Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Department of Paediatrics, Bloorview Research Institute, University of Toronto, Toronto, ON, Canada.
J Child Psychol Psychiatry. 2021 Dec;62(12):1435-1443. doi: 10.1111/jcpp.13417. Epub 2021 Mar 29.
Although early autism spectrum disorder (ASD) detection strategies tend to focus on differences at a point in time, behavioral symptom trajectories may also be informative.
Developmental trajectories of early signs of ASD were examined in younger siblings of children diagnosed with ASD (n = 499) and infants with no family history of ASD (n = 177). Participants were assessed using the Autism Observation Scale for Infants (AOSI) from 6 to 18 months. Diagnostic outcomes were determined at age 3 years blind to previous assessments.
Semiparametric group-based modeling using AOSI scores identified three distinct trajectories: Group 1 ('Low', n = 435, 64.3%) was characterized by a low level and stable evolution of ASD signs, group 2 ('Intermediate', n = 180, 26.6%) had intermediate and stable levels, and group 3 ('Inclining', n = 61, 9.3%) had higher and progressively elevated levels of ASD signs. Among younger siblings, ASD rates at age 3 varied by trajectory of early signs and were highest in the Inclining group, membership in which was highly specific (94.5%) but poorly sensitive (28.5%) to ASD. Children with ASD assigned to the inclining trajectory had more severe symptoms at age 3, but developmental and adaptive functioning did not differ by trajectory membership.
These prospective data emphasize variable early-onset patterns and the importance of a multipronged approach to early surveillance and screening for ASD.
尽管早期自闭症谱系障碍（ASD）的检测策略往往侧重于某个时间点的差异，但行为症状轨迹也可能具有信息性。
研究了自闭症谱系障碍儿童（n=499）和无自闭症谱系障碍家族史的婴儿（n=177）的年幼兄弟姐妹的早期 ASD 迹象的发育轨迹。参与者使用婴儿自闭症观察量表（AOSI）从 6 到 18 个月进行评估。诊断结果在盲法于先前评估的情况下在 3 岁时确定。
使用 AOSI 分数的半参数基于群组的建模确定了三种不同的轨迹：第 1 组（“低”，n=435，64.3%）的特征是 ASD 迹象水平低且稳定演变，第 2 组（“中等”，n=180，26.6%）具有中等且稳定的水平，第 3 组（“倾斜”，n=61，9.3%）具有更高且逐渐升高的 ASD 迹象水平。在年幼的兄弟姐妹中，3 岁时的 ASD 发病率因早期迹象的轨迹而异，在倾斜组中最高，其成员资格高度特异（94.5%）但敏感性差（28.5%）。被分配到倾斜轨迹的 ASD 儿童在 3 岁时的症状更严重，但轨迹成员的发育和适应功能没有差异。
这些前瞻性数据强调了早期发病模式的可变性以及采用多管齐下的方法对 ASD 进行早期监测和筛查的重要性。
