Date Presented 04/06/19
The current study aims to examine the utility of the First Years Inventory, a parent-report screener for early identification of autism spectrum disorder (ASD), as a potential tool for distinguishing ASD from other developmental delays. Despite being rarely addressed by previous studies in the field, the differentiation between these two outcome groups is critical for practitioners to be able to provide targeted interventions. Our findings suggest promising predictive validity for young infants.
Primary Author and Speaker: Yun-Ju Chen
Contributing Authors: John Sideris, Grace Baranek
PURPOSE: Although research has discovered behavioral markers that can reliably distinguish infants with autism spectrum disorder (ASD) from typically developing toddlers by the end of the second year of life, differentiating ASD from those with other types of developmental delays (e.g. speech delay, global developmental delay) poses additional challenges since they may share similar behavioral manifestations. Differentiating infants who have ASD from those who do not is a critical step towards the goal of initiating appropriate interventions, as it is possible that the interventions that are most effective for young children with ASD are different than those for other types of developmental delays. The current study aims to examine the utility of the First Years Inventory (FYI), a parent-report screener for early identification of social communication (SC) and sensory regulatory (SR) risk markers of ASD, as a potential tool of distinguishing ASD from other types of developmental delays. We also examine if the predictive models for the outcome membership remain consistent across different age groups (8-11 and 12-16 months).
DESIGN: The FYI survey was sent to a community sample of 40,000 families with an 8-16 month old infant through the North Carolina birth registry. The 6,498 parents who completed the FYI were sent surveys including Social Responsiveness Scale (SRS) once their child reached 3 years of age in order to confirm the child’s developmental outcome. From this, 67 children were reported as having ASD or were flagged by the SRS, and 256 children were reported as having non-ASD diagnoses or other developmental concerns. A total of 323 infants were split into two age groups (8-11 and 12-16 months) for further analysis, given recruitment targeted a wide age window.
METHOD: FYI domain scores (SC and SR) were obtained by taking the average of risk scores that had been assigned to the 66 FYI items based on the frequency distribution of Likert-scale responses. Logistic regression models were used to estimate receiver-operator characteristic (ROC) curves for each domain (SC and SR individually) and combination of the two domains together (SC+SR) as the predictors of outcome group classification. Stepwise logistic regressions were run to identify items which gave the most statistically significant improvement of the model fit.
RESULTS: In the 12-16 month group, the area under the curve (AOC) for SR domain (0.62) was slightly smaller than SC domain (0.64), and adding SR to SC made the AOC increase to 0.68. Two out of the three items entered into the regression equation were SC items. Interestingly, the AOC for SR domain alone (0.73) was larger than SC domain alone (0.58) and SC+SR (0.68) in the 8-11 month group, indicating that SR alone brings better prediction power. Four out of the five items entered into the regression equation were SR items.
CONCLUSION: Our findings suggest promising predictive validity of FYI for infants between 8 to 16 months of age. Sensory regulatory functioning seems to be a key construct for differentiating ASD from other developmental delays in the first two years of life. IMPACT STATEMENT: The results indicate that FYI is a promising tool which will assist occupational therapists and other practitioners in screening young infants more accurately, and providing early interventions that target core impairments, which could have a significant impact on daily life functioning and later quality of life.
References
Turner-Brown, L. M., Baranek, G. T., Reznick, J. S., Watson, L. R., & Crais, E. R. (2013). The First Year Inventory: a longitudinal follow-up of 12-month-old to 3-year-old children. Autism, 17(5), 527-540.
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(9), 1691-1710.
