A Novel Parent Report Questionnaire of Early Behavioral Signs Between 6 and 24 Months of Age: The Autism Parent Screen for Infants

Background:  Identifying early impairments in children who will subsequently be diagnosed with Autism Spectrum Disorder (ASD) is crucial to ensure that they gain timely access to interventions that will improve functional outcomes. Although prospective studies of high-risk infants have increasingly focused on direct observation of infants’ behavior during interactive assessments, prospective parent reports may provide valuable and complementary information. Parents are familiar with the infant’s naturally occurring behaviors across varied contexts. This study reports on a novel parent-report questionnaire, the ‘Autism Parent Screen for Infants’ (APSI), which was developed as a parent-report analogue of the Autism Observation Scale for Infants (AOSI), an observational assessment designed to elicit ASD-related behaviors (Bryson et al., 2008).

Objectives: Our primary objective was to examine whether APSI scores distinguish high-risk infants (‘HR’; older sibling diagnosed with ASD) who were diagnosed with ASD at 36 months from other HR and low-risk infants (‘LR’; no family history of ASD) on repeat assessments from ages 6 to 24 months.  

Methods:  Participants: Three groups of children: (1) HR siblings who did not receive an ASD diagnosis at 36 months (HR-N; n = 138), (2) HR siblings who did receive a diagnosis of ASD at 36 months (HR-ASD; n = 66), and (3) infants without a family history of ASD (LR; n = 79). ASD diagnoses were based on an independent expert clinical assessment using the ADOS and ADI-R.

Parent Report Questionnaire: The APSI is a 26-item forced-choice questionnaire modeled in content from the AOSI (Bryson et al., 2008), thus including items enquiring about atypical patterns of eye contact, visual tracking, responding to name, imitation, language, social development, joint attention, gestures, play, visual examination of objects, and emotional regulation. Parents of LR and HR infants completed the APSI at 6, 9, 12, 15, 18 and 24 months. 

Statistical Analyses: Performance on the APSI was compared using linear mixed modeling with Group (HR-ASD, HR-N, LR) and Age as Independent measures and APSI scores as the Dependent measure. Total scale score and groupings of questions by developmental domain (social-communication, sensory stimulation, temperament, and motor skills) were compared and group by age interactions were explored using Benjamini & Hochberg (1995) corrections. 

Results:  Total score on the APSI differentiated the HR-ASD group from HR-N and LR beginning at 6 months and at each subsequent age (q < .036). Subgroupings of questions also differentiated the HR-ASD group from the other two groups; social-communication at each time-point between 6 and 24 months (q < .039), temperament/reactivity from 12 to 24 months (q < .025), and sensory stimulation and motor skills from 9 to 24 months (q < .031; q < .025. respectively). Estimates of sensitivity and specificity at 12 months were 0.61 and 0.70, respectively. 

Conclusions: The APSI shows promise as a simple, low-cost parent-report monitoring tool, which may lead to earlier identification of risk and implementation of interventions to remediate problematic behavior in children at-risk for ASD.