Objective

This study examined variability in autism symptom trajectories in toddlers referred for possible autism spectrum disorder (ASD) who had frequent observations from 14 to 36 months of age.

Method

In total, 912 observations of the Autism Diagnostic Observation Schedule (ADOS) were obtained from 149 children (103 with ASD) followed from 14 to 36 months of age. As a follow-up to a previous analysis of ADOS algorithm scores, a different analytic approach (Proc Traj) was implemented to identify several courses of symptom trajectories using ADOS Calibrated Severity Scores in a larger sample. Proc Traj is a statistical method that clusters individuals into separate groups based on different growth trajectories. Changes in symptom severity based on individual ADOS items also were examined.

Results

Trajectory analysis of overall symptom severity identified 4 clusters (non-spectrum ∼25%; worsening ∼27%; moderately-improving ∼25%; severe-persistent ∼23%). Trajectory clusters varied significantly in the proportions of confirmatory ASD diagnosis, level of baseline and final verbal and nonverbal abilities, and symptom severity. For the moderately-improving group, social communication improved, whereas restricted and repetitive behaviors were stable over time. Language and verbal and nonverbal communication improved for many children, but several social affect and restricted and repetitive behavior symptoms remained stable or worsened.

Conclusion

Significant variability in symptom trajectories was observed among toddlers referred for possible ASD. Changes in social and restricted and repetitive behavior domain scores did not always co-occur. Similarly, item-level trajectories did not always align with trajectories of overall severity scores. These findings highlight the importance of monitoring individual symptoms within broader symptom domains when conducting repeated assessments for young children with suspected ASD.

中文翻译：

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使用14到36个月大的重复观察结果，得出自闭症症状轨迹的变异性

客观的

这项研究检查了可能患有自闭症谱系障碍（ASD）的幼儿的自闭症症状轨迹的变异性，该患儿在14到36个月大时有频繁观察。

方法

总共从149名儿童（103名患有ASD）中获得了912项自闭症诊断观察计划表（ADOS）的观察结果，年龄在14至36个月之间。作为先前对ADOS算法得分的分析的后续措施，在较大样本中使用ADOS校准严重性得分，采用了不同的分析方法（Proc Traj）来识别症状轨迹的多个过程。Proc Traj是一种统计方法，可以根据不同的增长轨迹将个人分为不同的组。还检查了基于单个ADOS项目的症状严重性变化。

结果

总体症状严重程度的轨迹分析确定了4个类群（非频谱约25％；恶化约27％；适度改善约25％；严重持续约23％）。在确定性ASD诊断的比例，基线水平以及最终的言语和非言语能力以及症状严重程度方面，弹道簇差异很大。对于中等改善组，社交沟通得到改善，而受限和重复的行为则随着时间的推移保持稳定。许多儿童的语言以及言语和非语言交流得到改善，但一些社交影响以及受限和重复的行为症状保持稳定或恶化。

结论

观察到可能发生ASD的幼儿在症状轨迹上的显着差异。社交，受限和重复性行为领域得分的变化并非总是同时发生。同样，项目级别的轨迹并不总是与总体严重性得分的轨迹一致。这些发现凸显了在对可疑ASD的幼儿进行重复评估时，在更广泛的症状范围内监视个体症状的重要性。