Screening for Social Disability At 12 Months Using the First Year Inventory

Background:  

The challenge of early screening for ASD is identifying which behaviors reliably detect emerging social disabilities.  The First Year Inventory (FYI), a parent-completed questionnaire, assesses a 12-month-old’s risk of ASD.  A retrospective study of the FYI suggests differing levels of social disability detection between its domains; no prospective data have been published.

Objectives:  

To examine:

1. Which domains of the FYI at 12 months differentiate infants who are likely to experience marked social disability at 24 months  
2. The concurrent association between parental report of behaviors on the FYI and clinicians’ ratings on the ADOS-T at 12 months

Methods:  

Participants included 84 families of 12-month old infants (110 families expected by May 2012): 50 with and 34 without a familial history of ASD. Parents completed the FYI prior to direct assessment of the child’s social-communicative skills with the Autism Diagnostic Observation Schedule-Toddler module (ADOS-T). The 61 questions on the FYI comprise two domains (Social Communication and Sensory-Regulatory), each domain consisting of four constructs.   ADOS-T yields Social Affect and Restricted and Repetitive Behaviors (RRB) scores.  At 24 months, the infants were reassessed, and classified as having ASD (n=12), broader autism phenotype (BAP,n=9)), non-social developmental delay (DD,n=21)) or no diagnosis (ND,n=42)). Analysis was conducted using between-group ANOVA with Bonferroni correction for multiple comparisons. Pearson’s r correlation was used to asses associations between parent report and direct assessment of social skills.

Results:  

Preliminary analysis showed no difference between the ASD and BAP groups; they were combined into a social disability group (SD,n=21) for subsequent analysis.  The groups differed in the Social Communication domain (F(2,83)=7.72,p=.001), such that SD>ND (p =.001) and SD=DD (p=.195).  There were no between-group differences for Sensory-Regulatory domain (p=.888).  We then analyzed scores on the four constructs of the Social Communication domain.  Differences were found for two: Social Orienting and Receptive Communication (F(2,83)=4.931,p=.010), such that SD>ND (p=.015), SD=DD (p=1.00) and DD>ND (p=.048) and Imitation (F(2,83)=11.0,p=.001),such that SD>DD (p=.001) and SD>ND (p=.001).

There was significant correlation of the ADOS-T Social Affect and the FYI Social Communication domain scores (r=.430,p=.001) and all of its constructs; including Social Orienting and Receptive Communication (r=.424,p=.001) and Imitation (r=.366,p=.001).  There was no correlation between the Sensory-Regulatory domain and the ADOS-T Social Affect or RRB scores.

Conclusions:  

Our preliminary results suggest that:

1. The Social Communication domain and Social Orienting and Receptive Communication construct of the FYI differentiated infants with social or developmental delays from those with no diagnosis.  The Imitation construct differentiated infants with social deficits from infants with non-social or no delays and constitutes a promising area of focus regarding screening for social delays at 12 months.
2. While significant, the associations between parent and clinician ratings of social skills were relatively modest.
3. Given the overlap in presentation between infants who later develop ASD versus those with broader autism phenotype; a realistic and clinically relevant aim of screening at 12 months might be the identification of infants at risk of a variety of social deficits who should be monitored closely and treated as needed.