Social-Communication Outcomes in Preschoolers Identified As at-Risk for ASD at 12 Months

Background: Early social-communication weaknesses are associated with poor social inclusion outcomes in adulthood. Therefore, early identification and treatment of social-communication deficits is critical in order to optimize outcomes. Research in the area of child development has consistently linked mother’s responsiveness to their young children with later developmental outcomes. The current study follows up on 3-5 year old children identified as at-risk for ASD on the First Year Inventory at age 12 months. The children participated in a RCT of an Adapted Responsive Teaching (ART) intervention between their 1st and 2nd birthdays, with families randomized to the ART group or a "referral to early intervention and monitoring" (REIM) control group.

Objectives: Our aim was to determine if parent responsiveness at 24 months in children identified as at-risk for ASD was predictive of social-communication skills at 3-5 years. We hypothesized that parents with higher Maternal Behavior Rating Scale (MBRS) scores on the factors of Responsiveness and Affect at 24 months would have children who show better social-communication skills at 3-5 years. Because parent responsiveness was a target of the ART intervention, and was significantly increased for parents in the ART group compared to the REIM group, we also hypothesized that children in the ART group would have reduced diagnostic severity in the dimension of social-communication at 3-5 years compared to children in the REIM group.

Methods: Families who had participated in the RCT were re-recruited for a follow-up study when the children were 3-5 years old. The original sample consisted of 87 children; so far, 55 families have returned for follow-up assessments. The following measures were used:

At 24 months

• Parent Responsiveness: Maternal Behavior Rating Scale- Revised (MBRS)
• Social-Communication Skills: Communication and Symbolic Behavior Scales (CSBS)

At 3-5 years

• Structural Language - Preschool Language Scales- Fifth Edition (PLS-5), Children’s Communication Checklist (CCC-2) Structural language subscales
• Social-Communication Skills- The Children’s Communication Checklist – Second Edition (CCC-2) Pragmatic Language subscales, the Pragmatic Rating Scale – School Age (PRS-SA), the Autism Diagnostic Observation Scales (ADOS-2), the Vineland Adaptive Behavior Scales (VABS-2), and the PLS-5 narrative retell task.

Results: Preliminary analyses were conducted with data on 32 children between 49-70 months old using the MBRS subscales of Responsivity, Affect, and Directiveness at 24 months to predict preschool outcomes on the CCC-2. The CSBS total standard score was used to control for baseline social-communication skills. All three MBRS subscales accounted for significant (p<.05) variance in the CCC-2 Structural Language subscales, above the variance accounted for by the CSBS (R² change=0.167), with Responsiveness having a positive effect as predicted, but the directions of effects for Directiveness and Affect opposite of what was predicted. The MBRS subscales did not significantly account for variance in the CCC-2 Pragmatic Language subscales. No intervention group differences were apparent in either structural or pragmatic language.

Conclusions: Preliminary findings support parent affect, responsivity, and directiveness at 24 months as significant predictors of preschool children’s structural language. Future analyses will include additional participants and measures relevant to the aims of this study.