Parental and Child Characteristics That Contribute to Parental Concerns in Toddlers at High Risk for Autism Spectrum Disorder over Time

Background: Parents of children with ASD commonly report concerns about their child’s behavior or development before their child’s second birthday (Baghdadli et al., 2003). These concerns correspond with clinical measures (McMahon et al., 2007), and may help identify children who may benefit from early intervention. However, less is known about the relative contribution of parent and child factors on the presence of concerns at different ages, especially in families who already have one child with ASD.

Objectives: To examine the extent to which parent well-being, child expressive language vocabulary (EL), and child social-communicative skills (SCS) contribute to parent concerns about their high-risk (HR) toddlers within the first 2 years of life.

Methods: Parents and HR toddlers (n=54 dyads) were part of a prospective multi-site study that assessed toddlers at multiple time points from 6-36 months. This study includes data from 18- and 24-month old visits. At both visits, parents completed the Parent Concerns Form, a 7-item questionnaire that probes for concerns in 7 behavioral domains. Scores were dichotomized to reflect “concerns” or “no concerns” at 18 and 24 months. All other measures were collected at the 18-month visit only. Parental well-being was based on aggregated scores from the Parenting Stress Index-Short Form (Abidin, 1990) and the Maternal Self Efficacy Scale (Teti & Gelfand, 1991). Child EL was measured using the “Understands and Says” subscale of the MacArthur Communicative Development Inventories (Fenson et al., 2007). Child SCS were assessed using the total score of the Screening Tool for Autism in Toddlers (Stone et al., 2008).

Results: Overall, 67% of parents expressed concerns about their child’s development at 18 months (n=36) and 50% at 24 months (n=27). Logistic regression analyses were used to examine whether 18-month measures of parental well-being, child SCS and child EL increased the likelihood of parent concern measured concurrently (at 18 months) and predictively (at 24 months). Results revealed that parent concerns at 18 months were predicted by lower levels of parental well-being (OR=1.21, p<.01) and lower levels of child EL (OR=.98, p<.05). Parent concerns at 24 months were predicted by lower levels of parental well-being (OR=1.17, p<.01) and lower levels of child SCS (OR=6.02, p<.01).

Conclusions: This study revealed two important findings related to the concerns of parents of HR toddlers. First, parental well-being was found to influence parents’ concerns about their child’s development both concurrently and predictively.  These results emphasize the importance of considering how elevated stress and/or self-perceptions of parenting competence may influence their evaluation of their toddler’s development.  Second, different aspects of child behavior appeared to influence parent concerns at different ages, with expressive language vocabulary contributing to concerns at 18 months and social-communication behaviors exerting more influence at 24 months. Expressive language may be more salient at younger ages because of the availability of common language milestones. In contrast, more subtle social-communication deficits such as imitation, play and joint attention may be more difficult for parents to recognize or detect until a bit later in development.