活后代的前瞻性纵向队列研究，这些孕妇的预产期在 1991 年 4 月至 1992 年 12 月之间。
通过因子分析，将父母对婴儿发育的同期报告（241 份问卷在 30 个月龄之前收集）与 11 岁时的 ASD 诊断（86 例）以及自闭症特征的衡量标准进行关联分析。
在后来被诊断为 ASD 的儿童中，在第一年更常报告视力和听力问题，从 6 个月大开始，社会、沟通和精细运动技能的差异明显。第二年开始出现重复行为以及在玩耍、模仿和喂养习惯方面的差异。24 个月时出现气质差异，30 个月时出现肠道习惯差异。所有这些早期迹象与人群中自闭症特征的存在密切相关，并且这些差异在发育的第一年就很明显。在最初的 30 个月发育过程中，预测后来的 ASD 和自闭症特征的最佳指标包括丹佛发育筛查测试的社会成就和沟通分数、麦克阿瑟婴儿沟通发展量表中的沟通技能（词汇和组合词）分数，以及重复行为分数。
在后来发展为 ASD 的一般人群儿童的第一年的发育过程中，报告了前驱症状、早期迹象和其他发育差异，并且更细微的自闭症特征差异也随之出现。随着发育的进展，其他差异也逐渐显现。这些发现证实了人们长期以来的怀疑，即早期差异强调了自闭症谱系障碍和更广泛的自闭症表型的多面性，并强调了社交沟通技能受损的核心地位。
