Familial Recurrence of Autism: Updates From the Baby Siblings Research Consortium.

OBJECTIVES: Autism spectrum disorder (ASD) is estimated to be ∼10 times higher in children with versus without an autistic sibling in population-based studies. Prospective studies of infant siblings have revealed even higher familial recurrence rates. In the current prospective longitudinal study, we provide updated estimates of familial ASD recurrence using a multinational database of infants with older autistic siblings. METHODS: Data were collated across 18 sites of the Baby Siblings Research Consortium, an international network studying the earliest manifestations of ASD. A total of 1605 infants with an older autistic sibling were followed from early in life to 3 years, when they were classified as ASD or non-ASD. Hierarchical generalized linear modeling, with site as a random effect, was used to examine predictors of recurrence in families and calculate likelihood ratios. RESULTS: A total of 20.2% of siblings developed ASD, which is not significantly higher than the previously reported rate of 18.7%. Male infant sex and >1 older affected sibling were significant predictors of familial recurrence. Proband sex also influenced recurrence rates, with siblings of female probands significantly more likely to develop ASD than siblings of male probands. Race and maternal education were also associated with recurrence in families. CONCLUSIONS: The familial recurrence rate of ASD, as measured in infant sibling studies, has not changed appreciably since previous estimates were made in 2011. Younger siblings of autistic children, particularly those who are male, have an affected female sibling, multiple affected siblings, or are impacted by social inequities, should be closely monitored and promptly referred for diagnostic evaluation.

Reaching While Learning to Sit: Capturing the Kinematics of Co-Developing Skills at Home.

This study examined the co-development of infant reaching and postural control across the transition to arms-free sitting at home. We observed infants with typical likelihood (TL; n = 24) and elevated likelihood (EL; n = 20) for autism at four biweekly sessions spanning the transition to arms-free sitting (infant age = 4.5-8 months at first session). At each session, infants sat on a pressure-sensitive mat with external support or independently, wore magneto-inertial sensors on both wrists, and reached for toys presented at midline. Analyses focused on characterizing and comparing control of sitting during reaching actions and standard kinematic metrics of reaching during Supported versus Independent Sitting. Although EL infants achieved arms-free sitting later than TL peers, there were no group differences on any measures. Across sessions, infants' control of the sitting posture during concurrent reaching movements improved in both contexts, though they were less stable as they reached when sitting independently compared to when sitting with support. A similar effect was apparent in the kinematics of reaches, with overall improvement over time, but evidence of poorer control in Independent relative to Supported Sitting. Taken together, these findings underscore the mutually influential and dynamic relations between emerging skills and well-established behaviors.

Attention and sensory integration for gait in young adults with autism spectrum disorder.

INTRODUCTION: Altered sensorimotor function is a common feature of autism spectrum disorder (ASD). As a result, spatiotemporal walking patterns are typically affected. Attentional processes relevant for locomotion may be altered in people with ASD. This study assessed the extent to which gait alterations observed under sensory challenging conditions are due to reduced attention-related processes in young adults with ASD. METHODS: Twenty-one adults with ASD and 21 age- and sex-matched neurotypical participants walked at a self-selected pace on a 10-m walkway under 12 sensory/attention conditions: hard or carpet flooring; well-lit or dim lighting; no attention task, an auditory choice-reaction time information-processing task, or a simple reaction time information-processing task. Gait data were collected with a 12-marker motion capture set and a trunk accelerometer. Spatiotemporal characteristics of gait were derived and compared between the two groups across gait conditions. RESULTS: Floor/light conditions impacted gait speed, average step length, average stance time, average step width, and step width variability similarly in both groups (p<0.05). The information processing tasks impacted average step length, gait speed, and step length variability (p<0.05). Group differences were found in step length metrics: the ASD group had decreased average step length during the simple reaction time information-processing task and neurotypical participants did not (p=0.039); the ASD group had increased variability on carpet compared to hard floor and the neurotypical group had no change in variability due to floor (p=0.015). SIGNIFICANCE: These results suggest that attentional set-shifting and somatosensory inputs may play an important role in ASD-related gait alterations. Step length metrics appear to be sensitive to group differences between ASD and neurotypical adults during sensory challenging conditions.

Movement as a Gateway to Participation for Individuals With Neuromotor Conditions: A Scoping Review.

PURPOSE: The purpose of this scoping review was to examine and analyze the developmental and rehabilitation literature related to movement and participation at key points of transition for individuals with neuromotor conditions. METHODS: Arksey and O'Malley's scoping review protocol was applied, and 37 articles were included. Extracted data included population, developmental transition points, movement opportunity, type of participation, and outcome measures. RESULTS: Most studies covered developmental transition points; none examined transitions as a variable for participation outcomes. Physical activity/exercise was the most common movement opportunity. Most publications used formal outcome measures of participation; others used observation or interviews. CONCLUSION: No publications adequately addressed the effect of movement opportunities on participation during developmental transition points.

Adding to the Conversation: Language Delays and Parent-Child Interactions in the Younger Siblings of Children With Autism.

In their first three years, children begin to maintain topics and add new information in conversation. In turn, caregivers create opportunities for language learning. Compared to children with no family history of autism (typical likelihood, TL), the younger siblings of children with autism spectrum disorder (ASD) are at elevated likelihood (EL) for both ASD and language delays. This study asked: (1) Do profiles of spoken language and conversational skills differ across groups? (2) Does spoken language relate to conversational skills? and (3) How does parent speech relate to child spoken language and conversational skills? Child spoken language, conversational skills, and parent speech were examined during toy play at home with three-year-old TL (n = 16) and EL children with ASD (EL-ASD, n = 10), non-ASD language delay (EL-LD, n = 21), and no delays or diagnoses (EL-ND, n = 37). EL-ASD children produced fewer intelligible utterances, and EL-LD and EL-ASD children produced shorter utterances than TL and EL-ND children. When utterances were intelligible, all groups were highly contingent to the topic. EL-ASD children were less likely than all other groups to add new information, and adding new information was positively associated with utterance length. Parents of EL-ASD children had fewer opportunities to respond contingently. However, all parents were highly topic-contingent when child speech was intelligible, and parent speech complexity varied with child language and conversational skills. Findings highlight strengths in conversational skills for EL-ASD children during toy play with parents and show that children and caregivers together shape opportunities for developing language and conversation.

Expression and co-regulation of negative emotion in 18-month-olds at increased likelihood for autism with diverse developmental outcomes.

LAY ABSTRACT: Managing negative emotion can be challenging for autistic individuals and their families from a young age. Parents help young children manage negative emotions by responding in comforting or supportive ways. Not much research has examined how negative emotions and parent responses to negative emotions are different in very young autistic children. This study used videotapes of 18-month-old toddlers and parents at home. We examined how much and how intensely toddlers expressed negative emotion in everyday situations, and how parents responded. Participants were younger siblings of autistic children, and we compared three groups-children that (1) later received an autism diagnosis; (2) had language delays but not autism; and (3) had no delays or autism. We found that autistic toddlers' negative emotion was more likely to be intense and to continue once it started compared with children without delays or autism. Language-delayed toddlers also showed some, but not all these differences. Parents responded similarly to negative emotions in all groups. When parents used strategies to help, it reduced the chances of the negative emotions continuing, although it may have been less helpful for autistic toddlers. This study shows that autistic children may express more intense and long-lasting negative emotions from an early age. It also shows that parents of autistic children are very responsive to their children's negative emotions, but these responses may not be as helpful to autistic children. While more research is needed, this study helps us understand how autistic toddlers may express and experience emotions differently.

Breakdowns and repairs: Communication initiation and effectiveness in infants with and without an older sibling with autism.

Infants initiate interactions to get their wants and needs met; but sometimes they are not effective in their communication and are misunderstood by caregivers. When this happens, they must recognize this breakdown in communication and attempt repairs. Experimental literature suggests that in neurotypically developing infants these skills develop during the first two years. However, little work has investigated communication breakdowns and repairs in populations of infants with known social communication difficulties (e.g., infants with an elevated likelihood for autism). Here we explored early social communication initiations, breakdowns, and repair strategies in naturalistic videos of 18-month-old infants (N = 64) with elevated likelihood (EL) for autism and other developmental delays (N = 49) and infants with population-level likelihood for autism (e.g., typical likelihood, TL, N = 15). EL infants, including those who later met criteria for autism (EL-AUT), initiated with caregivers, experienced breakdowns, and made repairs at similar rates to TL infants. However, the types of behaviors used differed, such that EL infants appeared to have a relative strength in making behavior regulation bids. EL-AUT infants used a large proportion of developmentally appropriate repair behaviors (i.e., addition and substitution), even though their repertoires of repair strategies were smaller. Additionally, EL-AUT infants produced a larger proportion of simplification repairs, which are less developmentally advanced and less helpful to interlocutors. Identifying patterns in how EL infants communicate with caregivers and capitalizing on their strengths could improve interventions focused on social communication.

Comparing apples to manzanas and oranges to naranjas: A new measure of English-Spanish vocabulary for dual language learners.

The valid assessment of vocabulary development in dual-language-learning infants is critical to developmental science. We developed the Dual Language Learners English-Spanish (DLL-ES) Inventories to measure vocabularies of U.S. English-Spanish DLLs. The inventories provide translation equivalents for all Spanish and English items on Communicative Development Inventory (CDI) short forms; extended inventories based on CDI long forms; and Spanish language-variety options. Item-Response Theory analyses applied to Wordbank and Web-CDI data (n = 2603, 12-18 months; n = 6722, 16-36 months; half female; 1% Asian, 3% Black, 2% Hispanic, 30% White, 64% unknown) showed near-perfect associations between DLL-ES and CDI long-form scores. Interviews with 10 Hispanic mothers of 18- to 24-month-olds (2 White, 1 Black, 7 multi-racial; 6 female) provide a proof of concept for the value of the DLL-ES for assessing the vocabularies of DLLs.

Infant Communication Across the Transition to Walking: Developmental Cascades Among Infant Siblings of Children with Autism.

New motor skills can shape how infants communicate with their caregivers. For example, learning to walk allows infants to move faster and farther than they previously could, in turn allowing them to approach their caregivers more frequently to gesture or vocalize. Does the link between walking and communication differ for infants later diagnosed with autism spectrum disorder (ASD), whose communicative and motor development differs from their neurotypically developing peers? We prospectively followed two groups of infants longitudinally during the transition from crawling to walking: (1) N = 25 infants with no family history of ASD; and (2) N = 91 infants with an older sibling with ASD. Fifteen infants were later diagnosed with ASD, and 26 infants showed a language delay (but did not receive an ASD diagnosis). After learning to walk, infants without ASD or language delay showed considerable changes in their communication: They gestured more frequently, and increasingly coordinated their gestures and vocalizations with locomotion (e.g., by approaching a caregiver and showing a toy). Infants with language delay showed similar but attenuated growth in their communication. However, infants later diagnosed with ASD did not display enhanced communication after they began to walk.

Early development in autism: How developmental cascades help us understand the emergence of developmental differences.

Many theories of autism spectrum disorder (ASD) focus on a single system or factor as an explanatory mechanism for autism symptoms and behavior. However, there is growing recognition that ASD is a complex, multisystem neurodevelopmental condition with origins in prenatal life. Researchers therefore need a conceptual framework that allows examination of the interplay between multiple interacting domains and systems and the ways in which they extend their influence beyond the individual into the surrounding environment. The developmental cascades perspective suggests that even relatively small perturbations in early emerging behaviors in domains that are not traditionally linked may influence subsequent achievements across these areas. In this chapter, we illustrate how a developmental cascades framework can be used to inform the study of developmental differences. The developmental cascades perspective provides us with conceptual and methodological tools for considering how variation in children's real time behavior can provide new insights into sources of variation in their developmental trajectories and outcomes. It also suggests approaches for intervention that leverage targeted skills in novel ways, creating opportunities to support development in other domains and fine-tune caregiver behavior to create powerful moments for infant learning.

Equifinality in infancy: The many paths to walking.

Many different pathways can lead to the same result or developmental outcome. What are the developmental routes that result in the onset of walking? In this longitudinal study, we documented patterns of infant locomotion during everyday activities at home for 30 prewalking infants. Using a milestone-based design, we focused on observations spanning the two months before the onset of walking (M age at walk onset = 11.98 months, SD = 1.27). We examined how much time infants spent in motion and when they moved, whether they were more likely to do so while prone (crawling) or upright with support (cruising or supported walking). Results showed immense variability in infants' practice regimes en route to walking-some infants spent relatively similar amounts of time crawling, cruising, and supported walking at each session, others preferred one method of travel over the alternatives, and some switched between different types of locomotion from session to session. In general, however, infants spent a larger share of their movement time in upright positions compared to prone. Finally, our densely sampled dataset revealed a clear feature of locomotor development: infants follow many distinct and variable paths to walk onset, regardless of the age at which it is attained.

Dynamics of the dyad: How mothers and infants co-construct interaction spaces during object play.

Studies of dyadic interaction often examine infants' social exchanges with their caregivers in settings that constrain their physical properties (e.g., infant posture, fixed seating location for infants and adults). Methodological decisions about the physical arrangements of interaction, however, may limit our ability to understand how posture and position shape them. Here we focused on these embodied properties of dyadic interaction in the context of object play. We followed 30 mother-infant dyads across the first year of life (at 3, 6, 9, and 12 months) and observed them during 5 min of play with a standard set of toys. Using an interval-based coding system, we measured developmental change in infant posture, how mothers and infants positioned themselves relative to one another, and how they populated interaction spaces with objects. Results showed that mother-infant dyads co-constructed interaction spaces and that the contributions of each partner changed across development. Dyads progressively adopted a broader spatial co-orientation during play (e.g., positioned at right angles) across the first year. Moreover, advances in infants' postural skills, particularly increases in the use of independent sitting in real time, uniquely predicted change in dyadic co-orientation and infants' actions with objects, independent of age. Taken together, we show that the embodied properties of dyadic object play help determine how interactions are physically organized and unfold, both in real time and across the first year of life.

Caregiver object labels within supported and coordinated joint engagement during interaction with toddlers at elevated and typical likelihood of autism.

BACKGROUND: Early in development, caregivers' object labelling contributes to children's word learning. Language development is a bi-directional process, and differences in joint engagement (JE) and language among children with developmental disabilities such as autism spectrum disorder (ASD) may provide caregivers varying contexts and opportunities to provide object labels. However, potential variation in caregivers' production of object labels and its relation to language development remain relatively unexplored among toddlers with ASD. AIMS: This study characterized the structural and functional features of object labels produced by parents of children with typical (TL) or elevated likelihood (EL) of ASD during naturalistic toy play. We examined features of object labels within two JE contexts, supported and coordinated JE, which are differentiated by a child's use of eye contact, as well as their relations with concurrent and future child language skills. METHODS & PROCEDURES: The present study included 55 (TL = 12, EL = 43) children who completed a naturalistic parent-child interaction in the home at 18 months of age. Children's expressive and receptive language was assessed at 18, 24 and 36 months. At 36 months, EL children were assessed for ASD and classified as either EL-No Diagnosis, EL-Language Delay or EL-ASD. Videos of interactions were divided into discrete engagement states, including supported and coordinated JE. All parent speech was transcribed and coded to capture structural (types, tokens, mean length of utterance (MLU), sentence position) and functional (follow-in comments, directives, lead-in labels) features of object labels as well as parent prompts for the child to produce a label. OUTCOMES & RESULTS: Parents of toddlers across outcome groups labelled objects at similar rates within each engagement state. However, parents of EL-ASD children provided the lowest rates of prompts for labels in supported JE and the highest rate of labels as the final word of an utterance (sentence-final position) in coordinated JE. Additionally, parent prompts in supported JE were related to concurrent child expressive language. Labels in sentence-final position were positively related to later language outcome when delivered in supported JE but were associated with poorer language outcomes when delivered in coordinated JE. CONCLUSIONS & IMPLICATIONS: Subtle differences in parent object labels across outcome groups demonstrate the role that child language and social engagement can play in influencing parent input and the cascading impact of this input on language development. WHAT THIS PAPER ADDS: What is already known on this subject Variations in caregiver object labelling can impact child language development. However, child characteristics such as language ability also actively shape the input caregivers provide, demonstrating the bi-directionality of language development. What this paper adds to existing knowledge The present study demonstrates that characteristics of the engagement context in which a label is delivered may be important for understanding how object labelling relates to child language acquisition and whether this relation varies for children who face challenges in language learning. What are the potential or actual clinical implications of this work? As child differences in social engagement emerge, parents may be more attuned to moments their children are engaging with eye contact. Caregiver-mediated interventions might consider strategies that guide caregivers in recognizing engagement without eye contact as a similarly meaningful opportunity for learning and encourage the use of rich input within these moments.

Infant locomotion shapes proximity to adults during everyday play in the U.S.

Learning to walk expands infants' access to the physical environment and prompts changes in their communicative behaviors. However, little is known about whether walking also shapes infants' proximity to their adult social partners during everyday activities at home. Here we followed 89 infants (42 boys, 47 girls; 92% White, not Hispanic or Latino) longitudinally and documented connections between infant locomotion and infant-adult proximity on two timescales: (1) across developmental time, by comparing data from a session when infants could only crawl to a later session when they could walk (M walk onset = 12.15 months, range = 8-15); and (2) in real time, by testing whether the amount of time that infants spent in motion (regardless of their locomotor status) related to their interpersonal distance to adults. The developmental transition to walking corresponded to a significant, but modest, decrease in infant-adult proximity. Infants' moment-to-moment locomotion, however, was strongly related to patterns of interpersonal distance: infants who spent more time in motion spent less time near adults and instigated more proximity transitions, resulting in shorter and more dispersed bouts of proximity throughout sessions. Findings shed new light on how infants' motor achievements can reverberate across other domains of development, and how changes in infant development that researchers often observe over months arise from infants' moment-to-moment experiences.

Capturing the complexity of autism: Applying a developmental cascades framework.

Developmental change emerges from dynamic interactions among networks of neural activity, behavior systems, and experience-dependent processes. A developmental cascades framework captures the sequential, multilevel, cross-domain nature of human development and is ideal for demonstrating how interconnected systems have far-reaching effects in typical and atypical development. Neurodevelopmental disorders represent an intriguing application of this framework. Autism spectrum disorder (ASD) is complex and heterogeneous, with biological and behavioral features that cut across multiple developmental domains, including those that are motor, cognitive, sensory, and bioregulatory. Mapping developmental cascades in ASD can be transformational in elucidating how seemingly unrelated behaviors (e.g., those emerging at different points in development and occurring in multiple domains) are part of an interconnected neurodevelopmental pathway. In this article, we review evidence for specific developmental cascades implicated in ASD and suggest that theoretical and empirical advances in etiology and change mechanisms can be accelerated using a developmental cascades framework.

Bidding on the go: Links between walking, social actions, and caregiver responses in infant siblings of children with autism spectrum disorder.

The development of walking is associated with a shift in how neurotypical infants initiate social interactions. Walking infants are more likely to locate objects in distant places, carry them, and then share those objects by approaching caregivers and using gestures to show or offer their discoveries (i.e., moving bids). The simultaneous organization of the behaviors necessary to generate moving bids requires the coordination of multiple skills-walking, fine motor skills, and gesturing. Infants with an elevated likelihood (EL) for autism spectrum disorder (ASD) exhibit differences and delays in each of these behaviors. This study investigated interconnections between infant walking, social actions, and caregiver responses in 18-month-old EL infants with diverse developmental outcomes (ASD, non-ASD language delay, no diagnosis). We observed 85 infant-caregiver dyads at home during everyday activities for 45 minutes and identified all times when infants walked, instances of walking paired with social action (i.e., approaching the caregiver, approaching while carrying an object, producing a moving bid), and whether caregivers responded to their infants' social actions. There were no group differences in infants' production of social actions. Caregiver responses, however, were more clearly modulated by outcome group. While all caregivers were similarly and highly likely to respond to moving bids, caregivers of EL-ASD infants were substantially more likely to respond when their infants simply approached them (with or without an object in hand). Taken together, this research underscores the complexity of EL infant-caregiver interactions and highlights the role that each partner plays in shaping how they unfold.

Developing language in a developing body, revisited: The cascading effects of motor development on the acquisition of language.

In the first years of life, infants rapidly acquire a series of new motor skills. They learn to sit independently, to walk with skill, and to engage in a wide variety of interactions with objects. Over these same years, infants also begin to develop language. These are not isolated events. In a complex developing system, even small changes in one domain can have far-reaching effects on development in other domains. This is the fundamental idea behind the rich framework known as the developmental cascades perspective. Here we employ this framework to show how early motor advances can exert downstream effects on the development of language. Focusing first on the emergence of independent sitting, then on the development of walking, and finally on changes in the ways in which infants act on and combine actions on objects, we describe how the nature and quality of infant actions change dramatically over the first few years and how this brings with it new possibilities for engaging the environment, more sophisticated ways of interacting with people, and significant alterations in communications directed by caregivers to the infant and coordinated with infant action in time and in meaning. The developmental cascades framework provides an approach for understanding how advances in motor skills influence communicative and language development, and more generally, for conceptualizing the constant, dynamic, and complex interplay between developing infants and their environments as it unfolds over time. This article is categorized under: Linguistics > Language Acquisition Psychology > Motor Skill and Performance Psychology > Development and Aging.

Early predictors of language skills at 3 years of age vary based on diagnostic outcome: A baby siblings research consortium study.

While previous work has identified the early predictors of language skills in infants at elevated familial risk (ER) and low familial risk (LR) for autism spectrum disorder (ASD), no studies to date have explored whether these predictors vary based on diagnostic outcome of ASD or no ASD. The present study used a large, multisite dataset to examine associations between a set of commonly studied predictor variables (infant gesture abilities, fine motor skills, nonverbal cognition, and maternal education level), measured at 12 months, and language skills, measured at 3 years, across three diagnostic outcome groups-infants with ASD ("ASD"), ER infants without ASD ("ER-no ASD"), and LR infants without ASD ("LR-no ASD"). Findings revealed that the predictors of language skills differed across groups, as gesture abilities were positively associated with language skills in the ER-no ASD group but negatively associated with language skills in the ASD group. Furthermore, maternal education level was positively associated with language skills in the ASD and LR-no ASD groups only. Variability in these early predictors may help explain why language skills are heterogeneous across the autism spectrum, and, with further study, may help clinicians identify those in need of additional and/or specialized intervention services that support language development. LAY SUMMARY: The present study identified predictors of language skills in infants with and without autism spectrum disorder (ASD). Maternal education level and 12-month gesture abilities predicted 3-year language skills in infants with ASD. Measuring these predictors early in life may help identify infants and families in need of additional and/or specialized intervention services that support language development.

Posture Matters: Object Manipulation During the Transition to Arms-Free Sitting in Infants at Elevated vs. Typical Likelihood for Autism Spectrum Disorder.

Aims: We investigated how infants grasped and transferred toys over a four-week period as they transitioned to arms-free sitting. We compared object manipulation in infants with typical likelihood (TL) and elevated likelihood (EL) for autism spectrum disorder (ASD) as they sat with vs. without support.Methods: Eighteen infants (7 EL; 11 TL; 5-8 months of age at the start of the study) were observed during three sessions at home across the transition to arms-free sitting. At each session, toys were presented to the infants in two different postures: sitting with support from a boppy pillow and sitting independently. Mean percentage of time spent grasping and rates of transferring objects between two hands were calculated for each infant at each session.Results: Both grasping time and transfer rate increased across the transition to arms-free sitting. EL infants, but not TL infants, spent significantly less time grasping toys when sitting independently than when sitting with support.Conclusions: Sitting plays a significant role in the development of object manipulation skills. Our results reveal a need to examine object manipulation skills in multiple posture contexts, especially in infants who exhibit motor delays.

Joint Engagement, Parent Labels, and Language Development: Examining Everyday Interactions in Infant Siblings of Children with Autism.

This study examined joint engagement, parent labels, and language development in infants with an elevated (EL) and typical likelihood (TL) for ASD. Parent-child interactions were coded for joint engagement and parent labels at 12 and 18 months, and language skills were assessed later in toddlerhood for 12 EL infants diagnosed with ASD (EL-ASD), 17 EL infants with language delay (EL-LD), 14 EL infants with no diagnosis (EL-ND), and 12 TL infants. Infants spent substantial time in supported joint engagement and received similar rates of input from parents across outcome groups. However, parents of EL-ASD infants increased the rate of labels provided in coordinated joint engagement. While labels positively predicted language for TL infants, the opposite pattern emerged for EL-ASD infants.