Attention, Arousal, and Affect Regulation From 4 to 42 Months: Comparisons of Children with ASD, with ASD Siblings, and with Neonatal Medical Risk for Developmental Disorders

Background:  

Risk for Autism Spectrum Disorders (ASD) due to medical (eg NICU) or familial (eg siblings) factors places infants at greater risk for regulatory difficulties that can lead to a variety of impairments, particularly in attention, arousal, affect, and motor systems. System inter-relationships change over time. ASD risk can alter the sequence of changes through influences on developing neural systems. In this regard, early deficits in Arousal-Modulated-Attention (AMA) have been reported (Karmel et al., 2010) in NICU infants at 4 months post term age (PTA) who were later diagnosed with ASD. These infants preferred high rates of visual stimulation when less aroused, more similar to that found in neonates than at 4 months. How such early types of regulatory deficits affect subsequent neurobehavioral functioning remains unclear.

Objectives:  

To examine regulation from 4-42 months in children diagnosed with ASD, in non-ASD-diagnosed siblings, and to compare these groups to a high-medical risk sample in the development of attention, arousal, motor activity, and affect.

Methods:  

Medically at-risk infants recruited as newborns for longitudinal follow-up studies were compared on measures of regulation from 4-42 months PTA. Three groups were defined: 1. Dx Autism Spectrum Disorder (ASD: n =53) ; 2. siblings of Dx ASDs (SIBs: n =42), and 3. no identified ASD, remainder of population (OTHERs: n >330). We measured: visual preferences to paired checkerboard patterns flashing at 1, 3, or 8 HZ (4 months); affect, arousal, and motor activity to multimodal visual, auditory, and tactile stimulation from a puppet saying “peekaboo” (4 & 7 months); affect to a novel arousing robot introduced into an open field (19, 22, & 25 months); and temperament estimated by caregiver responses using the Toddler Behavior Assessment Questionnaire – TBAQ (Rothbart/Goldsmith (25, 34, & 42 months).

Results:  

We found increased preference for greater visual stimulation:  ASDs>SIBs>OTHERs at 4 months; greater attention and less motor activity to multimodal stimulation during “peekaboo” in ASDs>SIBs and OTHERs at 7 but not 4 months; more positive affect to a novel arousing robot ASDs>SIBs>OTHERs at 19 months, but ASDs >SIBs and OTHERs at 22 and 25 months. Caregiver temperament ratings indicated ASDs displayed more ANGER (ASDs>SIBs>OTHERs at 25 months; ASDs>SIBS and OTHERS at 34 and 42 months), and experienced less PLEASURE (ASDs<SIBs<OTHERS at 25 months; ASDs<SIBs and OTHERs at 34 and 42 months).

Conclusions:  

Findings indicate that children with ASD show distinctly different but consistent patterns of regulatory deficits over age and measures as compared to ASD-risk children as early as 4 months of age. Findings with ASD siblings depended on age and task but shift appeared to shift more toward non-ASD over age. As none of these siblings were diagnosed, any regulatory deficits from problems at earlier ages require further exploration, potentially emanating from intervention or other sources.