Early Book Sharing Behaviors in An Infant Sibling Study

Background: The American Academy of Pediatrics (AAP) recommends both routine screening for autism spectrum disorders (ASD) and surveillance for risk factors of ASD from infancy in all children. Parent-child book sharing, widely encouraged by the AAP, provides a potential opportunity to monitor for early signs of risk for ASD. However, no one has yet compared how very young children with and without ASD interact with books. Objectives: 1) To characterize typical behaviors of infants at a very young age (6 to 12 months) while sharing a book with a parent. 2) To identify early signs of atypical development that may herald later ASD and that could be used for developmental surveillance in pediatric clinics. Methods: In an ongoing prospective study of infant siblings of children with ASD and controls aged 6 to 24 months, parents were instructed to videotape themselves playing with their child with a set of toys and books provided by the study. This produced “home video diaries” which were analyzed using a novel coding scheme based on previously developed coding schemata used for analysis of early literacy behaviors and of home videos of children later diagnosed with ASD. Frequency codes measured the following domains: sensory-motor behaviors (physical manipulation or exploration of the book); communication (verbal and/or non-verbal such as vocalizations and gestures); shared affect with caregiver, joint attention; and response to name. Global codes included overall level of parent engagement in book sharing activity, parental affect, and child's affect. Videotapes were coded by two trained coders, and inter-rater reliability was 0.80. Results: Preliminary results are available for 49 families. 60% of the families had at least 1 video diary available, with an average of 4 diaries per family (range: 0 to 21). Most children showed primarily sensory-motor behaviors in relation to the book across all ages analyzed. Verbal communication increased after 12 months of age, with an average of 12 vocalizations per book sharing episode between the ages of 15 to 17 months (compared to 5 or fewer vocalizations before 12 months). Instances of non-verbal communication were rare before the age of 12 months but were more frequent after 14 months (M=1.5, SD=1.77 at 14 months). Joint attention (either initiating or responding to joint attention) was very rare between the ages of 6 to 21 months in the videos analyzed to date. Parental behavior and affect remained stable over time, with most parents showing at least moderate engagement and positive affect. Children's affect was generally neutral in all ages. Conclusions: Observations of parent-child book sharing allow assessment of social interactions and communication in young children. In this preliminary analysis with ongoing data collection, a wide range of behaviors were observed and coded, providing new information about typical and atypical behaviors in young children. When the subjects reach 24 months and are assessed for ASD over the coming months, we hope to identify observable indicators of developmental risk in parent-child book sharing that could be used in pediatric primary care for developmental surveillance.