Early Red Flags for Autism Spectrum Disorders in Toddlers in the Home Environment

Background: Early detection of autism spectrum disorders (ASD) is crucial to optimizing child and family outcomes. Most research on early diagnostic features of ASD has been in clinical environments. Observation of behaviors of young children in their home environment is a possible way to assist in earlier diagnosis in a less time consuming, less stressful, and more cost-effective manner for families. Therefore there is a need for research on diagnostic features displayed in natural environments.

Objectives: The primary purpose of this study was to explore and quantify red flags for ASD in the behaviors of young children demonstrated in the home environment.

Methods: Participants were recruited from the ongoing longitudinal, prospective study of the FIRST WORDS^® Project. The children in this study (N = 60) were between 17 and 36 months of age when a diagnosis of ASD (n = 45) or developmental delay in which ASD was ruled out (DD; n = 15) was made, based on a battery including the Autism Diagnostic Observation Schedule (ADOS; Lord, Rutter, DiLavore, & Risi, 2002). Measures on the Systematic Observation of Red Flags for Autism Spectrum Disorders in Young Children at Home (SORF-Home; Wetherby & Woods, 2009) were coded from video-recorded home observations of the child interacting with a parent or caregiver during everyday activities for up to sixty minutes.

Results: Overall, the results of this study demonstrated that early red flags of ASD were evident in the home environment. Seven of the red flags previously identified in the clinical environment were demonstrated by a majority of children during the home observations—lack of warm, joyful expression with directed gaze; lack of coordination of gaze, facial expression, gestures and sounds; lack of response to name; lack of communicative vocalizations with consonants; inappropriate eye gaze; lack of response to contextual cues; and lack of sharing interest or enjoyment. Examination of the relationship between the early red flags and developmental level revealed no significant correlations between the red flags and nonverbal cognitive developmental level and medium to large negative significant correlations between some red flags and verbal developmental level. Significant correlations were observed between many of the early red flags and composite scores on the ADOS. No significant correlations were observed between measures of parent report of red flags and the early red flags measured in the home environment.

Conclusions: The results of this exploratory study extend knowledge on the nature of red flags for ASD in young children to the home environment which adds valuable information for both practicing clinicians and families. The findings offer important implications for understanding how early red flags of ASD can vary across home and clinical environments and for building consensus with families on early signs of ASD.