Predictors of Daily Living Skills in Children with Autism Spectrum Disorder

Background: Children with Autism Spectrum Disorders (ASD) show impairments in daily living skills (DLS) when compared with typically developing children (Liss, Harel, Fein, Allen, et al., 2001). DLS such as dressing, eating, and bathing have implications for children’s functional independence and thus for burden of care. Individual differences in DLS are related to IQ in 9-year-old children with low-functioning autism, but language and verbal memory predicted DLS in higher functioning children (Liss, et al., 2001).  Sensori-motor and especially fine motor skills were concurrently related to DLS in preschoolers with ASD (Jasmin, Couture, McKinley, Reid et al., 2008).  There is little research exploring predictors of DLS longitudinally.

Objectives: This study sought to determine whether developmental assessments including fine motor and language skills at 12 months predict DLS at 36 months.  This study also sought to determine whether predictive relations differed among groups of (1) infants with no family history of autism; (2) infant siblings of children with autism; and (3) infants who received an ASD diagnosis at 36 months.  

Methods: Participants included 32 children with no family history of autism and 57 children with at least one older sibling with autism or ASD.  13 of the autism siblings were diagnosed with an ASD by 36 months of age.  The Mullen Scales of Early Learning (Mullen, 1995) were administered at 12 months to assess visual receptive skills, fine motor skills, receptive and expressive language.  Daily Living Skills were evaluated by parent report using the Vineland Adaptive Behavior Scales (Sparrow, Balla, & Cicchetti, 1984) at 36 months. ASD diagnosis was based on the ADOS-G and confirmed by clinician’s judgment at 36 months

Results: Due to variability in baseline measures of DLS, analyses targeted change in DLS from 12 to 36 months.  Group membership was associated with change in DLS (F(2, 76) = 6.60, p < 0.01).  The ASD group (M=12.9 months, SD=5.7) made smaller gains in DLS than the unaffected autism sibs (M= 21.7, SD = 7.0) and typical controls (M = 21.4, SD = 8.0).   When each of the Mullen Scales was separately entered into a regression model that also included group, the group variable was no longer a significant predictor.  Fine motor, visual reception, and expressive language did not predict change in DLS.  Only receptive language was a significant predictor of change in DLS, (β = 0.40, t(74) = 3.76, p < 0.001) when group was also included in the model.

Conclusions: These findings suggest that variability in receptive language constrains the acquisition of DLS. Children’s comprehension of instructions may be an important focus of interventions designed to improve DLS. The longitudinal design of this research may explain the difference in findings relative to concurrent analyses in the research cited above.  Longitudinal research contributes significantly to the understanding of individual differences in the acquisition of daily living skills.