Examining the Relationship Between Otitis Media Occurrence and Autism Severity Among School Aged Children with Autism Spectrum Disorders Between the Ages of 7-9

Background: Otitis Media (OM) is a commonly diagnosed condition among children. OM has been identified as a significant factor in combinations of neuropsychological and neurobehavioral developmental difficulties such as increased severity in comorbid learning disorders and Attention Deficit Hyperactivity Disorder (Padolsky, 2008). Further, typically developing children with a history of chronic OM also evidence lower scores on measures of phonological awareness, rhyme and non-word reading, semantic skills of expressive vocabulary, word definitions, reading, language development, and literacy development (Winskel 2006). Frequencies of OM in early development have not been identified as more prevalent among children with ASD than in neurotypical populations (Rosen, Yoshida, & Croen, 2007); however, given the relationship between OM and symptom severity and language, the examination of OM in ASD is warranted. Recent cluster analyses of expressive phonology and word comprehension among children with ASD between the ages of 7-9 point to different subtypes of language disorder among the age group (Rapin et al., 2009). This suggests the possibility that for children of this age group with ASD, OM occurrence could exist as a factor in aspects of symptom severity and deficits during critical stages of development and learning. 

Objectives: The objective of the current study was to investigate the relationship of Otitis Media occurrence in childhood and autism severity and language ability among 7-9 year old children with ASD. Results may inform potential factors involved in the development of deficits and symptom presentation within an identified critical age range. 

Methods: Using individuals ascertained through the Simon’s Simplex Collection (distribution 8.2; http://SFARI.org), we investigated the occurrence of parent-reported occurrences of Otitis Media among 394 (348M; 46F) 7-9 year old children with ADI and ADOS-confirmed ASD diagnoses in relation to their autism severity scores and performance on the Peabody Picture Vocabulary Test (PPVT). Children were divided into two occurrence groups identified as having either no occurrence of Otitis Media or at least once occurrence (and up to more than 8 occurrences). Autism severity scores based on the ADOS Calibrated Severity Score as well as standard scores on the PPVT were examined between Otitis Media groups

Results: A significant main effect for Otitis Media was found for the sample in relation to autism severity score. Children with at least once occurrence of Otitis Media during their development had significantly higher autism severity scores compared to those without an occurrence (F (5,1) = 4.659, p < .05). Main effects for OM were not found for PPVT performance, although age group showed a significant main effect (F (5,2) = 6.108, p, < .05) with ASD nine-year-olds performing significantly higher than both eight-year-olds and seven-year-olds on the test.

Conclusions: The current study suggests that the occurrence of Otitis Media during development could play an important role in autism severity and symptom expression among children in a critical age range for skill development. Importantly, the present effects observed coincide with other language, processing, and behavioral deficits in ASD populations specific to this particular age group.