1. The Relationship of Early Intervention and Early Child Characteristics
to Autism and Disability Severity at School Age
Patricia Towle, Ph.D., Nicole Turygin, Ph.D., and Colleen O’Sullivan, Ph.D.
Leadership Education in Neurodevelopmental and related Disabilities (LEND) Program, Westchester Institute for Human Development, University Center for Excellence in Developmental Disabilities and New York Medical College
Background
Longitudinal studies of Autism Spectrum Disorder (ASD) are important to understand outcomes of children diagnosed early. Few studies have followed children from as early as the second year of life to school age. This study focuses on prediction of autism and disability severity at school age from both early childhood characteristics and early intervention experiences..
Results
Participant Characteristics at School Age
Goal 1: (continued)
B. What Therapies Did Children of Three Different Later Functioning Levels Receive?
B. Do Early Adaptive Scores Predict Autism Scores at School age?
ASD with Mod-Severe Disability
ASD with Mild Disability
No ASD Dx;
N %
N % % % %
Speech
100
ABA
Spec Ed (non-ABA) OT 92 80 PT 20
Family Training 40
Feeding
M SD
Total Therapies
Total Hours
Correlations between Time 1 Vineland (early adaptive skills) and Time 2 Autism Scores)
Three diagnostic categories at Time 2 were developed based on parent report of: current functioning ▪social skills ▪GARS scores ▪ learning difficulties, and special education services. The participants were then placed into one of three ASD and Disability categories.
GARS Tot
GARS Com
GARS Soc
GARS RRB
VABS T1
Comm
-.128
.346 56
.044
.753 54
-0.60
.662
-.178
.185 57
VABS T1 DLS
-.130
.332 58
.062
.650
-.176
.186
-.157
.234 59
VABS T1 Soc
-.339**
.009
-.159
.239
-.264*
.043
-.346**
.007 60
VABS T1 Mot
-.008
.957 52
-.034
.819 49
-.108
.450 51
-.073
.608
VAB T1 ABC
-.138
.320
-.046
.744
-.118
.396
-.158
.250 55
Distribution of Time 2 Diagnoses at School Age and Autism and Adaptive Scores for Each Level
Study Goals
What early childhood characteristics predict autism and disability level at school age?
What early intervention characteristics predict autism and disability at school age?
ASD with Mod-Severe Disability
ASD with Mild Disability
No ASD Dx;
N %
N %
VABS T2
ABC M N
61.83 23
80.85 13
104.60 10
GARS
94.61 36
70.85 20
54.60
Method
Participants
70 children who received early intervention evaluations and/or service coordination at WIHD and, through a chart abstraction coding system, were diagnosed with ASD before the age of 3 years old (Time 1). The same children were re-evaluated at age years old (Time 2). Twenty were evaluated in person.
Instruments :Time 1: Demographics, Vineland Adaptive Behavior Scales (VABS) and Childhood Autism Rating Scale (CARS); early intervention services child received through preschool.
Time 2: Parent Questionnaire ,Vineland Adaptive Behavior Scales and Gilliam Autism Rating Scale (GARS)
Procedure: Parents were contacted about participation in the study. Packets including consent form and questionnaires were mailed out. Each child’s early intervention hours were recorded from Department of Health early intervention charts. All instruments were scored and entered into the database using SPSS to conduct planned analysis.
Half the children were in the most severe category, one-third was milder, and about 20% did not retain an ASD diagnosis. Adaptive behavior (VABS) and autism severity scores (GARS) supported the categorization.
Only the Socialization subscale of the early Vineland had predictive power for later autism severity.
Age of Participants
Mean
Range SD
Age at Time 1
25 mos
13 – 36 mos
5.5 mos
Age at Time 2
10.5 yrs
7 – 18 yrs
2 yrs
The most common therapies were Speech, ABA, Special Instruction, and OT. Children who were more Severe at outcome tended to get more types of therapy, and more hours. However, the No ASD group had more hours than the Mild ASD.
Goal 1: Child Characteristics from Time 1 to Time 2
Goal 2: Early Intervention Experiences and Time 2 Diagnostic Status
A. Do Early Autism Scores Predict Autism Scores at School Age?
A. Does Age of Diagnosis (Starting Early Intervention) Predict Later Dx Level?
Discussion
Correlations between Time 1 CARS (early autism symptom severity), and Time 2 GARS (later autism symptom severity
Child early autism scores (CARS) and Vineland Socialization scores were predictive of later autism severity at follow up. This suggests continuity between ASD severity measured before age 3 years and when reported by parents at school age. Age when starting EI did not differ among the three outcome severity levels. The number of EI and Preschool therapies received was higher for the more severe children at outcome. More complex analyses (i.e., multiple regression) will explore more complex relationships between early and later variables.
ASD with Mod-Severe Disability
ASD with Mild Disability
No ASD Dx;
N=36
N=22
N=12
Age of Dx
M, SD
GARS tot
GARS
Comm
Social
RRB
CARS
Tot R
Sig N
384**
.016 39
.267
.116 36
.311
.054
465**
.002 40
There was no significant difference in age at diagnosis for children of different severity levels at school age.
CARS scores before age 3 significantly correlated to autism severity scores at school age.