Communication Spontaneity in Infants At High and Low Risk for ASD

Background: Pre-symbolic communication (e.g., gestures, vocalizations) provides the foundation for later language acquisition in a well-established developmental progression. Longitudinal studies demonstrate infants at high risk for ASD often show deficits in pre-symbolic and symbolic communication. One aspect of pre-symbolic communication receiving limited attention is communication spontaneity (CS), which refers to the level of support required to initiate communication. CS can range from very low (dependent on adult cues) to very high (based on individual, internal motivation). Clinical reports suggest CS is a challenge for many children with ASD.  However, there is very little research examining CS in children with pre-symbolic communication or the relationship between CS and other developmental constructs. Studies of CS in infants at high risk for ASD are needed to investigate whether this aspect of communication is diminished in at-risk infants and whether CS may be related to early social-communication difficulties. 

Objectives: We will describe a new measure of CS and examine CS in a cohort of 12-month-old infants with an older sibling with ASD (HR) and with typically developing older siblings (low-risk, LR). We aim to examine the relationships between CS and four domains of development: 1) language ability, 2) social-communication 3) social skills, and 4) adaptive skills. We will also compare 5) CS levels in the HR versus LR groups. 

Methods: Participants are part of a larger, multi-site, longitudinal study of development in at-risk infants (IBIS ACE Network). We examined a subsample of HR (n=43) and LR (n=21) 12-month-old infants from the University of Washington site. The Communication Symbolic Behavior Scales (CSBS:DP) was used to measure social-communication. To measure CS, videos of the CSBS:DP were blindly coded using a newly-developed coding system capturing the level of cuing required for a child to initiate communication acts. Language outcomes were measured by the Mullen Scales of Early Learning. Adaptive skills were measured by the Vineland Adaptive Behavior Scales. 

Results: Preliminary analyses indicate CS is positively associated with: 1) language ability on the Mullen Expressive Language (r=.439, p<.01) and Receptive Language (r=.319, p<.01) scales, and the Vineland Communication Composite (r=.492, p<.01), 2) social-communication on the CSBS Social Communication Scores (r=.437, p<.01), 3) social skills on the Vineland Social Composite (r=.357, p<.01), and 4) adaptive skills on the Vineland Adaptive Behavior Composite (r=.527, p<.01). 5) No significant difference between level of CS in HR vs. LR infants was found. 

Conclusions: Results indicate that higher levels of CS are related to higher language, social-communication, social and adaptive scores at 12 months. However, preliminary data suggests differences in CS in HR and LR infants may not be present at 12 months. Future analyses are needed to investigate the relation of CS to development at 24 months and whether early variations in CS are related to later-emerging ASD symptoms in infants at high risk for ASD. In addition to standardized measures of expressive and receptive language, the level of spontaneity with which children functionally apply these language skills may be an important consideration for early assessment and intervention in ASD.