Parent Education Level and Developmental Progress in Toddlers with ASD

Background: Given disparities regarding age of diagnosis and access to services amongst underserved populations, (Liptak et al., 2008) it is vital to examine factors associated with developmental gains in toddlers with ASD. Previous research has demonstrated an association between parental education level and earlier diagnosis as well as family’s income level and risk for ASD (Fountain et al., 2010; Rai et al., 2012). Additionally, maternal education level has shown to predict developmental gains following intervention (Ben Itzchak et al., 2011). Impact of paternal education in relation to developmental gains in early toddlerhood is less clear.

Objectives: The purpose of this study is to examine whether parent education level is associated with developmental progress in toddlers with ASD.

Methods: The current sample included 24 community-referred toddlers with ASD (20 males) who participated in a longitudinal study on social engagement. The study consisted of two separate visits (about 15 months apart), both of which included the Autism Diagnostic Observation Schedule, Second Edition, and Mullen Scales of Early Learning (Mullen). Families received ASD diagnoses and recommendations from a multidisciplinary team. In order to consider developmental progress on the Mullen between visits (mean age Time 1 (T1)=22.89 months; mean age Time 2 (T2)=38.30 months), a ratio was computed for each scale [(T2 age equivalent–T1 age equivalent)/(T2 chronological age–T1 chronological age)]. A ratio of greater than 1 indicated that for the given scale, the participant gained more in age equivalent (months) than he or she aged chronologically. Parents self-reported on educational attainment; this was coded into two categories: below bachelor’s degree (47.83% of mothers, 52.17% of fathers) and bachelor’s degree or beyond. Analyses considered toddlers’ developmental progress by determining whether parental education level was associated with aforementioned Mullen ratios. 

Results: Given that Mullen Fine Motor scores decreased significantly between visits, t(23)=2.47, p=.02, toddlers’ developmental progress was considered in terms of the remaining three Mullen scales (Visual Reception, Receptive Language, Expressive Language). One subgroup of participants consisted of those who made gains in all three areas, (“more progress”; 48.7% of participants). The other subgroup consisted of those with gains on two or fewer scales (“less progress”; 58.3% of participants). Fisher’s exact tests (rather than chi-square tests of independence, due to low expected cell counts) were conducted to examine the association between developmental progress and maternal/paternal education level. The association between maternal education and developmental progress was not significant, Fisher’s exact test p=.68. Conversely, there was a significant association between paternal education and developmental progress, Fisher’s exact test p=.01, whereby higher paternal education (i.e., bachelor’s degree or beyond) was associated with “more progress.”

Conclusions: When analyzing toddler outcomes between visits in three areas on the Mullen (Visual Reception, Expressive and Receptive Language), there was a significant association between paternal education level and developmental progress. There was no significant association with maternal education. Future research should examine the relevance of socioeconomic status and parental education level to ASD prognosis as well as how interventions can be adapted to better address needs of families from varying backgrounds.