Developmental Associations Between Attention, Language, and ASD Symptomatology in the Infant Siblings of Children with Autism Spectrum Disorders (ASDs)

Background:

Children with Autism Spectrum Disorders (ASDs) exhibit deficits in their ability to disengage and shift visual attention. They also show deficits in their ability to initiate joint attention (IJA), which in typically developing populations is associated with later language development. The infant siblings of children with an ASD (ASD-sibs) show similar impairments when compared to the infant siblings of typically developing children (COMP-sibs). Few studies have examined how these early deficits relate to one another and to later ASD symptomatology in ASD-sibs. 

Objectives:

This study examined the developmental associations between early visual attention, joint attention, language development, and ASD symptomatology in ASD-sibs and COMP-sibs.

Methods:

In the Face to Face-Still-Face Protocol (FFSF) at six months, parents were instructed to play normally with their infant, hold a still-face, and then resume play. Visual attention was measured as the frequency of infants’ gaze shifts at and away from the parent’s face during the FFSF. IJA was calculated as a mean frequency during the Early Social Communication Scales (ESCS) at 8, 10, 12, 15, and 18 months. A mean of receptive and expressive language abilities at 24 and 36 months was calculated using the Mullen Scales of Early Development. Later ASD symptomatology was measured as the sum of the Communication and Social Interaction Total and the Stereotyped Behaviors and Repeated Interests Scales of the Autism Diagnostic Observation Schedule (ADOS) at 30 months.

Results:

Overall, there were strong associations in ASD-sibs between early gaze shifts and IJA, and between IJA and ASD symptomatology. Gaze shifts were significantly correlated with IJA for ASD-sibs, r(24) = .49, p = .02, but not for COMP-sibs, r(18) =.21, p = .40. In addition, IJA was significantly correlated with ASD symptomatology for ASD-sibs, r(8) = -.77, p = .03, but not for COMP-sibs, r(10) = -.39, p = .26. There was some degree of negative association between gaze shifts and ASD symptomatology for ASD-sibs, r(8) = -.64, p = .09, but not for COMP-sibs, r(10) = .21, p = .56. Both ASD and COMP-sibs exhibited similar associations between IJA and later language. There was a tendency for IJA to be associated with receptive language for ASD-sibs, r(15) = .48, p =.07, and that correlation was significant for COMP-sibs, r(12) = .59, p =.04.  There was a tendency for IJA and expressive language to be associated for ASD-sibs, r(15) = .49, p =.07, and COMP-sibs, r(12) = .55, p =.06. Gaze shifts were not correlated with later language.

Conclusions:

Among ASD-sibs, flexible attention allocation at and away from the parent’s face at six months was associated with language and ADOS symptomatology two years later. In addition, in ASD-sibs, greater frequency of gaze shifts at six months predicted more frequent IJA behaviors from 8 to 18 months, which in turn predicted lower ASD symptomatology at 30 months. COMP-sibs did not exhibit developmental associations between visual and joint attention, and later ASD symptomatology. For ASD-sibs, early deficits in visual and joint attention may predict atypical developmental and later ASD symptomatology.