Edited by: Leonard Abbeduto, University of California, Davis, United States
Reviewed by: Meagan Talbott, University of California, Davis, United States; Laura J. Mattie, University of Illinois at Urbana-Champaign, United States; Angela John Thurman, University of California, Davis, United States
This article was submitted to Language Sciences, a section of the journal Frontiers in Communication
†These authors share senior authorship
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The early emergence of social communication challenges and their impact on language in infants later diagnosed with autism has sparked many early intervention programs that target social communication skills. While research has consistently shown lower scores on social communication assessments in the first year of life, there is limited research at 12-months exploring associations between different dimensions of social communication and later language. Understanding associations between early social communication skills and language would enhance our ability to choose high priority intervention goals that will impact downstream language skills. The current study used a standardized assessment to profile social communication skills across 516 infants with a high (HL) or low likelihood (LL-Neg) for autism (84% White, 60% Male), based on the presence of a sibling with autism in the family. The primary aim of the study was to profile social communication skill development in the second year of life and to evaluate associations between social communication skills and later language. HL infants who met criteria for autism (HL-ASD,
Autism spectrum disorder (ASD) is a neurodevelopmental condition, characterized by restricted, repetitive patterns of behavior and challenges in social communication (DSM-5; American Psychiatric Association,
Early social communication skills are a harbinger for later language development (Wetherby et al.,
Interventions provided before a diagnosis are referred to as pre-emptive interventions. Pre-emptive interventions have been reported to be feasible and acceptable by families (Green et al.,
While preemptive interventions are effective in teaching parents strategies to improve social communication outcomes, it is important to consider the impact of these interventions on language development trajectories. Fostering better language skills has been identified as a priority for interventions by the autism community (Kapp,
Autistic toddlers with better social communication skills measured in the second year of life also have better later language skills (Toth et al.,
While research has reported significant positive associations between social communication skills measured in the first year of life and later language, most of the existing studies focused on a limited number of specific skills, such as joint attention (Bottema-Beutel,
The present study is part of two multisite Infant Brain Imaging (IBIS) Network studies that prospectively followed three groups of infants: (a) typically developing infants with a low likelihood for developing autism (LL-Neg), (b) infants who have a family-history of autism but do not develop autism themselves (HL-Neg), and (c) infants who have a family-history of autism and who go on to have autism (HL-ASD). This study design provides the opportunity to prospectively explore social communication skills and their association to later language. The purposes of this study were: (a) to explore developmental trajectories of social communication skills across the three groups of infants, (b) to identify differences in social communication skills at 12-months and 24-months across the three groups of infants, (c) to explore temporal relationships between social communication skills measured at 12-and-24-months-of-age and later language, measured at 24-and-36-months-of-age and (d) to understand how social communication skills predict autism and language diagnostic outcomes.
This study included 516 infants form two IBIS studies. Data for the IBIS 1 study were collected between 2007 and 2012; and data for the IBIS 2 study were collected between 2012 and 2018. Data were collected at four sites: University of North Carolina at Chapel Hill; University of Washington; The Children's Hospital of Philadelphia; and Washington University in St. Louis Data for the current study were collected between January 10th, 2008, and February 19th, 2018. Procedures for this study were approved by local Institutional Review Boards. Written informed consent was obtained from parents prior to participation.
All participants were screened, and exclusions were made for the following reasons: (1) genetic conditions or syndromes, (2) medical/neurological conditions affecting growth, development, or cognition (e.g., seizure disorder) or significant sensory impairments (e.g., vision or hearing loss), (3) birth weight <2000 g and/or gestational age <36 weeks or significant perinatal adversity and/or exposure in utero to neurotoxins, (4) contraindication for MRI, (5) predominant home language other than English, (6) adopted children or half siblings, (7) first-degree relative with psychosis, schizophrenia, or bipolar disorder (Family Interview for Genetic Studies (FIGS; Maxwell,
For the IBIS 1 study, data were collected when infants were 6, 12, and 24-months-of-age. A detailed description of the IBIS 1 data collection protocol can be found in Estes et al. (
Infants were classified as autistic at 24-months if they met DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, edition IV, Text Revision; American Psychiatric Association,
Infant participants were assigned to three groups based on familial history status and diagnostic outcome. Infants who had a high likelihood for autism, by virtue of having an older sibling with autism, and met criteria for autism were assigned to the HL-ASD group (
The behavior sample of the CSBS (Wetherby and Prizant,
Overview of social communication skills measures in the CSBS composites.
Social | Emotion and eye gaze | Shifting gaze between object and communicative partner |
Communication | Frequency and variety of intentional communicative acts (e.g., requesting, refusing, seeking comfort) | |
Gestures | Use of conventional gestures (e.g., pointing, nodding, showing) |
|
Speech | Sounds | Use of sounds in communicative acts |
Words | Use of words in communicative acts | |
Symbolic | Understanding | Comprehension of object names, body part names, and person names (i.e., receptive vocabulary) |
Object Use | Use of objects during symbolic play |
All coders were trained based on guidelines described in the CSBS manual. Coders first reviewed coded practice videos with a trained coder. Next, they coded practice videos independently until they achieved 80% reliability with gold standard scoring. The gold-standard coding video was originally coded by a clinician with expertise in CSBS coding. Approximately 5% of the videos (
Through the coding process, administration errors were identified in the symbolic and social composites, which impacted the following clusters: emotion and eye gaze, communication, gestures, understanding, and object use. Videos with administration errors were excluded from analyses for the clusters with incorrectly administered composite(s), resulting in different data sets for each CSBS score (see
The MSEL (Mullen,
A second assessment, the Vineland (Sparrow et al.,
Next, cross-sectional analyses were completed at 12- and 24-months using the general linear model. Cross-sectional analyses were not completed at 15-months due to small sample sizes (
General linear models were used to explore the effects of 12-month CSBS scores on 24-month language scores (MSEL receptive and expressive language raw scores; and Vineland receptive and expressive language raw scores); and 24-month CSBS scores on 36-month language scores (MSEL receptive and expressive language raw scores). NVDQ at 24 months was included as a covariate to explore the effects of social communication on later language while controlling for non-verbal cognitive skills. A decision was made
Logistic regressions models were used to analyze the relationship between 12-month CSBS scores and 24-month diagnostic (HL-ASD vs. HL-Neg) and language outcomes (HL-Language Delay vs. HL-No Delay); as well as 24-month CSBS scores and 36-month language outcomes across HL infants. The LL-Neg group was not included for the language outcomes analysis due to the low occurrence of language delays in this group. Of the 141 LL-Neg infants who had language outcome data at 24-months, 9 met criteria for language delays.
For all the analyses, data collection site, maternal education, and sex of the infant were included as control variables. These control variables were selected
Descriptive data for study sample by Group.
% Male | 78 | 55 | 59 | χ2 = 14.10, |
χ 2 = 34.22, |
||||
High school diploma (%) | 42 | 31 | 16 | |
College degree (%) | 31 | 45 | 39 | |
Graduate degree (%) | 27 | 24 | 45 | |
χ 2 = 11.76, |
||||
High school diploma (%) | 43 | 32 | 23 | |
College degree (%) | 33 | 38 | 41 | |
Graduate degree (%) | 22 | 30 | 36 | |
Race | χ 2 = 12.91, |
|||
White (%) | 88 | 91 | 87 | |
African American (%) | 1 | 3 | 6 | |
Asian (%) | 1 | 1 | 1 | |
Multiracial (%) | 15 | 9 | 11 | |
62 | 223 | 115 | ||
9 | 15 | 10 | ||
65 | 241 | 129 | ||
Age at 12-months | 12.8 (0.73) | 12.6 (0.66) | 12.7 (0.83) | |
Age at 15-months | 15.8 (0.81) | 15.4 (0.45) | 15.5 (0.40) | |
Age at 24-months | 24.8 (1.30) | 24.7 (0.91) | 24.8 (0.87) | |
Age at 36-months | 39.7 (4.58) | 39.5 (4.90) | 43.8 (8.53) | |
12-months | 92.36 (14.97) | 101.18 (2.34) | 106.39 (11.48) | |
24-months | 80.18 (17.13) | 102.04 (15.60) | 110.27 (15.22) | |
36-months | 83.24 (21.29) | 103.97 (18.03) | 111.69 (15.31) | |
12-months | 109.38 (13.15) | 113.31 (12.68) | 116.39 (11.30) | |
24-months | 87.91 (13.04) | 101.98 (12.92) | 108.75 (13.16) | |
36-months | 87.28 (19.83) | 105.62 (16.47) | 109.14 (13.21) | |
12-months | 11.01 (2.65) | 12.27 (2.58) | 13.01 (2.49) | |
24-months | 18.01 (5.42) | 22.43 (4.17) | 23.81 (4.05) | |
36-months | 29.24 (7.08) | 33.96 (4.74) | 38.23 (5.16) | |
12-months | 11.67 (2.39) | 12.56 (2.06) | 13.76 (1.86) | |
24-months | 18.57 (6.69) | 25.27 (3.35) | 26.56 (3.07) | |
36-months Vineland ABC | 29.30 (7.30) | 33.56 (4.80) | 38.14 (6.26) | |
12-months | 89.47 (14.39) | 96.30 (13.98) | 100.48 (9.54) | |
24-months | 88.93 (9.75) | 101.51 (10.90) | 103.96 (11.43) | |
12-months | 16.14 (4.53) | 19.00 (5.26) | 20.40 (3.94) | |
24-months | 33.44 (12.76) | 45.93 (12.63) | 50.01 (11.54) | |
12-months | 9.55 (3.43) | 11.31 (3.25) | 12.46 (3.31) | |
24-months | 18.02 (6.24) | 24.07 (3.65) | 25.25 (3.44) |
Mixed linear models revealed significant group by age interaction effects (
Longitudinal mixed linear model with group by age interaction effects.
Emotion and eye gaze ( |
2 | 321 | 16.26 | <0.01* |
Communication ( |
2 | 347 | 8.56 | <0.01* |
Gestures ( |
2 | 347 | 6.59 | <0.01* |
Sounds ( |
2 | 347 | 8.23 | <0.01* |
Words ( |
2 | 347 | 29.08 | <0.01* |
Understanding ( |
2 | 159 | 36.85 | <0.01* |
Object use ( |
2 | 289 | 6.07 | 0.01* |
Developmental trajectory of CSBS scores by group.
At 12-months, the main group effect was significant for all CSBS scores (
Emotion eye gaze ( |
9.63 | 0.44 | 10.95 | 0.23 | 12.06 | 0.33 | 2 | 213.90 | 9.88 | < 0.01* | 0.07 | a < b < c |
Communication ( |
9.07 | 0.56 | 11.80 | 0.29 | 12.89 | 0.42 | 2 | 549.60 | 15.17 | < 0.01* | 0.10 | a < b, c |
Gestures ( |
6.57 | 0.47 | 8.53 | 0.24 | 9.92 | 0.35 | 2 | 415.30 | 16.45 | < 0.01* | 0.10 | a < b < c |
Sounds ( |
3.52 | 0.59 | 6.34 | 0.31 | 5.73 | 0.44 | 2 | 375.50 | 9.32 | < 0.01* | 0.06 | a < b, c |
Words ( |
0.40 | 0.24 | 1.00 | 0.13 | 0.95 | 0.18 | 2 | 17.86 | 2.62 | 0.25 | 0.02 | a, b, c |
Understanding ( |
1.04 | 0.54 | 1.62 | 0.29 | 2.07 | 0.41 | 2 | 25.26 | 1.67 | 0.42 | 0.01 | a, b, c |
Object use ( |
4.84 | 0.47 | 5.91 | 0.26 | 6.29 | 0.36 | 2 | 69.90 | 3.14 | 0.05 | 0.02 | a, b, c |
Emotion and eye gaze ( |
9.96 | 0.38 | 14.49 | 0.19 | 14.34 | 0.27 | 2 | 1,016.00 | 60.18 | < 0.01* | 0.30 | a < b, c |
Communication ( |
13.40 | 0.43 | 17.50 | 0.22 | 16.70 | 0.31 | 2 | 853.30 | 37.03 | < 0.01* | 0.19 | a < b, c |
Gestures ( |
9.08 | 0.45 | 12.59 | 0.23 | 12.53 | 0.32 | 2 | 651.90 | 26.63 | < 0.01* | 0.14 | a < b, c |
Sounds ( |
13.00 | 0.69 | 19.60 | 0.36 | 19.20 | 0.50 | 2 | 2,246.90 | 37.73 | < 0.01* | 0.19 | a < b, c |
Words ( |
9.55 | 0.99 | 17.75 | 0.51 | 18.78 | 0.71 | 2 | 4,008.20 | 33.43 | < 0.01* | 0.18 | a < b, c |
Understanding ( |
8.27 | 1.03 | 17.44 | 0.54 | 19.70 | 0.66 | 2 | 3,745.00 | 45.39 | < 0.01* | 0.36 | a < b < c |
Object use ( |
10.20 | 0.56 | 13.60 | 0.28 | 13.70 | 0.41 | 2 | 608.00 | 16.72 | < 0.01* | 0.10 | a < b, c |
*Significant interaction that survived adaptive FDR procedure.
The HL-Neg group scored significantly below the LL-Neg group on emotion and eye gaze, and gestures at 12-months (
At 24-months, for all CSBS scores, the main effect of group was significant (
The interaction effects of CSBS scores by group were not significantly associated with expressive language (
General liner model exploring main effects of social communication skills measured at 12-months on language abilities measured at 24-months.
Emotion eye gaze ( |
88.2 | 5.13 | 0.02* | 0.06 | 12.3 | 0.86 | 0.35 | 0.07 |
Communication ( |
151 | 8.87 | <0.01* | 0.10 | 72.5 | 5.06 | 0.03* | 0.11 |
Gestures ( |
172.7 | 10.18 | <0.01* | 0.11 | 88.6 | 6.20 | 0.02* | 0.13 |
Sounds ( |
312.8 | 18.85 | <0.01* | 0.14 | 198.2 | 14.17 | <0.01* | 0.16 |
Words ( |
136.8 | 8.02 | <0.01* | 0.04 | 126.6 | 8.93 | <0.01* | 0.05 |
Understanding ( |
311.8 | 19.34 | <0.01* | 0.10 | 247.8 | 17.93 | <0.01* | 0.12 |
Object use ( |
190.9 | 11.70 | <0.01* | 0.06 | 48.3 | 3.44 | 0.07 | 0.07 |
Emotion eye gaze ( |
1,624 | 11.52 | <0.01* | 0.09 | 745 | 5.72 | 0.02* | 0.10 |
Communication ( |
2,497 | 17.95 | <0.01* | 0.13 | 1,786 | 13.98 | <0.01* | 0.14 |
Gestures ( |
1,676 | 11.86 | <0.01* | 0.11 | 1,101 | 8.49 | <0.01* | 0.12 |
Sounds ( |
2,751 | 19.87 | <0.01* | 0.11 | 1,951 | 15.32 | <0.01* | 0.12 |
Words ( |
1,641 | 11.61 | <0.01* | 0.06 | 1,581 | 12.32 | <0.01* | 0.06 |
Understanding ( |
1,816 | 13.64 | <0.01* | 0.08 | 1,430.2 | 11.87 | <0.01* | 0.09 |
Object use ( |
1,689 | 12.10 | <0.01* | 0.06 | 669 | 5.14 | 0.02* | 0.06 |
Emotion eye gaze ( |
112.9 | 7.55 | 0.04* | 0.11 | 18.5 | 1.58 | 0.44 | 0.15 |
Communication ( |
63.8 | 4.34 | 0.05 | 0.11 | 15 | 1.31 | 0.44 | 0.14 |
Gestures ( |
91.4 | 6.25 | 0.04* | 0.11 | 30.2 | 2.66 | 0.36 | 0.14 |
Sounds ( |
22.5 | 1.52 | 0.25 | 0.06 | 0.60 | 0.05 | 0.82 | 0.08 |
Words ( |
3.9 | 0.26 | 0.61 | 0.02 | 2.3 | 0.20 | 0.82 | 0.02 |
Understanding ( |
88.9 | 5.31 | 0.05 | 0.06 | 52.3 | 3.85 | 0.35 | 0.07 |
Object use ( |
67.5 | 4.41 | 0.05 | 0.05 | 1.5 | 0.11 | 0.82 | 0.06 |
Emotion eye gaze ( |
223.6 | 13.85 | 0.01* | 0.11 | 136.4 | 8.76 | 0.01* | 0.12 |
Communication ( |
55.0 | 3.41 | 0.11 | 0.07 | 28.2 | 1.83 | 0.24 | 0.08 |
Gestures ( |
39.0 | 2.40 | 0.13 | 0.06 | 17.6 | 1.14 | 0.33 | 0.07 |
Sounds ( |
78.1 | 4.85 | 0.06 | 0.06 | 44.4 | 2.89 | 0.21 | 0.06 |
Words ( |
149.5 | 9.40 | <0.01* | 0.06 | 143.5 | 9.49 | 0.01* | 0.06 |
Understanding ( |
49.3 | 3.00 | 0.12 | 0.03 | 36.6 | 2.28 | 0.23 | 0.03 |
Object use ( |
35.9 | 2.21 | 0.14 | 0.02 | 6.9 | 0.43 | 0.51 | 0.02 |
The degree of freedom for all models was 1.
The interaction effects of CSBS scores by group were not significantly associated with receptive language, except for words and Vineland RL [(
For the remaining models with non-significant interaction effects of CSBS scores by group on receptive language, the interaction term was removed from subsequent models. Once the interaction effect was removed, CSBS scores that were significantly positively associated with 24-month MSEL RL, included emotion and eye gaze and gestures (
We also explored associations between social communication skills and later language in each group of participants. In the HL-ASD group, none of the 12-month CSBS scores were associated with MSEL and Vineland language scores (
For MSEL-RL, the HL-Neg group demonstrated significant positive associations with emotion eye gaze, and gestures (
The CSBS scores by group interaction effects were significant for MSEL EL and emotion and eye gaze (
General liner model exploring main effects of social communication skills measured at 24-months on language abilities measured at 36-months.
Emotion eye gaze ( |
232.3 | 10.79 | <0.01* | 0.24 | 166.4 | 8.99 | <0.01* | 0.28 |
Communication ( |
298.1 | 14.22 | <0.01* | 0.18 | 262.9 | 14.53 | <0.01* | 0.21 |
Gestures ( |
100.6 | 4.57 | 0.04* | 0.07 | 72.7 | 3.81 | 0.06 | 0.08 |
Sounds ( |
935.9 | 53.17 | <0.01* | 0.56 | 715.54 | 45.57 | <0.01* | 0.63 |
Words ( |
814.4 | 44.64 | <0.01* | 0.48 | 584.98 | 35.69 | <0.01* | 0.54 |
Understanding ( |
486.87 | 23.54 | <0.01* | 0.63 | 288.36 | 15.19 | <0.01* | 0.69 |
Object use ( |
72.9 | 3.34 | 0.06 | 0.08 | 33.5 | 1.74 | 0.19 | 0.10 |
Emotion eye gaze ( |
205.6 | 9.62 | <0.01* | 0.22 | 138.4 | 7.83 | <0.01* | 0.27 |
Communication ( |
169.3 | 7.88 | <0.01* | 0.13 | 139.7 | 7.89 | <0.01* | 0.16 |
Gestures ( |
106 | 4.86 | 0.03* | 0.06 | 73.9 | 4.09 | 0.05 | 0.07 |
Sounds ( |
530.6 | 27.10 | <0.01* | 0.36 | 342.72 | 20.6 | <0.01* | 0.42 |
Words ( |
531.1 | 27.13 | <0.01* | 0.31 | 321.9 | 19.23 | <0.01* | 0.37 |
Understanding ( |
679.02 | 36.84 | <0.01* | 0.82 | 426.42 | 25.75 | <0.01* | 0.92 |
Object use ( |
76.1 | 3.53 | 0.06 | 0.07 | 31.9 | 1.74 | 0.19 | 0.09 |
The degree of freedom for all models was 1.
For MSEL RL, the CSBS scores by group interaction effects were significant for emotion and eye gaze and understanding (
The interaction effects of remaining CSBS scores (communication, gesture, sounds, words, understanding, object use) by group on MSEL RL were not significant (
Follow-up groupwise analyses revealed unique patterns for 24-month social communication and 36-month language associations. The HL-ASD group demonstrated significant associations between emotion-eye gaze, sounds, words, understanding and MSEL-EL (
Logistic regression was used to determine if CSBS scores predicted later autism diagnoses and language delay status. These analyses were conducted within the HL infants only. Of the HL infants 22% met criteria for signs of early language delay at 24 and 36 months (
Number of infants identified to have language delays among HL-infants by visit.
HL | 309 | 192 |
HL-language delay | 69 (22%) | 42 (22%) |
HL-no delay | 240 (78%) | 150 (78%) |
The models exploring 12-month CSBS scores as predictors of 24-month autism diagnosis and language delay in the high-likelihood infants did not reveal any significant associations (
Logistic regression analysis exploring main effects of social communication skills measured at 12-months on diagnostic and language outcomes measured at 24-months in HL-infants.
Emotion eye gaze | −0.02 | 0.07 | −0.37 | 0.93 | 0.97 |
Communication | −0.12 | 0.06 | −1.99 | 0.33 | 0.89 |
Gestures | −0.04 | 0.07 | −0.57 | 0.93 | 0.96 |
Sounds | −0.02 | 0.06 | −0.26 | 0.93 | 0.98 |
Words | −0.04 | 0.20 | −0.22 | 0.93 | 0.95 |
Understanding | −0.01 | 0.08 | −0.09 | 0.93 | 0.99 |
Object use | −0.02 | 0.07 | −0.24 | 0.93 | 0.98 |
Emotion eye gaze | −0.08 | 0.09 | −0.93 | 0.49 | 0.92 |
Communication | −0.09 | 0.07 | −1.30 | 0.48 | 0.91 |
Gestures | −0.05 | 0.08 | −0.56 | 0.67 | 0.95 |
Sounds | 0.09 | 0.08 | 1.09 | 0.48 | 1.09 |
Words | −0.39 | 0.29 | −1.35 | 0.48 | 0.68 |
Understanding | −0.15 | 0.13 | −1.14 | 0.48 | 0.86 |
Object use | −0.03 | 0.09 | −0.37 | 0.71 | 0.97 |
Logistic regression analysis exploring main effects of social communication skills measured at 24-months on language outcomes measured at 36-months in HL-infants.
Emotion eye gaze | 0.00 | 0.10 | 0.03 | 0.98 | 1.00 |
Communication | 0.29 | 0.16 | 1.79 | 0.17 | 1.34 |
Gestures | −0.13 | 0.13 | −1.00 | 0.45 | 0.88 |
Sounds | −0.21 | 0.09 | −2.32 | 0.07 | 0.81 |
Words | −0.01 | 0.07 | −0.21 | 0.97 | 0.99 |
Understanding | −0.16 | 0.05 | −3.21 | <0.01* | 0.85 |
Object use | −0.14 | 0.10 | −1.42 | 0.27 | 0.87 |
This prospective study explored social communication skills and their associations to language in infants later diagnosed autistic. Social communication skills were evaluated at 12, 15, and 24-months in a large sample of infants that were either: (a) typically developing infants with no family history of autism (LL-Neg), (b) infants with a family history of autism who were later diagnosed autistic (HL-ASD), or (c) infants with a family history of autism who were not later diagnosed autistic (HL-Neg). The clinical implications for early identification and intervention for autism are discussed below.
HL-ASD infants demonstrated lower scores on social communication assessments at 12-months-of-age across widespread domains, and these early differences became more pronounced in the second year of life. These findings add to existing research reporting that social communication difficulties are detectable using standardized assessments as early as 9- to 12-months-of-age (Bradshaw et al.,
Across all infants, better scores on all CSBS clusters at 12-months-of-age were related to better expressive language scores at 24-months of age. Better emotion and eye gaze and gesture scores were associated with better 24-month receptive language scores. Further, better scores on the sounds, words, and understanding clusters at 24-months-of-age were associated with better 36-month receptive and expressive language scores. In addition, infants who had better emotion and eye gaze and communication skills at 24-months also had higher 36-month expressive language scores.
This current study is the first to explore associations between a wide range social communication skills and language in infants with a high likelihood for autism as early as 12-months-of-age. Extending this research to younger ages has revealed shifts in associations between early social communication and later language, unique to infants later diagnosed autistic.
In the HL-ASD group, none of the CSBS scores at 12-months were associated with language at 24-months-of-age. In contrast, CSBS scores as early as 12-months-of age were significantly positively associated with 24-month language in the HL-Neg and LL-Neg groups. This functional association did not emerge in the HL-ASD group until 24-months-of-age, at which point emotion-eye gaze, sounds, words, and understanding were significantly positively associated with 36-month receptive and expressive language. This finding is consistent with previous research that has reported that social communication skills measured 20-months-of-age and beyond are associated with downstream language skills in autistic toddlers (Yoder et al.,
Pecukonis et al. (
Although 12-month social communication skills were not associated with later language in the HL-ASD group, 24-month social communication skills were associated with later language, and this suggests that supporting early social communication development may relate to better downstream language skills. Further, HL-Neg infants are more likely to demonstrate language delays than LL-Neg infants (Miller et al.,
This study is also the first to explore the utility of social communication profiles in predicting autism diagnoses and language delays in infants with a high likelihood for autism. At 24-months, understanding scores significantly predicted 36-months language delay outcomes. While understanding scores accurately predicted high-likelihood infants who met criteria for language delays only 45% of the time; they accurately predicted infants who did not meet criteria for language delays 95% of the time. The understanding cluster measures receptive vocabulary. Our findings suggest that early receptive vocabulary can be used to screen out infants within the high likelihood group who do not need additional language interventions. Further, these findings also suggest that providing interventions in response to early receptive vocabulary developmental trajectories needs to be a key focus of preemptive interventions.
Overall, these findings suggest that preemptive interventions should follow a personalized, developmental approach and capitalize on existing social communication skills to increase bouts of shared engagement, use of intentional communication, and gesture use (i.e., skills measured in the social composite). During instances of intentional communication, the use of sounds and words can be encouraged using parental scaffolding. While infants later diagnosed autistic did not demonstrate significant differences at the group level on symbolic skills (i.e., understanding and object use) at 12-months-of-age, it is important to monitor these skills and provide interventions tailored to support symbolic skills as challenges in this area may emerge later in development.
While preemptive interventions for autism are yet to demonstrate conclusive evidence of efficacy, preliminary research reports are promising (Hampton and Rodriguez,
A limitation of this study is that the sample did not include infants with other developmental delays. Hence, the profile of social communication skills reported in this study may not be specific to autism. It should be noted, however, that approximately 30% of high likelihood infants who do not meet criteria for autism demonstrate other clinical concerns at school age, such as broader autism phenotype (BAP), Attention-Deficit/Hyperactivity Disorder (ADHD), and speech and language problems (Miller et al.,
Infants later diagnosed autistic demonstrate widespread challenges with social communication skills as early as 12-months-of-age and this gap in social communication skills was more pronounced in the second year of life. Better social communication skills at 12-months-of-age were not associated with better with downstream receptive and expressive language skills in this group. Contrastingly, infants who did not meet criteria for autism demonstrated significant positive associations between early social communication skills and later language. This functional association only emerged in autistic infants in the second year of life, at which point 24-month social communication skills were positively associated with 36-month language skills. Further, understanding (i.e., receptive vocabulary) scores at 24-months-of-age significantly predicted language delays in infants with an older autistic sibling. Taken together, these findings support the need for preemptive interventions that are designed to respond to early developmental trajectories that consolidate into an autism diagnosis. Social communication skills, particularly sharing attention, goal-directed communication (using gestures, sounds, and words), and understanding are ideal preemptive intervention targets as they related to better downstream language abilities.
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
The studies involving human participants were reviewed and approved by Institutional Review Board, The University of Texas at Dallas. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.
SR, MS, and JP-M contributed to conception and design of the study. AB, SM, CC, and LY organized the database. HA, SR, and MS contributed to the statistical analysis plan. SR wrote the manuscript. All authors contributed to manuscript revision, read, and approved the submitted Version.
This work was supported by grants through the National Institutes of Health (R00-MH108700 PI Swanson, R01-HD055741 PI Piven, R01-HD055741-S1 PI Piven, P30-HD003110 PI Piven, U54 EB005149 PI Kikinis) and the Simons Foundation (SFARI Grant 140209). The funders had no role in study design, data collection, analysis, data interpretation, or the writing of the report.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor LA declared a past co-authorship with the authors AE and JP.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
The authors thank the IBIS children and their families for their ongoing participation in this longitudinal study.
The Supplementary Material for this article can be found online at: