Examination of Developmental Sensitivity of Items on the Revised First Years Inventory Screener for Infants at Risk for a Later Diagnosis of Autism

PURPOSE: The First Years Inventory (FYI) Version 3.1 is a newly revised parent-report measure designed to identify infants aged 9–15 mo who are at risk for a later diagnosis of ASD. Despite myriad challenges (Reznick et al., 2007), early identification is essential to obtaining early services, such as occupational therapy, that may improve developmental outcomes (Macari et al., 2012). Because of maturational changes during this age range, items related to sensory–regulatory and social communication domains need to be assessed with respect to age norms to establish a psychometrically sound scoring algorithm to detect risk. That is, a given screening item may be highly sensitive to ASD risk in a child aged 15 mo but relatively insensitive to ASD risk in a child aged 9 mo. There is currently no parent-report screener for early risk of ASD that considers the effects of developmental sensitivity of individual items, particularly in sensory–regulatory functions. Thus, examination of developmental change in a large community sample was done to increase the utility of this screening for risk of ASD in clinical settings.

METHOD: The FYI was sent to 40,000 families in a community sample identified through the North Carolina birth registry who had an infant aged 9–15 mo. We received 6,657 valid responses (response rate = 17%), and 5,796 surveys were used for analysis after excluding 536 for preterm infants, 102 with <75% items completed, and 223 for children outside the age window.

The FYI uses a 5-point Likert scale (never to always) across two domains, social communication and sensory–regulatory functions. Parents completed the survey by estimating their child’s frequency of certain behaviors. There were 48 questions in each version with 27 core questions across the two versions, and thus 69 different items in total. Some items are reverse scored. Ordinal logistic regression analyses were conducted by item to examine the association between age (in mo) and the five-level ordinal response categories.

RESULTS: There were 10 items with pseudo R ² values falling between .15 and .35, indicating a moderate to strong association with age. All 10 items were in the domain of social communication. Two of these fell into the construct of social initiation and had the largest R ² values (>.30) in terms of the association between age and ordinal responses. Sensory–regulatory items showed no significant age-related associations from 9 to 15 mo.

CONCLUSION: The results showed that developmental change was a large factor in items tapping social communication, consistent with previous longitudinal findings (Feldman & Eidelman, 2009) that suggest linear increases in the first years of life. Accounting for developmental sensitivity when scoring specific items on ASD screening tools may help decrease false-positive rates for younger infants. However, sensory–regulatory functions were found to be less sensitive to developmental change across 9–15 mo, indicating that the items and cut points may perform similarly across this age range. Future item reduction analysis is needed to finalize a shorter and more clinically effective screening tool for use by occupational therapists and other health professionals for early identification of ASD.

IMPACT STATEMENT: Occupational therapists are among the first to assess young infants at risk for ASD; thus, effective early screening tools will enable more accurate recommendations for comprehensive evaluation and intervention.

References

Feldman, R., & Eidelman, A. I. (2009). Biological and environmental initial conditions shape the trajectories of cognitive and social–emotional development across the first years of life. Developmental Science, 12, 194–200. https://doi.org/10.1111/j.1467-7687.2008.00761.x

Macari, S. L., Campbell, D., Gengoux, G. W., Saulnier, C. A., Klin, A. J., & Chawarska, K. (2012). Predicting developmental status from 12 to 24 months in infants at risk for autism spectrum disorder: A preliminary report. Journal of Autism and Developmental Disorders, 42, 2636–2647. https://doi.org/10.1007/s10803-012-1521-0

Reznick, J. S., Baranek, G. T., Reavis, S., Watson, L. R., & Crais, E. R. (2007). A parent-report instrument for identifying one-year-olds at risk for an eventual diagnosis of autism: The first year inventory. Journal of Autism and Developmental Disorders, 37, 1691–1710. https://doi.org/10.1007/s10803-006-0303-y